Going for Gold – The Bridge to
Patient Care
Stacy Olea, MBA, MT(ASCP), FACHE
Field Director
Objectives
 Learn about The Joint Commission Laboratory
standards
 Explain the unique features of a Joint Commission
Laboratory survey
 Understand what to expect during your survey
 Learn what happens after the survey has been
completed
 Review how to use the available tools to assist you
with continuous compliance
 Present suggestions on how to resolve the top 10
findings
Delaware Valley Chapter CLMA Annual Fall Meeting
The Joint Commission’s Vision
All people experience the safest, highest quality, bestvalue health care across all settings.
The Joint Commission’s Mission
To continuously improve health care for the public, in
collaboration with other stakeholders, by evaluating
health care organizations and inspiring them to excel
in providing safe and effective care of the highest
quality and value.
3
Reasons Organizations do not use
The Joint Commission for
Laboratory Accreditation
 Employed Surveyor Cadre
 Did not know The Joint Commission offered a
laboratory program
 The Joint Commission does not have standards in
Forensic Drug testing
 No checklist
 Thought the laboratory surveyors where physicians
and nurses
Delaware Valley Chapter CLMA Annual Fall Meeting
Reasons Organization use The Joint
Commission for Laboratory
Accreditation
 Largest and oldest organization dedicated to survey process and risk
evaluation for over 19,000 health care organizations
 Professional surveyor cadre
 Tracer methodology and system evaluation
 Lab Advantage combined services option (PT, CE, and accreditation)
 Organizational alignment for operational synergy
 Cost is based on volume
 More than one way to meet the standards
 Annual procedure review can be done by signing one cover sheet
 Ability to detect risks that were unknown prior to the visit
 Onsite visit activities and findings added value to improving the quality
of healthcare
 Collaborative approach
Delaware Valley Chapter CLMA Annual Fall Meeting
Accreditation Standards
Comprehensive
Accreditation Manual for
Laboratory and Point-ofCare Testing (CAMLAB)
– Free print copy
– Electronic copy via E-dition
Focus on high quality, safe laboratory
services
– Expectations for performance – reasonable,
achievable, surveyable
– CMS recognizes Joint Commission accreditation
as meeting CLIA requirements
Delaware Valley Chapter CLMA Annual Fall Meeting
Accreditation Standards
Surveyors use standards for evaluation
– Patient tracer methodology
– Follow samples from collection to result
reporting
Organization-wide processes
– Valuable component of a complex delivery
system
– Not an isolated department
Delaware Valley Chapter CLMA Annual Fall Meeting
Broad vs. Prescriptive Requirements
Broad
– Processes (means
to an end)
– Many ways to
accomplish goals
– Processes designed
by Organizations
– Remains valid with
changing science
Prescriptive
– Specific requirements
(specific outcome)
– The only way
– Evidence-Based
– Readjustments are
required with changing
science
Delaware Valley Chapter CLMA Annual Fall Meeting
Unique Issues with Laboratory
Often uses prescriptive
requirements
– CLIA requirements
– Industry convention
Avoid prescriptive requirements
– Multiple effective methods may exist
– Could stifle emerging practices
– Tracers are a system review process
(rather than task verification)
– Allows standards to be nimble
Delaware Valley Chapter CLMA Annual Fall Meeting
Standards Development Process
Subject matter expert participation
Laboratory PTAC review
– Comprised of members from industry association
stakeholders
National Field Review
– 6 week public comment period
Board Committee (SSP) approves
6-month notification to allow preparation
Delaware Valley Chapter CLMA Annual Fall Meeting
Standards Development Process
New standards timeline (12-18 months)
– Research, revisions
– Public comment, pilot testing
CAMLAB updated (6 months)
– Standards updates
– Front matter/resource edits
Delaware Valley Chapter CLMA Annual Fall Meeting
Layout of CAMLAB
Front Matter
– How to Use this Manual
13 Chapters
– Shared Chapters
– Unique Chapters
Resources
– Glossary
– Standards Applicability Grid
Delaware Valley Chapter CLMA Annual Fall Meeting
Standards Chapters
Chapters Unique to CAMLAB
DC - Document and Process Control
specimen collection, test orders, test procedures,
reporting, record retention
QSA – Quality System Assessment for
Nonwaived Testing
proficiency testing quality control, standards for
specialties and subspecialties
Delaware Valley Chapter CLMA Annual Fall Meeting
Standards Chapters
