Women’s Health Newsletter
July 2013
In This Edition We Want to Hear From You
Contribute to SIG Calls
Jill’s AWHONN Recap Blog Women’s Health Playbooks Package Updates & Releases Industry Involvement Welcoming a New Arrival Cerner Health Conference Tips & Tricks
Graphing in Results Review Rebooting CE’s
“Did You Know...?”
Building things that don’t exist in standard content Point of service collections in the ambulatory clinic
Maintaining Industry Awareness
National Quality Measures
Women’s Health Newsletter We Want to Hear From You! Contributing to SIG calls: The Women’s Health SIG wants to hear from you!
Please
consider preparing a 1 5-20 minute presentation to share on our next SIG call, tentatively scheduled for Dec 11th, 2013. These calls are scheduled quarterly for us to share our successes, challenges, tips & tricks, and lessons learned while implementing today’s technology in Women’s Health Care. Every clients’ implementation is unique. Some of you had great presentations & posters at the AWHONN conference, these would be interesting to use for this SIG event. Please consider sharing your knowledge & experiences with this group! We’d love to hear from you. You can e-mail Angie or Susan at the addresses listed on the right. Thanks!
Sincerely,
Your SIG Leaders:
Angie and Susan
Jill’s Blog: Jill Meier’s AWHONN Experience Recap: Recently, I had the wonderful experience of attending AWHONN’s annual conference in Nashville, Tennessee. As a strategist on Cerner’s Women’s Health team, one of my key responsibilities is to maintain awareness of new industry standards and recommendations, and this conference provided me with the perfect opportunity to absorb as much information as I could. It’s a fantastic experience to be a part of 3,000+ perinatal nurses from all across the country. I would like to share with you a little bit of what I learned. On Sunday June 15th, AWHONN leaders were present to kick off the conference with opening ceremonies and awards. The keynote speaker, Rich Bluni, set the tone for the week with his engaging presentation: Inspired Care. Rich brought the audience from laughter to tears as he shared his experiences as a nurse on a pediatric trauma unit. Through his stories, Rich eloquently conveyed what all nurses know: Those sacred moments of joy, wonder, gratitude, insight, and even grief, that nurses experience are the true gifts of nursing. As clinicians, we need to embrace those moments, as they are what keep us inspired and connected to one another. I left the presentation feeling proud to be part of such a wonderful community of nurses. Both of the keynote speakers on Monday and Wednesday were excellent as well, using humor to illustrate their stories. Monday’s speaker, Liz Jazwiec, RN, addressed the ongoing problem of workplace negativity and its effect on productivity. Through her entertaining style, she reminded us that we should focus on service to others and how, by staying positive, we can influence those around us. On Wednesday, we were treated to a presentation by Jeanne Robertson, who showed us that maintaining a sense of humor in various situations is an asset for any healthcare professional. Throughout the week, I attended a total of 10 educational sessions and 1 panel discussion. Here are some of the highlights: Certified Nurse Midwife Nancy Jo Reedy discussed traditions and myths that are common during the care of women during labor and birth, and she shared how we should continue to strive towards evidence-based practice guidelines to improve care. Nurses have an important role in leading changes in clinical practice.
Juli 2013
I attended two presentations by one of my favorite speakers, Lisa A. Miller, CNM, JD. Ms. Miller uses both her clinical and her legal expertise to offer interesting perspectives on hot topics in perinatal nursing. Her presentation on uterine tachysystole was interesting to me for several reasons. The most important thing that I learned is that we need to rethink our beliefs regarding what ”normal” labor progress is. New evidence suggests that active labor really starts at 6 cms. rather than 4 cms. In addition, Ms. Miller encourages the use of a partogram to help with visualizing overall cervical changes and labor progress. Ms. Miller’s second presentation of the week concerned the use of digital tools and social media in healthcare. Ms. Miller provided examples of ways in which these new technologies can be helpful or detrimental, depending upon how they are used. I also attended two sessions by industry leader Kathleen Rice Simpson. In the first session, Dr. Simpson shared the recent summary of evidence from the National Institute of Child Health and Human Development regarding strategies to avoid primary cesarean birth. She demonstrated how the labor nurse can play an important role in helping the woman avoid a primary cesarean, through the use of non-medical interventions. In her second presentation, Dr. Simpson shared case studies involving the challenge of differentiating maternal and fetal heart rates. My key takeaway from this presentation was that nothing can replace the true hands-on assessment of the laboring woman by an experienced clinician.
