Quality Assurance: Down Range Dilemmas and Hot Topics

1. Quality Assurance: Down Range Dilemmas and Hot Topics COL Doreen Lounsbery Ms. Rosalind Gagliano

2. Reserve Component Credentials • Most USAR providers files are maintained by the Army Reserve Centralized Credentialing Affairs (ARCCA) • IMAs – at the MTF to which they are assigned • IRR – at HRC St. Louis • National Guard – Each State Surgeon’s Office • Centralization initiative is just beginning

3. Privileging for Deployment • ALL deploying providers are privileged by a TDA MTF • Active duty at their duty location • Reserve Component by the MTF responsible for the location through which they deploy • New process for this conflict: AR 40-68 does not reflect this process

4. Privileging for Deployment • ICTB and copy of privileges go to unit in theater • Commander or senior physician determines which privileges may be exercised at their location

5. Adverse Privileging Actions in Theater • Abeyance may be initiated by the senior physician in the unit • Notification to privileging MTF is necessary ASAP (MEDCOM notification also) • Investigating officer appointed in theater • Results of investigation go back to privileging MTF for action on privileges • MEDCOM QM will coordinate to expedite decisions

6. Medical Records • Often MTF will need medical records from theater • Coordination with PASBA to obtain from theater or from the repository at PASBA • Note: records are not as complete nor legible as we would expect

7. Issues • Notification to MEDCOM on UCMJ actions taken in theater regarding providers • Quality Management processes in theater • Starting to look more at these issues • TJC does not apply to deployed units, but they are trying to meet standards • Detainee care

8. Issues • Deploying providers who are unlicensed or who require supervision (don’t even think about it) • MOU allows coalition force providers to present appropriate credentials and work in our medical units • Volunteer civilian providers

9. HOT TOPICS: TELEHEALTH • OTSG/MEDCOM policy applies only to TH within AMEDD TDA facilities. --ICTB & delineation of privileges required --Direct care: Receiving MTF privs only for svcs rec’d --Consult: Rec. MTF keeps copy of ICTB & delineation, no privs necessary.

10. HOT TOPICS: TELEHEALTH • If a telemedicine practitioner prescribes or renders a diagnosis, or otherwise provides clinical treatment to a patient, the telemedicine practitioner is credentialed and privileged by the organization receiving the telemedicine service. An organization may use credentialing information from another TJC accredited facility, so long as the decision to delineate privileges is made at the facility that is receiving the telemedicine service.

11. HOT TOPICS: TELEHEALTH RAD= Radiologist(s) • TH between MTF and Contract RAD --Licensure: In state where RAD located & MTF state --Privileging: MTF must priv each RAD per TJC (and ACR)

12. HOT TOPICS: TELENURSING • HELP LINES, “ASK-A-NURSE”, etc. --1997, NCSBN: TH is the practice of nursing -- Nurse providing nursing services by TH must be licensed in state where MTF is and where nurse is --Nurse Compact aids multi-state nursing