IAC Cardiac Electrophysiology Accreditation

The Heart Rhythm Society (HRS) recently announced the launch of the IAC Cardiac Electrophysiology accreditation program, in which facilities performing EP procedures can document their commitment to quality. Here we speak with Frank Vermeiren, MS, RT (R)(CV), RDCS, Director of Accreditation, Cardiac Electrophysiology, and Tamara Sloper, CMP, Director of Marketing/Communications, both with the Intersocietal Accreditation Commission (IAC). 

Why do we need an accreditation process?

IAC Cardiac Electrophysiology accreditation is designed to certify facilities that perform cardiac electrophysiology procedures by ensuring that the facility meets quality benchmarks based on published clinical guidelines, best practices, and outcomes. The intent of the accreditation process is twofold. It is designed to: (1) recognize facilities that provide quality cardiac EP services, and (2) be used as an educational tool to improve the overall quality of the facility. 

By participating in the accreditation program, facilities have the ability to demonstrate their commitment to quality care.

Through the accreditation process, facilities assess every aspect of daily operation and its impact on the quality of health care provided to patients. While completing the accreditation application, facilities often identify and correct potential problems, such as revising protocols and validating quality improvement programs. 

The general public and members of the cardiac electrophysiology community will recognize an unmatched commitment to providing quality health care by facilities that achieve IAC accreditation. IAC Cardiac Electrophysiology accreditation demonstrates accountability.

The training and experience of the cardiac EP specialist performing the procedure, the type of equipment used, and the quality assessment metrics each facility is required to measure all contribute to a positive patient outcome. IAC accreditation is a “seal of approval” that patients can rely on as an indication that the cardiac electrophysiology facility’s processes and procedures have been carefully evaluated by medical experts in the field of treatment and management of heart rhythm disorders. 

Accreditation by the IAC indicates that the facility has undergone an intensive application and review process and is found to be compliance with the published standards, thus demonstrating a commitment to quality patient care in cardiac electrophysiology. Comprised of a detailed self-evaluation followed by a thorough review by a panel of medical experts, the IAC accreditation process enables both the critical operational and technical components of the applicant facility to be assessed, including representative procedural documentation and their corresponding final reports.

How did this voluntary accreditation program come about? When did this program first become available?

Modeled after the success of the first IAC accreditation program created in 1990, IAC Cardiac Electrophysiology was created in 2014 to accredit facilities performing cardiac electrophysiology procedures, becoming the eighth division of the IAC. A nonprofit organization highly regarded for its accreditation programs, the IAC is committed to its mission of Improving Health Care through Accreditation^® through a rigorous peer review process. The IAC provides accreditation programs for vascular testing, echocardiography, nuclear/PET, MRI, diagnostic CT/dental CT, carotid stenting, vein treatment and management, and cardiac electrophysiology. To date, the IAC accrediting divisions have granted accreditation to more than 14,000 sites throughout the United States, Canada, and Puerto Rico. IAC accreditation is widely respected within the medical community, as illustrated by the support of more than 40 national medical societies. 

The IAC Cardiac Electrophysiology program officially launched in early February 2016, with publication of the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation and availability of the application through IAC’s Online Accreditation portal.

Tell us about how the IAC Cardiac Electrophysiology program is governed. 

IAC Cardiac Electrophysiology accreditation is developed by way of an intersocietal, multi-specialty approach that is the foundation of the accrediting divisions under the IAC umbrella. 

Through the IAC, the cardiac electrophysiology community has been provided with the unique opportunity to develop standards and establish an accreditation process to recognize quality benchmarks based on published clinical guidelines, best practices, and outcomes. Recognizing the relevancy of the mission of the IAC to the specialty of cardiac electrophysiology, the Heart Rhythm Society (HRS), Pediatric and Congenital Electrophysiology Society (PACES), and Society of Invasive Cardiovascular Professionals (SICP) have each committed to participate as sponsoring organizations of the IAC Cardiac Electrophysiology program. As such, each organization provides representatives to the Board of Directors. Cardiology members-at-large also have seats on the Cardiac Electrophysiology Board of Directors, for a total of nine board members. The involvement in the IAC as cardiac electrophysiology experts has enabled the specialties to have input in the accreditation process since its creation through the development of the standards and the corresponding online application. Now that the program is fully operational, the Board members will continue to participate in the program through periodic revisions to the Standards, the review of applications for accreditation/rendering of accreditation decisions, and overall steering of the accreditation program. 

Explain the accreditation process and the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation. In what areas does this program provide accreditation? 

IAC Cardiac Electrophysiology accreditation is offered in the following areas: testing and ablation, device implantation, and chronic lead extraction. 

