When looking at an external medical review, it requires the trained eyes of the experienced
health care specialists that perform the external medical review. This is achieved by having an extensive staff with central responsibilities to oversee the records retrieval process and the use of any abstraction parameters that are applied to the medical record analysis.
Having an extensive and diverse review team is very important. It is not uncommon to have the medical records reviewers come from a pool of highly qualified practitioners that number in the thousands. The reasons for using such a large pool of medical record examiners is to try to eliminate basis in the review process. If your organization is an nationwide organization, then the medical reviewers need to be selected from a pool of qualified reviewers that are distributed across the nation. Even if your organization is more regionally focused, it is important that your standards of patient care are at the level of nationwide (federal) compliance.
Of course the costs basis needs to be adjusted depending on where the patient lives in the country, but the standards of care are more ubiquitous, more universal and need to be applied across the board for patients of all types no matter where they may happen to live in the United States.
Quality assurance is achieved by the application of inter-operating ability and reliance testing combined with other processes to make sure the evaluations are fair and unbiased. Records profiling is used with pattern recognition in the abstraction of data in order to support the conclusion about utilization and the standards of care. The review of utilization processes allows the practitioners to assemble a set of preferred policies that prohibit the improper allocation of resources and exchange information as required to increase the quality of care.
Reviews of the patient medical records may be either retroactive or run concurrent with the patients stay in or usage of the facility services. These concurrent reviews are used to determine what procedures and treatment are medically necessary and where redundancy and excessive application of testing and procedures may be eliminated. The exchange of information between the facility staff and independent operators creates an overall view of the patient case which allows for progression analysis and care quality evaluation. These issues are well examined by an external medical review.