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The ICAEL office is fully staffed with knowledgeable technical and support professionals who are ready to answer any questions you may have while completing the application for accreditation. Below is a listing of some of the most frequently asked questions:
ICAEL FAQ of the Week
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How many continuing education credits do the staff members need for reaccreditation? |
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The Medical Director and the medical staff members need 15 echo-related credits earned within the 3-year period just prior to your filing deadline. Ten must be Category 1 AMA; no more than five may be another type. The Technical Director and the technical staff members need 15 echo-related credits earned within the 3-year period just prior to your filing deadline. For example, a laboratory sending in the application on 6/10/11 must have the required number of CMEs from 6/10/08 to 6/10/11.
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Don't see the question you were looking for? Contact the ICAEL staff for assistance.
How long does the ICAEL accreditation review process take?
Once the application is submitted online and the supporting documentation (case studies, final reports, etc.) from the laboratory are received in the ICAEL office, the accreditation review process generally takes approximately 12 to 16 weeks to complete and the decision returned to the facility. This date is contingent upon when the application is received in the office. There are no fixed deadlines to submit the application. For details on complete review process, visit the ICAEL Application Review section»
What should I do first when beginning the application process?
When beginning the accreditation or reaccreditation process, read the current ICAEL Standards. They are the foundation on which ICAEL accreditation is built. Next, you should perform a critical self-exam of the lab to determine where you do not meet Standards, and change your protocols/policies/methods etc. to come into compliance with Standards. When you are confident that your application package (including cases and reports) would demonstrate substantial compliance with Standards, you should complete the application, choose representative case studies and gather other documentation.
How many studies does an interpreting physician need to read per month/year to be compliant with Standards?
We recommend that the Medical Director and Medical Staff interpret 300 studies/year for Adult Transthoracic or Pediatric Transthoracic, 50 studies/year for Adult Transesophageal and 100 studies/year for Adult Stress echocardiography. However these are recommendations, not requirements.
I can’t locate a representative case for a particular physician (or sonographer). Should I leave them off the application?
You are obligated to list all of the sonographers who perform echocardiograms in your lab and all of the physicians who read those studies. You must plan to represent the staff appropriately, even if it means switching sonographers or readers for a particular study. As a practical matter, you may omit staff members from your application only if they scan/read very irregularly (for example, just to cover for a vacation) and their volumes in your lab are very low.
Do we list our part-time and PRN sonographers and readers on our application?
Generally, you must include on your application all staff members who are a part of your laboratory at the time of filing of your application for accreditation or reaccreditation, even if they are part-time or PRN. You may omit staff members from your application only if they scan/read very irregularly (for example, just to cover for a vacation) and their volumes in your lab are very low. You must include anyone who works regularly, even if infrequently. All staff listed on your application must be considered when choosing representative cases.
Do we have to send a case to represent each sonographer and each reading physician in our laboratory?
The number of cases required from a particular lab is based on the total number of sonographers plus reading physicians. However, the number of staff members in your lab may exceed your required number of cases, so there may be staff members listed on your application for whom no cases are submitted.
What is the definition of "staff"? Is it just sonographers or both sonographers and physicians?
Your "staff" consists of any sonographers who perform echocardiograms in the laboratory and any physicians that interpret echocardiograms for your laboratory.
What if a staff member quits before the application is filed?
A staff member who quits before the application is filed must be removed from the application. Any cases performed/read by that person must be removed and replaced with a case by current staff.
I will be submitting volume data from 2010, so do all the case studies submitted need to be from 2010 or can I include some from 2011?
The volume data that you submit is for a 12-month time period that you will choose, but your TTE/TEE cases must have been performed no more than twelve months back from your filing date (36 months for SE).
Can the Technical Director serve as Director in more than one laboratory?