We Want to Hear From You! (Continued) Contributing to SIG calls:
Angie Conner, RN, BSN Clinical Application Analyst Information Technology
On Tuesday, an interesting panel discussion involved key leaders from three different disciplines of perinatal care. A nurse from AWHONN (Audrey Lyndon), a midwife from the American College of Nurse Midwives (Holly Powell Kennedy), and an OB physician from the Society of Maternal Fetal Medicine (Daniel O’Keeffe, MD) discussed their work surrounding communication among caregivers. They shared how important crucial conversations are between caregivers in labor and delivery, and how good communication has been proven to decrease lawsuits and promote safe patient care. That evening, Cerner sponsored a networking event at Baptist Hospital. The staff at Baptist graciously provided guided tours of their beautiful women’s health facility, and we had an opportunity to meet with clinicians from across the country. During the social event, I was pleasantly surprised to cross paths with someone I worked with 25 years ago, who now lives in a different state! OB nurses really are members of a special community.
Floyd Medical Center
Topics of other sessions that I attended throughout the week included: obstetrical triage, baby-friendly initiative, simulation labs to train new OB nurses, diabetes in pregnancy, and sexuality across a woman’s lifespan. Each of these presentations not only offered valuable information, but sparked some ideas for future development projects.
Director - Obstetrical Services
Overall, my 4 days in Nashville provided me with fresh and exciting perspectives on perinatal healthcare, and my experience reinforced my sense of pride and community with fellow nurses. For those of you who have a chance to attend an AWHONN event, I can guarantee you it will be time well-spent!
susan.nigro@olathehealth.org
aconner@floyd.org
Susan Nigro RNC-OB, BSN Olathe Medical Center Olathe, Ks. 66061 913-791-4419
Women’s Health Newsletter Women’s Health Playbooks PowerChart Maternity Physician’s Playbook -- NOW GA!! Set of established standards and recommendations used to improve the productivity & user experience satisfaction level. Contains standards (privs/prefs), content / structure layouts, workflows, and training. Released GA – June 28, 2013 Playbook link: https://wiki.ucern.com/ display/PhysicianExperience/ Physician+Experience
PCM Nursing Playbook Similar structure as with the physician playbook only for the nurse position. Will contains standards (privs/ prefs), content / structure layouts, workflows, and training. uCern wiki site still under construction… Tentative Release – Q 4 2013
Package Updates Reporting Packages: 1) We are restructuring our reporting packages. Our Women’s Health reports will now be distributed in two separate reporting packages, Acute Reports and Ambulatory Reports. The first release is noted below: Package 66994: Inpatient Reports Reports included in this package: • Open Pregnancies by EGA-EDD • OB Activity Log • Delivery Summary • Fetal Well-Being • Extractable Birth Log Book • Prenatal Summary Genview • Labor & Delivery Summary Genview • Pregnancy Summary Genview • Newborn Discharge Information Summary Package 67619: Ambulatory Reports Reports included in this package: • Open Pregnancies by EGA-EDD • Fetal Well-Being • Prenatal Summary Genview • Labor & Delivery Summary Genview • Pregnancy Summary Genview Note: These reports will no longer be a part of the Content package release. Any updates to reports will always be updated to the associated package. 2) We are also introducing our updated Genview Summary Smart Templates: • Prenatal Summary Genview • Labor & Delivery Summary Genview • Pregnancy Summary Genview • Newborn Discharge Information Summary Each smart template has been given a face-lift to improve readability and maintain consistency between the Women’s Health smart templates. Note: We have moved away from the old smart template architecture that had the prefix ki* program names and will now only be supporting the new wh* prefix program names smart templates from this point forward.
July 2013
Package Releases:
A New Arrival Welcome Sofia!