Chapters Shared with Other Programs
EC – Environment of Care
physical environment, equipment, hazardous
materials/waste, fire safety, utilities
HR – Human Resources
staff qualifications, orientation, training, competence,
performance
LD – Leadership
structure, relationships, organizational culture,
operations
NPSG – National Patient Safety Goals
two patient identifiers, reporting critical results, hand
hygiene
Delaware Valley Chapter CLMA Annual Fall Meeting
Anatomy of a Standard
Standard
Identifies a goal (i.e., participation in proficiency testing)
Rationale/Introduction
Explains why it is important to achieve the goal
Provides background information for requirement
Element of Performance (EP)
Outlines the steps needed to achieve the goal
Expectations for compliance
Delaware Valley Chapter CLMA Annual Fall Meeting
Standards Applicability Grid
Not all requirements apply to all specialties
– Based on services provided by your laboratory
– Specialties listed horizontally, standards vertically
Delaware Valley Chapter CLMA Annual Fall Meeting
Scoring
 Scoring Process
– Category A EPs: relate to structural requirement
– Category C EPs: frequency based that are scored based on
the number of times an organization is found not to be
compliant
– Performance expectation
– Score 2 = Satisfactory compliance
– Score 1 = Partial compliance
– Score 0 = Insufficient compliance
– Track record achievements at the time of survey
– Score 2 = 24 month
– Score 1 = 6 to 23 months
– Score 0 = Fewer than 6 months
Delaware Valley Chapter CLMA Annual Fall Meeting
Accreditation Decision
How accreditation decisions are made
– Criticality model
– The more immediate the risk the shorter
the period of time given to address
noncompliance
– All partially compliant and insufficiently
compliant EPs must be addressed
Delaware Valley Chapter CLMA Annual Fall Meeting
What is unique to our survey
process?
Employed surveyor cadre
Priority Focus Process
Concentration on the operational
systems that directly affect the quality
and safety of diagnostic services
National Patient Safety Goals
Tracer Methodology
Delaware Valley Chapter CLMA Annual Fall Meeting
Employed Surveyor Cadre
 Effective evaluators
– Process is thorough, fair, and objective
– Process identifies most critical safety and quality issues
– Process is inclusive of mandatory (regulatory) and collaborative
(inspirational) modes
– Process is continuous, not event driven
– Process is guided by surveyor experience and expertise, informed
by data
– Process looks at systems and integration, not a list of tasks
 All have clinical laboratory management experience
 A full time surveyor will evaluate approximately 60 laboratories a year
 Anatomical pathologist surveyors are available upon request
 Surveyor continual training and performance monitoring
Delaware Valley Chapter CLMA Annual Fall Meeting
Priority Focus Process
 Data driven tool that provides surveyors with pre-survey
information that has been developed using a standardized
methodology
 Helps surveyors evaluate health care organizations’
performance more consistently
 Helps to focus the surveyors’ assessment on quality and safety
issues specific to an individual laboratory
 Sources used includes The Joint Commission, the laboratory
and other public sources
 PFP reports are posted to your extranet site quarterly and as
changes warrant
– The top four-to-five priority focus areas
– The clinical/service groups
Delaware Valley Chapter CLMA Annual Fall Meeting
Operational Systems
Approach
 Our mission and vision drives us to look at how the
laboratory is integrated into patient care
 We will spend time outside of the laboratory
– Nonwaived ancillary Point of Care Testing sites
(cardiac cath labs, ORs)
– A sampling of waived and PPMP Point of Care
Testing sites
– Transfusion administration and management
– Perioperative Transfusion Services
– Tissue storage and management
– Hospital Integration
Delaware Valley Chapter CLMA Annual Fall Meeting
NPSG.01.01.01
 Use at least two patient identifiers when providing
laboratory services.
 EP1 - Use at least two patient identifiers when
administering blood or blood components; when
collecting blood samples and other specimens for
clinical testing; and when providing other treatments
or procedures. The patient’s room number or
physical location is not used as an identifier.
 EP2 - Label containers used for blood and other
specimens in the presence of the patient.
Delaware Valley Chapter CLMA Annual Fall Meeting
NPSG.02.03.01
 Report critical results of tests and diagnostic procedures on a timely
basis.