It is the intention of the Standards that the Technical Director (TD) be full-time in the laboratory. If the TD is not full-time, or is TD in more than one lab (with other sonographers in the lab), then there must be a second credentialed sonographer present in the lab, who is able to take over the TD duties when the TD is absent. Note that if the TD is the sole sonographer in more than one lab, then he/she is “full-time” (i.e., 100% time) in each lab.
Can a non-credentialed sonographer scan alone, without the supervision of the credentialed Technical Director?
A qualified sonographer may scan unsupervised. See Part I, Section 1.4.1 for the three ways to qualify as a sonographer. If none of the three pathways are met, then all of that sonographer’s work must be directly supervised by a qualified sonographer until one of the three criteria is met.
How many continuing education credits do the staff members need for reaccreditation?
The Medical Director and the medical staff members need 15 echo-related credits earned within the 3-year period just prior to your filing deadline. Ten must be Category 1 AMA; no more than five may be another type. The Technical Director and the technical staff members need 15 echo-related credits earned within the 3-year period just prior to your filing deadline. For example, a laboratory sending in the application on 6/10/11 must have the required number of CMEs from 6/10/08 to 6/10/11.
Please explain which physicians are required to earn Testamur status from the NBE.
If the Medical Director or medical staff members qualify solely by “training and experience” option “C” (three years echo experience and 1800/1200 interpretations), then they must pass the NBE by 2015 to remain qualified to interpret echocardiograms. In other words, any reader who does not have actual Level II or III training (not an equivalent) must pass the NBE by 2015. Note that no cardiologist who has completed his or her training before 1990 will have Level II or III training, and therefore must pass the NBE by 2015. Physicians trained after 1989 should contact their graduate programs to determine whether or not their training included Level II/III training in echocardiography.
One of the physician groups reading echoes in our lab is already accredited with the hospital at which they practice. Do we still need submit information regarding those physicians or can we submit their accreditation certificate instead?
We do not accredit individuals, so being a member of one accredited lab has no bearing on the accreditation application of a second lab. We accredit labs only; an echo lab consists of the staff members who perform and read echoes for that lab. Staff members may appear on more than one application, but all of their information must be included with each application.
Is there a standard for the number of echoes a sonographer should complete per day, or an average time that should be allotted per study?
We do not have a Standard for how many echocardiograms are to be performed by sonographers in the course of a day. Part II. Section 2.2.3 does state that 45 to 60 minutes or more must be allotted for a complete transthoracic echocardiogram. This means that there must not be less than 45 minutes scheduled for any echo.
Do I need to delete all patient identifiers for all the studies I submit?
No, please do not remove any patient identifiers. The Accreditation Agreement has a Business Associate clause that covers the HIPAA regulations.
Can the sonographers give any preliminary study information to the referring doctor, patient’s nurse, the patient or the medical chart?
No, the sonographers may NEVER give any preliminary information, comments, opinions, etc., verbal or written, to anyone except the interpreting physician. This is tantamount to practicing medicine without a license.
How do we write a QA policy?
A quality assurance policy is a comprehensive, multi-section, lab-specific document, which must provide a detailed description of your lab's policy on each of the components in Part I, Section 5 of the ICAEL Standards. At a minimum, the policy must address appropriate use criteria, instrument maintenance, procedure volumes, CMEs, correlation, report timeliness/completeness, QA meetings with attendance requirements, and record-keeping. The three required QA measures in Section 5.1.10 must also be incorporated into your policy. Laboratories must implement the QA initiatives outlined in their policies, and perform these QA measures on an ongoing basis throughout the accreditation period. We have published a sample template that may be used to help you create a QA policy in the Sample Documents section. View the sample template»
I don’t understand the appropriate use criteria section of the QA Standards.
Be sure to refer to the related article noted in the Bibliography on page 17 of the Standards. Also, refer to the January 2011 JASE paper on quality operations in the echo lab (www.intersocietal.org/icael/main/links_references.htm) for a helpful explanation of AUC. Confer with your Medical Director or other physicians to create the AUC section of your QA policy, the required related policies, forms on which to track data and the mechanism for educating referring physicians (see Part II, Section 2.1.2 of the Standards). All of the criteria specified in the Standards must be incorporated into the policy. Visit the Sample Documents section for sample policies, data-tracking forms and a letter to referring physicians that you may view and modify for your laboratory.