PowerChart Maternity Content Package Releases: Package # 67063 for PowerChart Maternity (US): Inpatient contains the following: • New IView bands specific to inpatient antepartum patients. Sections include PIH, bleeding, and gestational diabetes • Updates to neonatal IView: Added Neonatal abstinence syndrome score which will display in the neonatal summary • Streamlining naming convention for dynamic group from “Baby/ Fetus” to “Baby” Package # 67061 for PowerChart Maternity (US): Ambulatory contains the following: • Additions to Antepartum Intake form: New antepartum risks added, information on menstrual history and father of baby, delivery location, planned/unplanned pregnancy, date of tubal sterilization signed consent • Updates to risk factor rules which auto-populate risk factors to the patient Problem List, and associates them to the current active pregnancy if applicable • Working view in IView to support OB office physician documentation workflow
Industry Involvement: AWHONN Call for Presenters is open now through September 10th: Shine your light! Call for presenters at 2014 AWHONN Convention Do you have something to say about the care of women and newborns? Now’s your chance! The call for presenters is open for the 2014 AWHONN Convention in Orlando, Fla., at Disney’s Coronado Springs Resort, June 14-18. Presenting at the AWHONN convention ensures that your talk, research, case studies or innovative programs will be heard or viewed by a highly skilled, sophisticated, and influential body of nurses. There are five application options: (1.) Specialty Sessions (2.) Research (Papers or Posters) (3.) Evidence-Based Quality Improvement Research Projects (Papers or Posters) (4.) Innovative Program (Papers or Posters) (5.) Case Study (Papers or Posters). All abstracts are due no later than Sept. 10. Learn more about the criteria, read further instructions and access our electronic submission site.
Congratulations to our Managing Director, Patrizia Smouse and her family! They welcomed a beautiful baby girl on Thursday, July 18th. Sofia Elisa Gomez arrived at 1:05pm. She came in at 7lbs 13oz and 20 inches long, and is as cute as can be. Mom and baby are doing great!
Women’s Health Newsletter Cerner Health Conference: October 6th - 9th. Join us in Kansas City for the 2013 CHC conference! Check out the Women’s Health focused Education Sessions offered: MONDAY – October 7th 10:30AM Session 428 Successful Training Strategies – From Conception to Birth. Amy Hansberry, Mindy Brancamp, Beloit Health System Carlene Henriques, Adventist West 2:15PM Session 218 Talk about “Meaningful” Use in Women’s Health - Physician Benefits of using the system from Ambulatory through Acute Christopher Morosky, The Hospital of Central Connecticut Dr. Lantzman, Alaska Native 3:30PM Session 145 Maternal Risk Factors for Preterm Birth and the Impact on Infant Morbidity & Mortality Candace Rouse, LifeBridge Health TUESDAY – October 8th 11:00AM Session482 2 Different Paths: From Conception, Collaboration through Discharge & An accelerated delivery of PowerChart Maternity & FetaLink Penny Wilms, Trinity Health Conrad Ramirez, UHS Hospital_St. Mary’s Regional Medical Center
Tips & Tricks Graphing/Results Review and selecting other values The Graphing component within Results Review is a tool used to evaluate trends in patient results. The clinician can select the specific data elements they wish to view and the graph will be generated. While you are viewing a patient’s flowsheet, you can generate a graphic representation of the numeric result values. The graph plots the values and displays the unit of measure along the y-axis. If no units are displayed, the graph is generated, but no units label is displayed along the y-axis. Complete the following steps to view or print a graph of all results of a certain type: 1.Select the name of a specific test or procedure for which results are given in a numeric value. (You can either select the name or the check box just to the left of it.) This marks the check box with a check mark. 2.If you want more than one graph generated at the same time, select another test name. 3.From the Options menu, select Graph . The system generates and displays a graph for each type of test you selected. 4.Click Combine on the Flowsheet Graph window to plot the selected result types on the same axis (without units displayed). Click Split to plot each result type on a separate graph. Either way, the time continuum represented along the x-axis is consistent for all graphs. You can compare one result to another for possible cause and effect relationships. 5.Click Print to print the graph you are viewing. If you are viewing a set of graphs, a dialog box prompts you to select which graph or graphs you want to print. Also, if you are viewing a set of graphs, you can right-click one graph and select Print from the context menu. To copy a graph to the clipboard, select Copy. This stores the graph as a bitmap (graphic) that can be pasted into a document. Only one graph can be copied at a time. Click Close to return to the previous window