 EP1 - Collaborate with organization leaders to develop written
procedures for managing the critical results of tests and diagnostic
procedures that address the following:
– The definition of critical results of tests and diagnostic procedures
– By whom and to whom critical results of tests and diagnostic
procedures are reported
– The acceptable length of time between the availability and
reporting of critical results of tests and diagnostic procedures
 EP2 - Implement the procedures for managing the critical results of
tests and diagnostic procedures.
 EP3 - Evaluate the timeliness of reporting the critical results of tests
and diagnostic procedures.
Delaware Valley Chapter CLMA Annual Fall Meeting
NPSG.07.01.07
 Comply with either the current Centers or Disease
Control an Prevention (CDC) hand hygiene
guidelines or the current World Health Organization
(WHO) hand hygiene guidelines.
 EP1 - Implement a program that follows categories
IA, IB, and IC of either the current CDC or WHO
hand hygiene guidelines.
 EP2 - Set goals for improving compliance with hand
hygiene guidelines.
 EP3 - Improve compliance with hand hygiene
guidelines based on established goals.
Delaware Valley Chapter CLMA Annual Fall Meeting
Tracer Methodology
 Uses actual patients as the framework for assessing standards
compliance
 Individual tracers follow the experience of care through the
entire health care process in the organization
 System tracers evaluate the integration of related processes
– Coordination and communication among disciplines and
departments
– In-depth discussion and education regarding the use of data
in performance improvement
 Reference document available at
http://www.jointcommission.org/tracer_methodology_101/
Delaware Valley Chapter CLMA Annual Fall Meeting
Tracer Methodology
 Common starting points for tracers
– Sample Collection
– Critical results
– Transfusion Medicine
– Point of Care Testing
– Frozen Sections
 Documents reviewed during tracers
– Order
– Instrument maintenance records, calibration verification, quality control
– Policies and Procedures
– Employee competency
– Blood Utilization Review
– Process Improvement
– Patient Medical Records
 Staff interviews and Direct Observations
Delaware Valley Chapter CLMA Annual Fall Meeting
Joint Commission Survey
Options
Pathologist
Corporate Surveys
– Dedicated Team
– Orientation to your Organization
– Annual Summation
Simultaneous Surveys
– Other Programs
– Sister facilities
Concurrent Surveys
Delaware Valley Chapter CLMA Annual Fall Meeting
On-Site Survey Activities
 Surveyor photo, bio and survey agenda are posted
to the extranet site at 07:30 local time (mobile app)
 Depending on the complexity of the organization a
survey may last more than one day and could
involve a team of surveyors
 Once the surveyor arrives, the organization’s
extranet must be checked for confirmation of the
survey and identification of the surveyor
 Preliminary Planning Session
 Opening Conference
 Orientation to the Organization
Delaware Valley Chapter CLMA Annual Fall Meeting
On-Site Survey Activities
 A Daily Briefing occurs every morning of a multiday
survey, with the exception of the first day
 Competency Assessment
 Personnel education/qualification verification
 Regulatory Review
 Proficiency Testing Validation/Performance
Improvement Data Review
 Individual Tracers
 Physical Environment
 Survey Report Preparation
 CEO Exit Briefing and Organization Exit Conference
Delaware Valley Chapter CLMA Annual Fall Meeting
Required Documentation
Documentation list for your survey
– The 24 month reference in the following
items is not applicable to initial surveys,
except for proficiency testing data.
– For initial surveys, a minimum of 4 months
of data must be available for review.
Delaware Valley Chapter CLMA Annual Fall Meeting
Required Documentation
 As a laboratory, you should have the following information and
documents available for the surveyor to review during the
Surveyor Planning Session
– Name of key contact person who can assist in planning tracer
selections
– CLIA Certificates, Specialties and Subspecialties, State Licenses,
and personnel license or certification if required by the state or
organization policy
– An organizational chart and map of the facility
– Ability to retrieve testing records for patients who have had
laboratory tests or other services for the past 24 months (4 months
if an initial survey)
– Performance improvement Data for the past 24 months (4 months
if an initial survey)
– Proficiency data by CLIA number for the past 24 months
Delaware Valley Chapter CLMA Annual Fall Meeting
Required Documentation
 As a laboratory, you should have the following information and
documents available for the surveyor to review during the
Surveyor Planning Session
– Results of periodic laboratory environment inspections from the safety
committee or safety officer
– Manifests for the disposal of hazardous waste for the past 24 months (4
months if an initial survey)
– A list of specialties and subspecialties performed by the lab
– A list of tests performed (test menu) and instruments used including all
ancillary and point of care sites
– Measures of Success (MOS) identified in the Plan of Action from the
Periodic Performance Review
– Employee personnel files will be reviewed, including employee education
records, competency documentation, and employee health information
– Note: Surveyors may need to see additional documents throughout the
survey to further explore or validate observations or discussions with staff.