For the QA requirements, what is the difference between correlation and variability?
Correlation is the process of comparing a particular echo result to the corresponding result from another diagnostic modality, for the purpose of determining whether the echo study and report were accurate. If the results of the two studies do not correlate, the study and report should be reviewed to discern any areas needing improvement or closer compliance with Standards. The variability study determines whether there is variability in the diagnostic criteria utilized by the reading physicians (or, utilized by a single physician over time). Per Part II, Sec. 3.1 of the Standards, there is to be no variability in diagnostic criteria among readers.
I received your letter stating that our accreditation was delayed. How can I determine exactly what was missing in our original application?
First, read the Standards that were identified in the letter with the reason(s) for the delay; your application package did not demonstrate substantial compliance to these Standards. You should review the cases, reports, protocols, etc. that you submitted with your application to determine why they did not meet the Standards. Next, when you receive the “reviewer findings” CD (which may have been sent with your decision letter), review it for detailed comments about each aspect of your application. Note that although the reviewers try to specify each area of non-compliance, you must ultimately use the Standards as your source of information on ICAEL requirements.
How do we determine the blood pressure that is now part of the required demographic information?
For inpatients, check the patient’s monitor or chart for a very recent blood pressure (at or very close to the time of the echo); if there is no recent reading, have the nurse take the pressure. For outpatients, the pressure must be taken at the time of the echo by the sonographer or other personnel.
Why was the requirement to comment on the structure and function of each valve removed from the Standards?
The Board of Directors removed the requirement to specifically comment on valve structure and function, thus allowing a comment of “Normal” to be acceptable for a valve that is completely normal in structure and function. However, if any valve pathology exists, then the required comment should specifically include a description of the structure as a means of explanation of the abnormal function.
Note: The Standards still require that reports accurately reflect the content and results of the study and that abnormal findings be localized and quantified.
If we apply in transesophageal echo, will our intraoperative TEE lab be covered?
No, there are no ICAEL Standards at the present time that address intraoperative TEE. Your ICAEL accreditation will not cover the OR’s TEE lab. Do not list the anesthesiologists who perform them solely in the OR; they are not considered part of your echo lab.
We can’t find enough positive stress echoes to submit. What do we do instead?
Representative SE cases may have positive echo results, or, must have regional wall motion abnormalities at rest. You may choose cases performed up to 36 months before the application filing date. There are no alternatives to the case study requirements. If you cannot submit the required SE cases, you may wish to apply later for stress (when you can submit a complete application including the required cases).
For reaccreditation, how do I complete the application?
Simply update the information on each page, and be sure to hit “Next” after each page to save the edited information. Add and delete staff members on pages 4 and 5. Do not use the “Begin Reaccreditation” feature unless you want to erase all of the previous data and start over.
How does a required site visit decision differ from the random site visit or audit?
As part of the IAC accreditation process, applicant laboratories could potentially be required to undergo a site visit of their laboratory. During the process of rendering an accreditation decision, the Board of Directors may determine that a site visit is required in order to better assess the laboratory and determine the final accreditation decision.
Read more about Accreditation Decisions»
The random site visit or audit will be performed at an undisclosed date and will occur after the laboratory is granted accreditation by the IAC.
Are all accredited laboratories required to undergo a random site visit or random audit?
Yes, in an effort to further substantiate continued compliance by accredited laboratories and in response to the requirements sanctioned by the Centers for Medicare & Medicaid Services (CMS) for CMS appointed Accreditation Organizations as part of the Medicare Improvements for Patients and Providers Act (MIPPA), the IAC has implemented a policy requiring all accredited laboratories to undergo an audit or site visit at some time during their three-year accreditation period. Read more about Random Site Visits and Audits»
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