The Exam Licensure and Disciplinary Database is a valuable resource for member boards to ensure public protection and it is important to use creative solutions to overcome the barriers to participation. This article is based on a presentation by Seif A. Mahmoud at the 2019 FSBPT Annual Meeting.
The singular purpose of the Exam, Licensure, and Disciplinary Database (ELDD) is public protection. The ELDD pulls in and aggregates information from exam registration, PT Compact purchases, and jurisdictional databases. These disparate sources of data are coalesced under individual licensees with the use of an FSBPT ID. Therefore, we can track an individual who has or holds multiple state licenses even as their name and geographic information change.
It is important to note that FSBPT is very careful with this data. We will never sell it to a third party. We only consider sharing it in aggregate for research projects that also advance our mission: public protection. Only FSBPT staff who need to see personal identifying information have access to that data—other staff have restricted or limited access to the database based on their need-to-know. Additionally, jurisdictions can only see individuals who have a connection to their jurisdiction and the information they can view is limited.
Regulatory boards should participate fully in the ELDD so that they can be aware of what their licensees are doing outside of their jurisdiction—jurisdictions receive regular alerts through FSBPT’s Disciplinary Notification Service. Additionally, participating in the ELDD is a necessary component of joining the PT Compact as boards need that information on licensees practicing on a PT Compact privilege in their state.
As stated previously, the data also supports research that advances the goal of public protection. This research can help inform regulatory decisions for boards. However, when we do research, we only look at five-star states—or states that are participating fully—so we have an incomplete picture. Regulators can learn a lot from a more complete view of the profession and a stronger understanding of what is happening across jurisdictions. The ELDD also has amazing potential to help us better understand risks in order to minimize harms.
In order to turn every state into a five-star state, we need to overcome the typical barriers in creative ways.
Most of the barriers we hear about tend to fall into three major categories: Legal or Privacy concerns (our board cannot share state data), technology concerns (the systems we use does not allow for this type of data sharing), or workload concerns (our board is not sufficiently staffed to be able to handle this extra work).
Jurisdictions can run into multiple legal or privacy concerns. For example, they might not have the authority to share information on licensees. There may be federal and state laws that do not allow data sharing. However, several jurisdictions have found creative ways to overcome these barriers.
For example, Oregon did not have the authority to release licensee information, including social security numbers. We use the social security numbers to dedupe records in the ELDD, so this was an issue. To work around that, during their renewal process, they included an extra step asking licensees to give their consent to release the data. Most licensees, about 85 percent, consented, which made deduping much more feasible. We worked closely with Oregon using other techniques to manually dedupe the remaining 15 percent of records.
Louisiana had a similar issue with sharing social security numbers. They worked around that by verifying information for all new licensees based on a New Score or a Score Transfer (one of which is required for the issuance of any new license in Louisiana). Every time they update their own system, they also update the ELDD.
Washington, DC, is not allowed to share information with other organizations, but they are allowed to share information with vendors. Therefore, they made the case that FSBPT and the ELDD provide an important service to the board. The ELDD saves staff time by supplying notifications—staff do not have to spend extra time tracking down what licensees are doing outside of Washington, DC. They made the case that they were not just sharing data, they were sharing data for a specific purpose and a specific benefit. Because FSBPT offers this important service, they were able to get approval by classifying FSBPT as a vendor.
We can also work with states on setting up a contract. Some boards do not have the authority to enter into a contract, while other boards require it. When needed, we can help states develop a contract to allow them to submit data to the ELDD. For Georgia, some of the important aspects of the contract involved how FSBPT handles the data—how it is used, how we protect it, and how it is updated. We can look at the contractual language that your state requires and then keep the language as simple as possible while addressing those requirements.
Finally, any state that joins the PT Compact must pass legislation that gives the board the legal authority to participate in the ELDD. Therefore, if your state joins the PT Compact, you can address any legal concerns with participation in the ELDD by virtue of enacting the PT Compact language.
It is important to look at the specific laws that are barriers and see if there are ways to negotiate exceptions to those. Additionally, some of the laws just create controls and processes that do not stop participation but help minimize risk for the state. It is important to sort that out instead of just thinking your jurisdiction has laws that block participation. FSBPT attorneys can help you work through those by examining the intent and the applications of those laws.
Technology can also be a huge hurdle. We need the jurisdiction’s system to be able to share data with the ELDD. However, the systems that each jurisdiction uses can vary greatly in how modern and sophisticated they are and how well they work. Some systems do not have an export feature, which is needed to complete this work. Other system do not have the ability to track new fields, such as the FSBPT ID. Additionally, if tweaks or upgrades are needed, the staff (or financial) capacity to make those upgrades is often limited. Finally, sometimes the board and staff do not have access to the database as the database and corresponding technology is housed in a different department or by a vendor.
FSBPT has resources to help with this barrier. States can apply for a grant that the FSBPT Board will review. The money must go to a project that supports our shared core mission of public protection. The grant may fund part or all of a system upgrade with the agreement that the jurisdiction takes on the cost of maintenance. The FSBPT board recently approved a grant for Georgia where we paid to have their system changed to create an export.
Technology is changing all the time. There are constantly new systems and enhancements. FSBPT can help you break through some of these constraints to figure out specific ways to create the data extracts needed to participate in the ELDD.
Overcoming both legal and technological barriers may be feasible, except that they both require extra work. However, board staff sizes are usually very efficient—there is not a lot of wiggle room to take on additional tasks. We recognize that everyone is busy.
For example, the Virgin Islands only has one staff member who is responsible for many boards. She just did not have the bandwidth to do what was needed to participate in the ELDD. Therefore, a board member actually volunteered to come in and enter license information from paper files into the ELDD. In addition, since they did not have a technological database, we worked with them to create an excel spreadsheet that they can maintain and work with going forward. They are also planning to apply for an FSBPT grant soon. While it is certainly not ideal to have a board member do administrative work, that is one creative way that one board was able to work around this barrier.
Wisconsin also had a workload issue. We worked with them to come up with a solution and now they simply email us to let us know when someone has been disciplined. They direct us to the website where the information is available and we enter that information into the ELDD based on that public information. A few other jurisdictions are starting to do this as well.
The best way to have solid data is to have strong data-sharing relationships with each jurisdiction. The ELDD would work best if every jurisdiction reported disciplinary information on a weekly basis and worked with us to help match your licensees to existing records. While there are barriers to that ideal partnership, FSBPT is here to help each jurisdiction overcome them.
Seif A. Mahmoud
Managing Director of Information Systems, Federation of State Boards of Physical Therapy
Seif A. Mahmoud is responsible for overseeing the Information Management and Technology assets of the Federation of State Boards of Physical Therapy (FSBPT), the Foreign Credentialing Commission on Physical Therapy, and the International Network of Physiotherapy Regulatory Authorities. His education includes a Bachelors of Science in Information Systems from the University of Texas at Arlington. Prior to joining the FSBPT staff in 2002, Seif provided consulting services in the fields of electronic commerce, web-based corporate operations, and business partner integration.
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