July 2013
Tips & Tricks Rebooting CEs (Connectivity Engines) Should nursing be responsible?: We have found that occasionally should an issue arise with FetaLink and troubleshooting is needed, that clinicians are turning the CE (connectivity engine or “little black box”) off and back on as opposed to calling the HELP desk or their facilities designated FetaLink contact. It is Cerner’s recommendation that nursing should not be performing or responsible for rebooting the Connectivity Engines. Rebooting the CE should a last resort and be performed only by a trained Biomed or IT individual as designated by each facility. Powering off of the Fetal Monitor Connectivity Engine (FMCE) and/or Device Adapter (D/A) interrupts the data collection from the fetal monitor, resulting in data loss. If a patient is being actively monitored, this should be done only under the direction of your Cerner representative and with the appropriate backup measures having been instituted. Please refer to the FetaLink wiki link for further details. https://wiki.ucern.com/display/public/reference/Troubleshoot+FetaLink
Cerner Health Conference (continued): TUESDAY – October 8th 1:30PM Session 343 Restructuring the support of FetaLink (and other iBus applications) - Success story Benji Long, University of Missouri Health Care 2:45PM Session 92 Powerchart Maternity and Anesthesia: Deliver Me From Pain Kim McAdams, Angie Conner, Floyd Medical Center WEDNESDAY – October 9th 10:15AM Session 314 ST Analysis as an Adjunct to Electronic Fetal Monitoring Maureen Brennan, Neoventa 11:30AM Session 306 Women’s Heatlh - iPoc Development, Partnership & Beyond Terry Carson, Teri Leydon, Dee Dee Johnson, MedStar_St. Mary’s Hospital
Also stay tuned for more details around our Women’s Health focused events happening the week of CHC: • FetaLink Technical Training • Local Hospital Site Tour • SIG Reception
Women’s Health Newsletter “Did You Know” How to build things that don’t exist in standard content: Are you a Rules person? Rules, in the EHR world, can help support our workflows. Even though the rule build below is in addition to our PCM content, we thought it might be beneficial to everyone. This month we would like to share a simple rule build for lactation. This rule would fire a consult to the Lactation Consultant if the LATCH score was below 8. This “baby friendly” rule will help you recognize a breastfeeding problem before it gets worse and help keep those exclusive breastfeeding scores up! All of you IT teams…open up the tool “Discern Visual Developer” and follow the build in the screenshot below:
“Did You Know” How are you doing with your Point of Service collections in your OB Ambulatory clinics? Did you know that our Rev Works solutions can help you identify those receivables that need to be collected before the patient leaves your facility? Before the patient arrives in the clinic, she can enter her information in the patient portal and the eligibility can be verified by the system prior to her arrival. Using established best practice protocols ensure that patient access staff request copay, co-insurance, and deductible from eligible patients which results in 50% of receivables collected before the patient leaves the facility. With one solution alone – Eligibility and Benefits Verification – the front line staff no longer has to go to the phone or a website to determine eligibility. The software pulls in the insurance demographic data from the registration information and manual entry is not required. RevWorks Services (26 solutions strong) creates strategic client partnerships to address the challenges and workflow inefficiencies beyond what is typically covered in technology relationships. Contact your CRE today to find out about analyzing the health of your revenue cycle.