Delaware Valley Chapter CLMA Annual Fall Meeting
From Survey Report to
Accreditation Decision
 A preliminary report is available on the extranet until midnight
of the day the survey has been completed.
 The accreditation decision is not made until all of your
organization’s post-survey activities are completed
 The final summary of survey findings report will be posted on
your extranet site.
– It will include which findings require an Evidence of
Standards Compliance (ESC) submission within 45 days
(direct impact standards) and/or 60 days (indirect impact
standards)
 Upon approval of your organization’s last submitted ESC, your
accreditation decision is posted to your extranet site and to
Quality Check (www.qualitycheck.org)
Delaware Valley Chapter CLMA Annual Fall Meeting
Standards Clarification
 Organizations have the opportunity to submit a clarifying ESC if
they believe that their organization was in compliance with a
standard at the time of the survey
 The clarification must be submitted within 10 business day
following the posting of the organization’s report to the extranet.
 When submitting clarifying ESCs after a survey event, it is
important to follow the directions in the submission tool. You
need to address the EP as well as the actual surveyor
observation.
 The submission of a clarification does not negate the
requirement for submission of a corrective ESC within 45 or 60
days if the RFI continues, nor does it provide an organization
with additional time to submit its ESC.
Delaware Valley Chapter CLMA Annual Fall Meeting
Corrective ESC
 An acceptable corrective ESC report must detail the following:
– Action(s) that the organization took to bring itself into compliance
with a standard
– The title of the person(s) responsible for implementing the
corrective actions or approving a revised policy, procedure, or
process
– Compliance at the EP level and include a Measure of Success
(MOS) if applicable
 There may be times when an ESC will also be conducted on
site by a surveyor
– Provides the opportunity to evaluate the organization’s success in
correcting issues
– Allows the surveyor to provide coaching and guidance to the
organization supporting its efforts to achieve and maintain
compliance
Delaware Valley Chapter CLMA Annual Fall Meeting
Measure of Success (MOS)
A numerical or quantifiable measure,
usually related to an audit to determine
if action was effective and sustained
Due four months after notification of an
acceptable ESC
Not required for all ESCs
Delaware Valley Chapter CLMA Annual Fall Meeting
Help us improve the survey
process
Customer Value Assessment
– Before the survey happens
– Allows you to set expectations
– After the survey is over to evaluation our performance
HCO Evaluation
– Your opportunity to provide us with feedback on the survey
process and the surveyor(s)
– Exceed Expectations, Meets Expectations, Below
Expectations, Not Observed
– 14 questions with room for comments
– Additional line to enter your information if you want
someone from The Joint Commission to contact you
Delaware Valley Chapter CLMA Annual Fall Meeting
Accessing Standards Via E-dition
Standards Interpretation Group
(SIG)
Phone:
630-792-5900 Option 6
Online:
http://www.jointcommission.org/Standards/OnlineQuestionForm/
FAQs:
http://www.jointcommission.org/Standards/FAQs
Delaware Valley Chapter CLMA Annual Fall Meeting
Intracycle Monitoring
Located on your Joint Commission extranet
site
Required on your off cycle year and can be
accessed before your first survey
Three options available
Opportunity to ask questions and develop
plans of action in a non-punitive manner
Delaware Valley Chapter CLMA Annual Fall Meeting
Leading Practice Library
 Opened to all of our accredited organizations
 Database to formally identify and share leading
practices (including case studies, white papers,
tools, policies, etc.) which reflect excellent
compliance with Joint Commission standards and
National Patient Safety Goals.
 Sort by program
Delaware Valley Chapter CLMA Annual Fall Meeting
Center for Transforming
Healthcare
 Formed in 2009 to find solutions to pressing health care issues
identified by CEOs
 Uses DMAIC principles to analyze and identify root causes
which vary by institution
– One size does not fit all for persistent issues!
