Comparative Analysis of HQS, JCI and HIMSS-EMRAM Quality Assessment Models Widely Used in Turkey

Abstract

The standards developed for measuring quality ensure the management of the dynamic structure of health services, the reduction of uncertainties, and the prevention of errors since quality relies on measurement, evaluation, and continuous improvement. Additionally, the models used in measuring health service quality are divided into two: case-based and indicator-based. Using the document analysis method, this study compared the Joint Commission International (JCI), Healthcare Quality Standards (HQS) and Healthcare Information and Management Systems Society (HIMSS) – Electronic Medical Record Adoption Model (EMRAM) models, which are included in the indicator-based health quality measurement models, in terms of the concepts, processes, and standards featured in them. Within the scope of the study, a total of 1,141 standards from all three models were examined. Ethical approval was taken from local ethics committee on 10/08/2020. Upon the comparison, it was understood that the HQS and JCI models were more similar in "presence rates" than the HIMSS-EMRAM model in terms of concept (83%), process (66%), and standard (64%). It was concluded that HIMSS EMRAM standards can be used as a very useful tool for making improvements and identifying deficiencies in HQS and JCI processes. Keywords: Medical ?nformatics, Healthcare Quality, Quality ?ndicators, Healthcare Standard, Healthcare ?nformation Management.

Introduction

Quality is a set of activities carried out to offer a product or service at a low cost and in a way that can meet the needs of customers at the maximum level (Bakan et al., 2015). The concept of quality should be structured so that it covers all the services provided, enables the efficiency of the service to be measured, associates the processes with the results and is limited to technical, mechanical and scientific knowledge and is constantly changing(Arpat et al., 2014). Service quality is defined as the customer's general judgment about the superiority or excellence of a product or service(Devebakan, 2015). Healthcare service quality, on the other hand, refers to all efforts to prevent potential adverse circumstances on the health condition of individuals or to ensure the recovery of individuals(Aygar & ?nsüz, 2017). Therefore, measuring and evaluating the quality of healthcare services is pivotal in terms of determining the areas for improvement in healthcare services and increasing the quality of the service provided. In this way, it is possible to provide a health service that covers all actors in health institutions and meets the expectations and needs (K?dak et al., 2015). Case-based and indicator-based models are used to measure the quality of healthcare services in Turkey. This study discusses the Healthcare Quality Standards (HQS) and the Electronic Medical Record Adoption Model (EMRAM) developed by the Joint Commission International (JCI) and the Healthcare Information and Management Systems Society (HIMSS), which are indicator-based models. This study, which examines documents about JCI, HQS and HIMSSEMRAM models by using the document analysis method, compares the concepts used by and the processes examined by these models, and the measurement criteria. Healthcare Quality Standards (HQS) in Turkey National Quality Evaluation The purpose of establishing HQS is to enhance the safety and satisfaction of both healthcare professionals and individuals who intend to make use of healthcare services, by following international developments, paying attention to the needs and expectations of patients, and making the services provided by health institutions and organizations measurable (Erta? & ?elik, 2018). The Ministry of Health provides training to HQS evaluators on all processes related to the establishment, development, implementation and evaluation of these standards(Güdük & K?l??, 2017). HQS evaluators are selected from individuals who have completed at least one basic medical undergraduate program and have 2 years of experience in the field. Healthcare Quality Standards-Hospital was established in 2005. A pilot scheme was put into action in 2007. New standards were added in 2007 and 2008. In 2009, private hospitals were additionally included in the evaluation. HQS were revised in 2011 and 2015(Erta? & ?elik, 2018). The latest version (version 6) was used by health institutions initially in 2020. When the 2005 and 2020 versions of the constantly updated HQSs are compared, it is understood that many improvements have been made. The activities carried out concerning Healthcare Quality Standards (HQS) within the scope of the "Regulation on the Development and Evaluation of Healthcare Quality" to regulate the practices based on the establishment and development of the required standards, the evaluation of the practices adopted by health institutions, and the provision of quality service to meet the expectations are undertaken by the General Directorate for Healthcare Services, Department of Healthcare Quality Accreditation and Employee Rights Department (TC. Sa?l?k Bakanl???, 2020; Uysal & Yorulmaz, 2018).More..