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Glossary of Regulatory Terms

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Source: Improving Public Policy for Regulating Maine's Health Professionals, October 1997, A report to the Governor and the Maine Legislature, prepared for Medical Care Development, Inc., Main Health Professions Regulation Project, by Judy Kany and Saskia D. Janes.

Accreditation: A conformity assessment process where an organization or agency uses experts in a particular field or interest or discipline to define standards of acceptable operation/performance for organizations and measure compliance with them.: (Ham, Michale, Fundamentals of Accreditation,American Society of Association Executives, 1997.)

Certification: Unlike licensure (which is authorized by state statute), is the process whereby a profession or occupation voluntarily establishes competency standards for itself. Certification plays a helpful role in protecting the public, especially in cases where the state legislatures have not opted to regulate the profession or occupation through licensure. However, there are broad variations in this voluntary process.

Some certification organizations require the completion of rigorous education, experience, and examination criteria. Others, unfortunately, do not. The private sector has established organizations to review and verify (accredit) the integrity of these certification programs. However, certification organizations are not required to submit their programs to such accreditation. Also, unlike licensing authorities, certification organizations lack the authority to limit incompetent or illegal practice. (National Society of Professional Engineers, 1996.)

Credentialing: A generic term for licensure, certification, and registration. Can also be used as a term for a voluntary process under the auspices of private sector associations. (Shimberg and Roederer, 1994.)

Health care practitioner: Physicians and all other health professionals who are certified, registered or licensed in the healing arts, including, but not limited to nurses, podiatrists, optometrists, chiropractors, physical therapists, dentists, psychologists and physicians' assistants. (24 M.R.S.A. 2502 sub. 1-A.)

Health care provider: Any hospital, clinic, nursing home or other facility in which skilled nursing care or medical services are prescribed by or performed under the general direction of persons licensed to practice medicine, dentistry, podiatry or surgery in this State and which is licensed or otherwise authorized by the laws of this State. (14 M.R.S.A. 2502 sub. 2.)

Licensure: The process whereby a governmental authority, in accordance with state statute, determines the competency of individuals seeking to perform certain services. Through licensure, state governments grant individuals the authority to engage in an area of practice, generally to the exclusion of others, based on demonstrated education, experience, and examination. Licensees are required by law and code of ethics to faithfully discharge their responsibilities impartially and honestly. As a general rule, state governments possess the authority to discipline licensees who fail to comply with statutes and regulations and to take action against unlicensed individuals who practice within the scope of a licensed profession or occupation. (National Society of Professional Engineers, 1996.)

Professional competence: The application of knowledge and skills in interpersonal relations, decision making and physical performance consistent with the professional's practice role and public health, welfare and safety considerations. In many professions, the requisites of competence change over time as various factors reshape the scope of practice and as the individual practitioner specializes. (Interprofessional Workgroup on Health Professions Regulation, 1996.)

Quality: The Institute of Medicine (IOM) has defined "quality" as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." (Lohr, 1990 as noted in E. McGlynn, 1997.)

The IOM definition (of quality) suggests that (1) quality performance occurs on a continuum, theoretically ranging from unacceptable to excellent; (2) the focus is on service provided by the health care delivery system; (2) quality may be evaluated from the perspective of individuals or populations; (4) research evidence must be used to identify the services that improve health outcomes; and (5) in the absence of scientific evidence regarding effectiveness, professional consensus can be used to develop criteria. (E. McGlynn, 1997.)

Registration: The process by which an individual is listed as eligible to provide a regulated service. Not all registration processes require the demonstration of competency in that service. (National Society of Professional Engineers, 1996).

Scope of Practice: The level of medical responsibility and/or health services a practitioner is legally authorized to offer to the public.

Allied Health Professions: Occupations comprised of professionals who fulfill roles in the health care system, including assisting, facilitating, and complementing the work of physicians and other health care specialists. A few examples are clinical microbiologists, medical technologists, clinical psychologists and radiologic technologists.

Primary Care Workforce: The primary care workforce are those Direct Patient Care personnel who spend at least 50 % of their time in the direct care of patients - especially professions such as physicians, physician assistants, advanced practice nurses and nurse midwives. For most federal shortage designation programs the term, primary care physician, includes medical doctors (M.D.s) and doctors of osteopathy (D.O.s) in the specialties of general practice, family practice, general internal medicine, obstetrics and gynecology, and general pediatrics.

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Last updated September 03, 2010