 Projects include:
– Hand hygiene
– Hand off communications
– Wrong Site surgery
– Surgical Site infections (with ACS)
– Safety Culture
 Solutions database available from Joint Commission to enter
your own data and perform your own project to improve care
Delaware Valley Chapter CLMA Annual Fall Meeting
Lab Central
New customer portal that improves
accreditation:
– Allows organizations to organize files in one place
to make surveys more efficient
– Surveyors can review data before the survey to
get better snapshot of organization
– Data available for ICM discussion with SIG
– Provides a place for private document
management
Mandatory use starting January 1, 2013
Delaware Valley Chapter CLMA Annual Fall Meeting
Delaware Valley Chapter CLMA Annual Fall Meeting
Delaware Valley Chapter CLMA Annual Fall Meeting
Delaware Valley Chapter CLMA Annual Fall Meeting
Delaware Valley Chapter CLMA Annual Fall Meeting
From Accreditation to Continuous
Compliance
 Concentrate on incorporating the frameworks and
concepts of standards and EPs into day-to-day work
rather than viewing the concepts as rules that must
be followed
 Read Perspectives each month to identify
new/updated standards, scoring, standards
interpretation
 Sign up for E-Alerts
 Complete your intracycle monitoring
 Contact SIG to submit standard questions
 Enter your information into Lab Central
Delaware Valley Chapter CLMA Annual Fall Meeting
Resources and Tools
 Resources and Tools available
– CAMLAB
– Perspectives monthly publication
– Joint Commission Center for Transforming Healthcare
– Account Executive
– Joint Commission extranet site
– Leading Practice Library
– BoosterPaks
– E-dition web-based manual
– Lab Central
– Joint Commission webpage
– CLSI crosswalk
– Standards’ Frequently Asked Questions
– Tracer Methodology 101 article
– Sign up for E-Alerts
– Lab Focus
– Free audio conferences
Delaware Valley Chapter CLMA Annual Fall Meeting
Resources on the Web
Centers for Medicare & Medicaid Services (CMS)
CLIA: www.cms.hhs.gov/clia
COPs: www.cms.hhs.gov/CFCsAndCOPs/
Centers for Disease Control and Prevention (CDC)
www.phppo.cdc.gov/clia
Food and Drug Administration CLIA Database Search
www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCLIA/Search.cfm
CLSI-Joint Commission Crosswalk
http://www.clsi.org/Content/NavigationMenu/Resources/TJC_
CrosswalkWEB.pdf
Delaware Valley Chapter CLMA Annual Fall Meeting
Top 10 Findings
 Top 10 Initial Survey
Findings
– DC.02.03.01 EP2
– WT.05.01.01 EP3
– QSA.02.03.01 EP3
– QSA.02.08.01 EP2
– WT.05.01.01 EP4
– QSA.01.01.01 EP5
– QSA.02.04.01 EP6
– NPSG.02.03.01 EP3
– DC.02.01.01 EP1
– QSA.01.02.01 EP2
 Top 10 Overall Survey
Findings
– QSA 01.01.01 EP5
– QSA.02.03.01 EP3
– WT.01.01.01 EP3
– QSA.02.08.01 EP2
– QSA.01.02.01 EP2
– DC.02.03.01 EP2
– QSA.01.01.01 EP6
– QSA.02.04.01 EP6
– QSA.02.04.01 EP7
– WT.03.01.01 EP5
Delaware Valley Chapter CLMA Annual Fall Meeting
Initial and Overall Top 10
 DC.02.03.01 The laboratory report is complete and is in the
patient’s clinical record. EP2 - The laboratory report includes
the name and address of the laboratory performing the test.
 QSA.02.03.01 The laboratory performs calibration verification.
EP3 – Calibration verification is performed every six months.
See CAMLAB for additional Notes.
 QSA.02.08.01 The laboratory performs correlations to evaluate
the results of the same test performed with different
methodologies or instruments or at different locations. EP2 –
The laboratory performs correlations at least once every six
months. The correlations are documented.
