Transcript Component 4: Introduction to Information and Computer

Component 1:
Introduction to Health Care
and Public Health in the U.S.
Unit 6: Regulating Health Care
Lecture 1
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human
Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
Lectures in This Unit
• Lecture 1: Regulatory Agencies and
Professional Associations
• Lecture 2: Law
• Lecture 3: Medicine, Professional Liability, and
Medical Malpractice
• Lecture 4: Key Processes for the Confidentiality
and Safety of the Patient
• Lecture 5: The Physician-Patient Relationship
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Topics in This Lecture
• Nonprofit Accrediting Organizations
– The Joint Commission
– URAC (formerly called Utilization Review
Accreditation Commission)
• Regulatory Agencies
• Professional Associations
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JC History
• 1910: The forerunner of JC is called the “end-result”
system
• 1951: Joint Commission on Accreditation of
Hospitals (JCAH) is created and starts accrediting
and certifying health care organizations
• 1987: Name changed to Joint Commission on
Accreditation of Healthcare Organizations (JCAHO)
• 2007: Name simplified to Joint Commission (JC);
currently accredits and certifies more than 18,000
organizations and programs in the U.S.
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JC Mission
“To continuously improve health care for the
public, in collaboration with other stakeholders,
by evaluating health care organizations and
inspiring them to excel in providing safe and
effective care of the highest quality and value”
The Joint Commission.
http://www.jointcommission.org/facts_about_the_joint_commission/
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JC Accreditation
• Earned by an entire health care organization
(hospital, nursing home, office-based surgery
practice, etc.)
• Tools the JC uses to measure performance
– Integrated Survey Process (ISP): Evaluates
performance across organization
– ORYX: System for health care organizations
to report to the JC about patients with
certain conditions (core measure sets)
• The core measure sets reported depend on the
type and size of the organization
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ORYX: Core Measure Sets
• Examples
– Heart attack
– Pneumonia
– Inpatient psychiatric care
– Children’s asthma
– Stroke
• Each core set has performance measures
– For example, the JC looks at whether children
with asthma received certain drugs in the hospital
and were sent home with a management plan
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JC Certification
• JC-accredited organizations and providers of
health care staffing services can also earn
certification for specific programs or services
– For chronic diseases and conditions
• Examples: asthma, diabetes, heart failure
programs
– Programs can be within the medical center or
in the community
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JC Patient Safety Activities
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National Patient Safety Goals
Universal Protocol
Office of Quality Monitoring
Speak Up™ program
Sentinel Event Policy
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URAC
• Formerly known as the Utilization Review
Accreditation Commission
• Mission: “To promote continuous improvement in
the quality and efficiency of health care
management through processes of accreditation
and education”
URAC. http://www.urac.org. Accessed April 12, 2011.
• Has more than 25 accreditation and certification
programs for various types of health care
organizations
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URAC Health
IT Accreditation
• Outlines best practices for an effective
compliance program, including:
– Health websites
– HIPAA (Health Insurance Portability and
Accountability Act) privacy and security
• Designed for a wide range of organizations
involved in health care IT
• See urac.org
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URAC Health
IT Accreditation (cont’d)
• These health care organizations must comply
with HIPAA:
– Health plans—health insurance companies,
employer-funded health plans, and
government programs that pay for health
care, such as Medicare or Medicaid
– Health care providers that conduct certain
business electronically
– Health care clearinghouse (organizations that
processes health information)
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Regulatory Agencies
• Public authorities at state or federal level,
established by legislative act to enforce
standards in a specific field in the private sector
• Agency’s regulations = laws
• Agency might conduct hearings and hand down
judgments
• Goal is consumer protection
• Example: Food and Drug Administration (FDA)
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FDA Overview
• Part of Department of Health and Human
Services, charged with oversight of:
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FDA Mission
• Protect public health
– Regulates drugs
• Performs drug approvals
• Provides drug safety information
• Spreads the message about medication errors
– Helps speed up product innovations
– Helps public obtain accurate science-based
information
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Professional Association
• A nonprofit organization that wants to support:
– A particular profession
– The interests of individuals engaged in that
profession
– The public interest
• Sets requirements:
– For entry into the profession—possibly
requires license or certificate
– For maintaining membership in the profession
• Members generally have a significant amount of
education, training, or experience
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American Board of Medical
Specialties (ABMS)
• Description: “An organization of medical specialty
boards with shared goals and standards related
to the certification of medical specialists”
• Member boards certify specialist physicians
– Also subspecialists; for example, adolescent
medicine is a subspecialty of family medicine
• Board certification differs from licensure, which
sets minimum competency for physicians
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American Hospital
Association (AHA)
• 5,600 organizational members
• 41,000 individual members
• Major programs
– Advocacy
– Resource center (47,000 books on health
care)
– Health Planning and Administration (HEALTH)
database
– Annual survey of U.S. hospitals
– Reports and studies
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American Medical
Association (AMA)
• 240,000 members
– Physicians with an MD or DO degree, or a
recognized international equivalent
– Resident physicians and fellows
– Medical students
• Major programs
– Resources for physicians
– Advocacy
– Publishing medical journals
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Summary
• Hospitals and other health care organizations are
accredited by the Joint Commission
• The Joint Commission also certifies specific health care
programs and conducts patient safety activities
• URAC accredits and certifies a wide range of health care
organizations, and it has an accreditation program for IT
professionals
• Regulatory agencies such as the FDA protect consumers
by setting and enforcing standards
• Professional associations govern their members but not
the public at large
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