July 2013
Maintaining Industry Awareness: National Quality Measures Why is PI Important to Healthcare Organizations? Process Improvement is important because of the impact it has on patient care, meeting regulatory guidelines, and reimbursement. Several organizations have formed to help define and drive the movement forward. Below are a few… National Hospital Quality Measures (NHQM): The Joint Commission and the Centers for Medicare and Medicaid Services combined efforts to create an aligned manual specifying common national hospital performance measures. The measurement areas are: Acute Myocardial Infarction, Children’s Asthma Care, Heart Failure, Pneumonia, Surgical Care Improvement Project, and Pregnancy and Related Conditions. The goal is to minimize data collection efforts for these common measures and focus efforts on the use of data to improve the healthcare delivery process. Organizations can utilize PI methodologies to help meet the required documentation standards for these core measures as well as improve the outcomes they are documenting. The Joint Commission: Joint Commission standards address the organization’s level of performance in key functional areas, such as patient rights, patient treatment, and infection control. The standards focus not simply on an organization’s ability to provide safe, high quality care, but on its actual performance as well. CMS: The Centers for Medicare and Medicaid Services (CMS), a component of the Department of Health and Human Services (HHS), administers Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and the Clinical Laboratory Improvement Amendments (CLIA). Along with the Departments of Labor and Treasury, CMS also implements the insurance reform provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Social Security Administration is responsible for determining Medicare eligibility and processing premium payments for the Medicare program. CMS provides guidance and regulations that impact a hospital’s reimbursement for care provided. National Quality Forum: The National Quality Forum (NQF) is a not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting. The NQF has endorsed over 200 consensus standards. Institute for Healthcare Improvement: The Institute for Healthcare Improvement (IHI) is an independent, not-for-profit organization focused on improving healthcare with measurable and continual progress in Healthcare Safety, Effectiveness, Patient-Centeredness, Timeliness,
Are you a part of our social network? Become a member of our Women’s Health Collaboration Community on uCern. uCern is a great way to stay up to date on the latest developments around PowerChart Maternity and FetaLink, hear about upcoming events, network and share tips and tricks with your peers. If you are not already a member, we hope you’ll sign up soon!
Join us on uCern Follow Cerner on Facebook Follow Cerner on Twitter Follow the Women’s Health team on Facebook Follow the Women’s Health team on Twitter
Women’s Health Newsletter Maintaining Industry Awareness (Continued) Efficiency, and Equity. IHI impacts healthcare organizations through programs and campaigns aimed at education and improvement. The IHI campaign, ‘Protecting 5 Million Lives from Harm’ is the latest campaign, focused on protecting patients from 5 million incidents of medical harm over the next two years. Hospital Quality Alliance: The Hospital Quality Alliance (HQA) is a public-private collaboration to improve the quality of care provided by the nation’s hospitals by measuring and publicly reporting on that care. This collaboration includes the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association, the Federation of American Hospitals, and the Association of American Medical Colleges, and is supported by other organizations such as the Agency for Healthcare Research and Quality, the National Quality Forum, the Joint Commission on Accreditation of Healthcare Organizations, American Medical Association, and many others. The goal of the program is to identify a robust set of standardized and easy-to-understand hospital quality measures that would be used by all stakeholders in the healthcare system in order to improve quality of care and the ability of consumers to make informed healthcare choices. Highlights from a few of the Organizations: 1. National Quality Forum (NQF) http://www.qualityforum.org/Home.aspx NQF reviews, endorses, and recommends use of standardized healthcare performance measures. Performance measures, also called quality measures, are essential tools used to evaluate how well healthcare services are being delivered. NQF’s endorsed measures are often invisible at the clinical bedside but quietly influence the care delivered to millions of patients every day. Measures: • Make our healthcare system more information rich • Point to actions physicians, other clinicians, and organizations can take to make healthcare safe and equitable • Enhance transparency in healthcare • Ensure accountability of healthcare providers • Generate data that helps consumers make informed choices about their care Working with members and the public, NQF also helps define our national healthcare improvement ‘to-do’ list, and encourages action and collaboration to accomplish quality improvement goals.