Serving as the basis for the accreditation program, the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation are an extensive document defining the minimal requirements for cardiac EP facilities to provide high-quality care. Sections within the published Standards include Personnel and Supervision, Facility (inclusive of examination and interpretation areas, storage space, equipment and instrumentation, and equipment and instrumentation quality control), Administrative, Procedures, and Protocols and Quality Improvement. Facilities may visit https://intersocietal.org/ep/main/about_standards.htm to download and review the comprehensive document. The Standards are used by facilities as both a guideline and the foundation to create and achieve realistic quality care goals. 

What initial steps need to be taken prior to application submission?

Completion of the application requires detailed information on all aspects of facility operation as well as the submission of actual procedural documentation for review. The procedural documentation is crucial in determining the facility’s compliance with the Standards, and is the basis for judgment of the quality of work that the facility performs. Once the self-evaluation is completed and the application is submitted to the IAC, the facility and procedural documentation is reviewed by the Board of Directors. All aspects of the review are confidential. In addition, facilities undergo a comprehensive site visit of their program as part of the accreditation process. 

IAC offers a convenient online application format accessible from any computer, by multiple users. As a first step, creation of an account is necessary to gain access and begin the application process: https://intersocietal.org/ep/seeking/your_account.htm. Facilities preparing their applications for accreditation are encouraged to explore the IAC Cardiac Electrophysiology website to view and utilize the many tools and resources made available, including report templates and sample quality improvement reports and facility policies, access to recorded webcasts, CME resources, and links and references.

In addition to basic information about the facility and staff, the application requires detailed information related to procedural and complication documentation, policies, and quality improvement measures. Helpful resources, including several policy examples and a procedure checklist, may be found at https://www.intersocietal.org/ep/seeking/sample_documents.htm. 

Discuss the procedure selection process.

Each facility is asked to provide documentation of their most recent procedures performed. Specifically, a list of a minimum of 30 consecutive cases from each of the areas of accreditation in which the facility is applying for accreditation is required. From this list, a small sample is randomly selected for review. Required procedural documentation includes the following: 

• Clinical diagnosis leading to the cardiac electrophysiology procedure
• Baseline ECG
• Patient history and physical documentation 
• Cardiac Electrophysiology procedure report 
• Nurse monitoring report during the procedure
• Anesthesia monitoring report during the procedure
• Cardiovascular assessment documentation pre and post procedure
• Documentation of the post-procedural rhythm
• Most recent reports from prior Cardiac Electrophysiology testing 
• Complication information (if appropriate)

What are the costs associated with the accreditation process? How long does the review process take?

Access to the IAC accreditation application is free of charge. Applicant facilities are charged the accreditation fee ($6,000), due at the time of application submission. The review process takes approximately 8 to 12 weeks to complete, upon which time an accreditation decision is rendered to the applicant facility. Because the accreditation process strives to recognize substantial compliance with the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation when determining the facility’s accreditation status, the IAC will give due consideration to the facility’s plans and progress toward achieving compliance. For this reason, the IAC will conduct a site visit to each facility within their first year of accreditation.

Upon earning accreditation, facilities receive a certificate package inclusive of their official notification, accreditation certificate, and tools to market their status. In addition, a unique and detailed application review findings letter for every applicant facility is prepared, which outlines the peer review findings and provides helpful guidance. This customized report is designed as a tool to be used by accredited practices to ensure continual improvement. When applying for reaccreditation in three years, facilities are required to demonstrate that they have addressed the issues raised at the site visit and those in the application review findings as part of their commitment to continuously improve their processes, and ultimately, the patient care they provide. 

What is the value of the IAC Cardiac Electrophysiology accreditation? Why should a facility consider participating in this initiative? 

By performing a thorough self-assessment to identify and correct potential areas of nonconformity and evaluation of QI programs for compliance with the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation, facilities experience one of the greatest benefits of the accreditation process: the self-improvement aspect. Most significantly, the advantages gained through the self-evaluation process are the overall operational improvements that are a direct result of reviewing the Standards to ensure compliance and subsequent completion of the detailed online accreditation application. Oftentimes, protocols and policies are updated or sometimes instituted, resulting in improvements in the facility’s overall operations.

Beyond the paramount benefits related to quality, there is the value associated with the perception of being an accredited facility. Once accredited, facilities are encouraged to explore the wide range of opportunities for promoting their accreditation status to patients, referring physicians, and insurers. In today’s information age and era of savvy health care consumers, the general public has begun to understand the importance of looking for evidence of quality as it relates to their medical care. News-oriented television programs, along with mainstream print media, have spotlighted inadequate medical procedures and brought the need for quality in these fields to the public’s attention.