Delaware Valley Chapter CLMA Annual Fall Meeting
Initial and Overall Top 10
 QSA.01.01.01 The laboratory participates in Centers for Medicare &
Medicaid Services (CMS) approved proficiency testing programs for all
regulated analytes. EP5 – For each specialty, subspecialty, analyte,
or test, the laboratory’s proficiency testing results meet satisfactory
performance criteria in accordance with law and regulation. See
CAMLAB for additional Notes.
 QSA.02.04.01 The laboratory evaluates instrument-based testing with
electronic or internal systems prior to using them for routine quality
control. EP6 – The laboratory performs external quality controls at the
following frequencies:
– As defined by the evaluation (either weekly or monthly)
– According to the manufacturer’s recommendations
– With each new lot number, shipment, or package of reagents
The external quality control results are documented.
Delaware Valley Chapter CLMA Annual Fall Meeting
Initial and Overall Top 10
 QSA.01.02.01 The laboratory maintains records of its
participation in a proficiency testing program. EP2 – For
individual unacceptable proficiency testing results, the
laboratory conducts an investigation of all potential causes,
provides evidence of review, and performs corrective action
sufficient to address and correct the issues identified in the
investigation. These actions are documented. See CAMLAB
for additional Notes.
Delaware Valley Chapter CLMA Annual Fall Meeting
Initial Top 10
 WT.05.01.01 The organization maintains records for waived testing.
– EP3 – Quantitative test result reports in the patient’s clinical record
for waived testing are accompanied by reference intervals (normal
values) specific to the test method used and the population
served. See CAMLAB for additional Notes.
– EP4 – Individual test results for waived testing are associated with
quality control results and instrument records. See CAMLAB for
additional Notes.
 NPSG.02.03.01 Report critical results of tests and diagnostic
procedures on a timely basis. EP3 – Evaluate the timeliness of
reporting the critical results of tests and diagnostic procedures.
Delaware Valley Chapter CLMA Annual Fall Meeting
Initial Top 10
 DC.02.01.01 The laboratory has procedures for each laboratory
test. EP1 – Written laboratory procedures for each test meet
the following requirements:
– They contain a complete description of the test.
– They include detailed instructions for performing the test.
– They adhere to manufacturers’ instructions (preanalytical,
analytical, and postanalytical phases of testing).
– They include the date of implementation.
– They reflect the laboratory’s current practice.
– They are readily available to staff performing the testing.
See CAMLAB for additional Notes.
Delaware Valley Chapter CLMA Annual Fall Meeting
Overall Top 10
 WT.01.01.01 Polices and procedures for waived tests are
established, current, approved, and readily available. EP3 – If
manufacturers’ manuals or package inserts are used as the
policies or procedures for each waived test, they are enhanced
to include specific operational policies (that is, detailed quality
control protocols and any other institution specific procedures
regarding the test or instrument).
 QSA.01.01.01 The laboratory participates in Centers for
Medicare & Medicaid Services (CMS) approved proficiency
testing programs for all regulated analytes. EP6 – The
laboratory’s proficiency test performance is successful for each
specialty, subspecialty, analyte, or test, as required by law and
regulation. See CAMLAB for additional Notes.
Delaware Valley Chapter CLMA Annual Fall Meeting
Overall Top 10
 QSA.02.04.01 The laboratory evaluates instrument-based testing with
electronic or internal systems prior to using them for routine quality
control. EP7 – The laboratory performs external quality controls at the
number of levels specified by the specialty and subspecialty
requirements (for example, blood gases require three levels of quality
control). The external quality control results are documented.
 WT.03.01.01 Staff and licensed independent practitioners performing
waived tests are competent. EP5 – Competency for waived testing is
assessed using at least two of the following methods per person per
test:
– Performance of a test on a blind specimen
– Periodic observation of routine work by the supervisor or qualified
designee
– Monitoring of each user’s quality control performance
– Use of a written test specific to the test assessed
Delaware Valley Chapter CLMA Annual Fall Meeting
Objectives
 Learn about The Joint Commission Laboratory
standards
 Explain the unique features of a Joint Commission
Laboratory survey
 Understand what to expect during your survey
 Learn what happens after the survey has been
completed
 Review how to use the available tools to assist you
with continuous compliance
 Present suggestions on how to resolve the top 10
findings
Delaware Valley Chapter CLMA Annual Fall Meeting
Demonstration of the Extranet
and The Joint Commission
Webpage
Delaware Valley Chapter CLMA Annual Fall Meeting