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April 1, 1998
by Polly Schneider
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Starting in 1999, foreign hospitals will be able to get a "U.S.-approved" stamp as the Joint Commission of Accredited Healthcare Organizations rolls its accreditation services abroad. Working off of existing relationships developed from more than 20 years of consulting and educational programs in every region of the world, the Joint Commission International (JCI), a partnership between JCAHO and its consulting subsidiary Quality Healthcare Resources, Inc., will target governments and hospitals in the Middle East, Latin America and Western Europe, according to Tina Donahue, executive director of JCI.

JCI will also work with the U.S. Agency for International Development and World Bank to start programs in developing countries where funding is scarce. An AID contract under way now in Zambia is helping that country launch an accreditation system: The JCI has also worked in the remote locales of Kurdistan and Siberia. The export of U.S.-style healthcare may be hard to sell in certain regions. "The problem is most other countries don’t have standards like we do in the United States so this will be a whole new experience for them," Donahue says. The U.K., Canada, Australia and New Zealand are the few countries outside of the U.S. that have had long-term accreditation programs.

Part of the JCAHO’s mission abroad has been to help hospitals develop an information management infrastructure, including information systems needed to track and measure care. "More and more people around the world are getting interested in performance measurement, which means you’ve got to manage information," Donahue says. The international community’s top interests include the CPR, management of patient information across the continuum, and performance indicators. "The ORYX initiative has been of great interest to people abroad," she says.

Five years ago the JCAHO won a contract with Saudi Arabia’s Ministry of Health to start a quality improvement program and develop the physical infrastructure to support an electronic medical records system in several hospitals. The needs were basic: according to Donahue, the hospitals did not have paper medical records, much less an electronic version. The Saudis are still working on the implementation of an EMR today. Donahue acknowledges progress has been slow: "There were so many differences in the way care was delivered there compared to the U.S. Many of the standards were not applicable and quite a few were culturally not appropriate."

Still, Donahue says that obtaining data to measure performance in healthcare is in high demand by scientists and physicians around the world. She says working with other countries will put the JCAHO in a better position to help healthcare organizations resolve fundamental issues barring progress in quality improvement, such as data accuracy. The Center for Performance Sciences, Lutherville, Md., is another organization offering performance measurement services to hospitals overseas, including clients in Taiwan and India.

--Polly Schneider is senior editor at Healthcare Informatics


By Kathleen Kimball-Baker

Trusting the credibility of information on the Internet is a widespread concern, particularly in the world of medicine and health. One international nonprofit organization is addressing this problem: Health on the Net Foundation (HON), based in Geneva, Switzerland, has advanced a code of ethics called the HONcode and encourages makers of medical and health sites to abide by it and display its logo.

"This is a first step toward guaranteeing the quality of information on the Web," says Ron Appel, PhD, head of the Molecular and Bioinformatics Lab at the University Hospital of Geneva and a member of HON’s executive committee. "Of course, it’s not a real guarantee, but if a site displays the HONcode, at least you know they are morally committed."

The code requires, in part, that sites provide advice only from medically trained and qualified professionals (or clearly state if not); provide information designed to support, not replace, the relationship between a patient and provider; adhere to legal confidentiality requirements of the country or state of origin; and support information with clear references (and HTML links if possible) to source data, and include "balanced evidence" for any claims about benefits or performance of treatments, products or services. The full text of the code’s eight principles, its logo and policies can be found at

Eventually, says Appel, HON will offer the Web equivalent of a medical and scientific gold standard for professional journals: peer review. Panels of experts in different fields will review sites and report their findings back to HON, which in turn will post the results, says Appel.

Still, the process is likely to be confounded by the speed with which data can be changed and updated on the Internet. Appel acknowledges this, but adds that the "likelihood is quite high" that what is found to be good through peer review on one date will meet the test on another.

HON was created in 1995 to "advance the development and application of new information technologies, notably in the fields of health and medicine."

Kathleen Kimball-Baker is a Minneapolis-based healthcare writer.