Why are standardized practice guidelines important? 

Throughout the 25-year history of the IAC, our standards have been developed with the assistance of thought leaders in the field of health care and guided by expert consensus documentation. There are 29 such documents sited in the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation, with the primary guidance provided by the Heart Rhythm Society Expert Consensus Statement on Electrophysiology Laboratory Standards: Process, Protocols, Equipment, Personnel, and Safety. Within this document it is stated, “The goal is to provide physicians, administrators, and regulatory personnel with the recommended requirements for building, staffing, and running a modern EP laboratory to optimize patient outcomes, minimize patient risk, and provide a safe and positive environment for physicians and staff.”

How can quality improvement measures affect patient care? 

There are four areas in which facilities are required to perform quarterly quality improvement measures. The objective of these measures is to standardize quality metrics to evaluate processes of care, identify areas for improvement, and implement corrective actions to improve patient outcomes. These areas of measure include: test appropriateness, safety and procedural outcomes, interpretive quality review, and report completeness and timeliness. 

Once a cardiac EP facility has achieved IAC accreditation, what should facilities know about maintaining compliance and site visits?

Though the accreditation application provides only a “snapshot” of facility functions and quality, it is expected that accredited facilities continuously adhere to and uphold the Standards on a daily basis. In the legal accreditation agreement submitted by all applicant facilities, it is stated that once granted accreditation, “the facility bears the burden of showing and maintaining compliance during the application review period and for the duration of accreditation.”

In an effort to further substantiate continued compliance by accredited facilities, the IAC requires all accredited facilities to undergo a site visit within the first year of accreditation and an audit at some time during their three-year accreditation period. Facilities are randomly selected and assigned a date by a computer program to receive an audit. Once selected, the facility is notified via e-mail and provided with instructions for submitting the required audit materials. No additional fees are assessed to the facility as a result of these processes.

What information will be presented at Heart Rhythm 2016 about the IAC Cardiac Electrophysiology accreditation?

As part of Heart Rhythm 2016, the IAC staff will be present in the HRS booth/EPicenter to discuss the new program and answer questions. 

Following the HRS Scientific Sessions, a live webinar will be offered to provide further information to interested cardiac electrophysiology facilities about the new program. Information about both the presentations and webinar is included below:

IAC Cardiac Electrophysiology Accreditation Program
May 5 | 10:30 AM - Noon
Moscone Convention Center, Room 2007, Moscone West
This session will provide an overview of the new program, including a discussion of established cardiac electrophysiology guidelines and the standardization of procedural requirements through accreditation. Presented by David E. Haines, MD, FHRS, President of the IAC Cardiac Electrophysiology Board of Directors, Gerald A. Serwer, MD, FHRS, representative of the HRS on the IAC Cardiac Electrophysiology Board of Directors, and Amy S. Leiserowitz, RN, CCDS, member-at-large on the IAC Cardiac Electrophysiology Board of Directors. For details, visit: www.abstractsonline.com/pp8/#!/3934/session/346
Note: Only registered attendees of Heart Rhythm 2016 may attend this event.

IAC Accreditation in Cardiac Electrophysiology: Easy as 1, 2, 3
May 6 | 10:45-11:45 AM
EPicenter Theater 2, Hall D
This session will provide a detailed overview of the application process when facilities apply for accreditation through IAC Cardiac Electrophysiology. Presented by Frank Vermeiren, MS, RT (R)(CV), RDCS, Director of Accreditation – IAC Cardiac Electrophysiology. For details, visit: www.abstractsonline.com/pp8/#!/3934/session/436
Note: Only registered attendees of Heart Rhythm 2016 may attend this event.

IAC Cardiac Electrophysiology: Accreditation Simplified
May 24 | 1 PM ET
Presenter: Frank Vermeiren, MS, RT (R)(CV), RDCS, Director of Accreditation - IAC Cardiac Electrophysiology, will present a live webinar (followed by a Q&A session). 
Register at: www.prolibraries.com/iac/?select=webinar_register&webinarID=1603

What has been the response to the program so far? Approximately how many facilities have enrolled or achieved accreditation thus far?

Following the recent launch of the program and successful accreditation of our first two facilities through a pilot program, we have been very pleased with the response from the cardiac electrophysiology community. Several applications have been started, and we are taking calls every day from facilities working to begin the application process.

Is there anything else you’d like to add?

With a long history and reputation for offering friendly and responsive customer service, the IAC is fully staffed with both clinical and administrative personnel to guide participating facilities through the process. The IAC looks forward to working with the cardiac electrophysiology community as they begin the accreditation process.