ABPM: Taking a Medical Certifying Board from Paper Files to Cloud-Based Collaboration

Desktop view of the project

The Challenge

Tecture was engaged by the American Board of Preventive Medicine (ABPM) to create an online application for two new subspecialties -- Addiction Medicine and Clinical Informatics. Taking on these additional subspecialties would mean a fivefold increase in applications to be processed and reviewed in its yearly certification cycle, from a historical average of about 400 applications to a projected 2,000. Little did we know the demand would far exceed this!

ABPM is one of 24 member boards of the American Board of Medical Specialties that are responsible for certifying physician competence in a given medical specialty or subspecialty. This independent certifying function of medical boards (which entails intense scrutiny of an applicant’s credentials, education, and experience before sitting for the board exam) is a fundamental means of ensuring qualified physicians in the healthcare system.

ABPM had neither the staff nor reviewers to handle this expansion, given labor-intensive, paper-based processes then in use. Think floor-to-ceiling stacks of bankers boxes full of application files. Board reviewers would hunker down in a conference room for long days over a long weekend to review the applications, assessing  applicants’ qualifications and passing file folders back and forth. This process, while collegial, was obviously not scalable.

The online applications for the new specialties had to be ready in a matter of four months. Once engaged in the project, ABPM asked Tecture if we could take on a comprehensive system to handle the applications for all its specialties simultaneously. So we stepped up to the challenge. Once immersed in the project we discovered one of our most fundamental challenges -- records of physician information and board decisions were not always consistently maintained in a single system. Important information was scattered across repositories, ranging from spreadsheets to paper files to emails. In addition to creating a new application system with a new comprehensive database, all this old data would need to be collected, vetted and migrated into the new system.

Our Process

Big challenges require robust processes. To create a fully capable system that encompassed more than just physician applications, Tecture addressed these challenges on several fronts. 

Tecture has been a terrific partner in this process. There are some companies you employ; they do their job and everyone walks away happy. Others go beyond that level and have a real commitment to the project and to the organization. It is our good fortune that Ben R, Dan and all the others at Tecture are in the second category. When this is done it will be a world class product. -Ben MungerPhD, Interim Executive Director, American Board of Preventive Medicine

First, we mastered the requirements for certifying physicians in the various specialties and certification pathways -- qualifications such as medical school degree, licensure, other certifications, fellowships, verifiable practice experience, etc., in the various sorts of career paths a physician might take. These requirements are extraordinarily complex and were inconsistently documented. Understanding and documenting them would be key to creating the certification system, so creating (and maintaining!) authoritative requirements documents was essential for our development process.

ABPM Requirements

Second, Tecture paid thorough attention to the application’s user experience design. Given the complexity of requirements and certification pathways, it was not uncommon, even with a paper application, for physicians to apply on an inappropriate pathway. This often meant returning the application to the applicant, starting over, sometimes missing deadlines, and unnecessarily high rejection rates. In constructing the online application Tecture broke the process into discrete steps and carefully scrutinized each step. We inserted not just clearly worded instructions, but tooltips, visualizations, FAQs, and even an interactive “Am I Qualified?” quiz to assist applicants in understanding each step of the application process and what certification requirements were relevant to them. This approach resulted in a dramatically lower number of abandoned and rejected applications.

ABPM Wireframes

Third, Tecture approached the engagement holistically. To adequately build an online application for multiple specialties (and subspecialties), it was important to consider not just the application itself, but all the supporting data and business processes involved in a certified physician’s entire career. This entailed thorough, ongoing analysis of ABPM’s business processes that would be required for the year-round certification procedure. Moreover, we interviewed the greatest variety of stakeholders possible in order to collect as many perspectives as possible.

Fourth, given the extraordinarily short project timeline, Tecture adopted an agile development strategy that rolled out new features, improvements, and enhancements continually throughout the open application. Each feature set -- from collecting application data through staff processing, board review, releasing decisions, and exam registration -- was put into place as it was needed in the certification calendar. By thoroughly understanding ABPM’s business processes and adroit prioritization, Tecture was able to proverbially build the airplane while flying it.

Finally, as the date for opening up applications drew near we at Tecture saw that the DIY customer support system the board had been using would not be adequate to the introduction of a brand new online system serving five times as many applications as in the past. There was certainly not time to build a support ticketing system, so we strategically made use of off-the-shelf resources by putting in place a third-party online support system (Zendesk) to automate customer support and enable Tecture to better support ABPM staff. In fact, during peak times Tecture staff provided direct customer support ourselves as needed. (In the second year of the engagement we built our own customer support system that is fully integrated into the certification process, in effect a full CRM that ties every contact with a physician to their record in the system.)

Tecture's Solution

Tecture built a complete, end-to-end medical board certification system for ABPM that serves the three main specialties and four subspecialties of the board. This system handles the electronic submission and review of thousands of applications, management of tens of thousands of certified physicians, exam registrations, maintenance of certification, and recertification. It integrates data from multiple sources in the medical field such ABMS that automates such operations as licensure verification and action notifications.

The system is comprised of:

  • An integrated database with every aspect of a physician’s data - from initial certification through maintenance of certification (and recertification if needed) to retirement.
  • A redesigned public facing website with clear, easy-to-understand displays of certification requirements for each specialty, including an interactive quiz to guide one to the appropriate application pathway.
  • An application submission system that guides a physician through the application process, tracks their completion, provides contextual help, provides tools such as a practice hours calculator, and performs requirements checks to ensure the application is complete and ready for review upon submission.
  • An administrative system for processing applications, and performing staff reviews and verifications, before assigning them to board reviewers, as well as various tools for generating reports and mailing lists.
  • A collaborative review system that enables reviewer to examine applications and all supporting documentation online over the web. A reviewer can easily consult with colleagues to get a second opinion. (No more marathon onsite review meetings.)
  • An integrated customer service ticketing system to support applicants, candidates, and diplomates tied to the physician’s applications, certifications, and contact data.
  • Integration of multiple data sources such as ABMS, to automate many verification steps.
  • Integration with an electronic signature service, automating verifications of residencies, fellowships, and practice activities.
  • A program director’s portal enabling residency and fellowship program directors to easily verify a physician’s graduation, as well as receive their exam results.
  • A complete Maintenance of Certification System (MOC) to track progress in meeting ongoing maintenance of certification requirements (including an easy to track dashboard).

Results

ABPM was able to accommodate a 500% increase in its certification applications last year as a result of taking on two new, dynamic subspecialties.

All applications and reviews are now online. The Board has eliminated paper files and marathon in-person review sessions. Board reviewers can now review applications from any location any time, day or night, yet online maintain the collegial collaboration of former in-person review sessions. Even verifications of practice experience are conducted entirely online.

The Board now has a reliable, authoritative record of all decisions, deliberations, and actions taken in regard to certifications and maintenance of board certification.

Board staff have the online tools to perform their operational tasks, and many of these tasks have been automated.

And, by the way, the Board’s physician search page to find certified addiction physicians (an application built by Tecture) was recently featured on the John Oliver Show.

ABPM Homepage


Previous Next