July 2013
Never Events: According to the National Quality Forum (NQF), “never events” are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility. Some states have enacted legislation requiring reporting of incidents on the NQF list. Reducing or eliminating payments for “never events” means more resources can be directed toward preventing these events rather than paying more when they occur. The Deficit Reduction Act represents a first step in this direction, allowing CMS, beginning in FY 2008, to begin to adjust payments for hospital-acquired infections. 2. NQMC is a public resource for evidence-based quality measures and measure sets. NQMC also hosts the HHS Measure Inventory. http://www.qualitymeasures.ahrq.gov/index.aspx NQMC is an initiative of the Agency for Healthcare Research and Quality (AHRQ) , U.S. Department of Health and Human Services. It is a database and Web site for information on specific evidence-based health care quality measures and measure sets. NQMC is sponsored by AHRQ to promote widespread access to quality measures by the health care community and other interested individuals. The NQMC mission is to provide practitioners, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining detailed information on quality measures, and to further their dissemination, implementation, and use in order to inform health care decisions. NQMC builds on AHRQ’s previous initiatives in quality measurement, including the Computerized NeedsOriented Quality Measurement Evaluation System (CONQUEST), the Expansion of Quality
Women’s Health Newsletter Maintaining Industry Awareness (Continued) of Care Measures (Q-SPAN) project, the Quality Measurement Network (QMNet) project, and the Performance Measures Inventory (PMI). Measures by Topic Browse topics to find measures represented in NQMC that are linked to a particular term derived from the U.S. National Library of Medicine’s (NLM) Medical Subject Headings (MeSH), a controlled vocabulary for disease/condition, treatment/ intervention, and health services administration. MeSH is one of the controlled vocabularies included within the Unified Medical Language System (UMLS). MeSH terms are arranged hierarchically ranging from broad headings to more narrow concepts. The search function allows a quick means to find the Measure Initiatives for a specific specialty such as “Obstetrics” with the ability to click on a single initiative to view the summary of details for it. Below is a sample of the Obstetric measures and a portion of a single summary description:
July 2013
3. NCQA - National Committee for Quality Assurance http://www.ncqa.org/HomePage.aspx The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda. The NCQA seal is a widely recognized symbol of quality. Organizations incorporating the seal into advertising and marketing materials must first pass a rigorous, comprehensive review and must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high quality care and service.
Cerner’s Approach to Regulatory Compliance It’s challenging for Healthcare facilities / providers to comply with federal regulatory requirements. To add to the complexity, these requirements change frequently. Cerner reviews these new statutes, regulations and requirements on a regular basis, and has developed solutions to help your clients improve compliance efforts.
Women’s Health Newsletter Maintaining Industry Awareness (Continued) PowerChart Maternity Within PowerChart Maternity, we currently utilize several features to help facilitate compliance with the quality measures such as discern rules, perinatal core measures, and IPOCs in an effort to aid in the clinicians ability to ensure that necessary documentation is being entered and captured. We are continuing to grow in this area and will strive to stay current with the latest standards and updates.
In addition, our clients use any of the other Cerner solutions mentioned below to help improve their compliance efforts.
July 2013
Other Cerner’s Solutions: • Cerner has developed Regulatory Reporting; complementing the Regulatory Reporting solution, Cerner offers specifically designed data abstraction content for the NHQM measures in the Knowledge Catalog (KS-26808) and Cerner EK for Regulatory Standards (KS-26850), which aids in gathering regulatory data from Cerner Millennium®. • PowerInsight solutions are required for internal performance management reporting and monitoring of the NHQM measures. PowerInsight extracts data from Cerner Millennium, enabling clients to view clinical, operational and financial data in daily, weekly or monthly reports. • Lighthouse quality and performance improvement offerings bundled around specific industry quality objectives. Lighthouse uses dashboards, reports and queries to provide financial, condition, enterprise-wide and even third party data. Lighthouse quantifies current performance and identifies gaps to optimal practices. With rules and alerts for surveillance, education and ongoing assessment, clients can drive measurable improvements in quality, safety, cost and outcomes. • PowerChart Office Analytics (PV-00100), enabling physician practices to aggregate data and turn it into actionable information. By measuring outcomes, this solution helps users pinpoint areas for clinical improvement. The offering enables practices to meet industry-wide quality standards for P4P initiatives. Physicians must collect clinically-relevant data to comply with current regulations. Clients can deliver statistical, comparative and longitudinal reports, providing useful information to monitor performance improvement while staying ready for accreditation surveys.
Additional PI, Regulatory & Quality References: • Six Sigma - http://www.isixsigma.com/ • Lean - http://www.lean.org/ • National Quality Forum - http://www.qualityforum.org/ • Baldrige National Quality Program - http://www.quality.nist.gov/index.html • Resources for Lean Manufacturing - http://www.superfactory.com/ • Society For Health Systems - http://www.iienet2.org/SHS/ • American Society for Quality - ASQ: Links: Healthcare • CMS - Centers for Medicare & Medicaid Services • The Joint Commission - http://www.jointcommission.org/