Sanjiv Kaul, MD, FASE

From the types of questions I am frequently asked, it is apparent that there is some confusion among our members and others involved in the practice of echocardiography about the connection between the National Board of Echocardiography (NBE), the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL), and the American Society of Echocardiography (ASE). In this President’s Message, I will try to clarify the relationships as well as the interactions.

NBE and ICAEL serve as quality assurance bodies, with ASE serving as a professional membership organization. NBE was established for the certification of physicians practicing echocardiography, while ICAEL was formed for accreditation of echocardiography laboratories. Both organizations are recognized for their leadership in developing measures for assuring standards for quality and safety in the delivery of cardiovascular health care. ICAEL evaluates organizations’ performance based on these standards; NBE evaluates individuals’ performance on interpretation and training standards. ASE established both NBE and ICAEL by contributing seed monies and providing experts as board members, and then spun them off in 1996 as independent bodies. The boards of directors of both institutions have representatives from ASE. ICAEL is now overseen by an independent body, the Intersocietal Accreditation Commission, which has no historical relationship with ASE.

The independence of these bodies from ASE and from each other is crucial, mainly in order to avoid any actual or perceived conflicts of interest. Hence, ASE can continue to advance the field of echocardiography by developing guidelines and consensus documents without being limited in any way by accreditation/certification requirements. It can continue to offer educational courses that review the state of the art without concerns about its effects on NBE or ICAEL. For example, it can offer the ASCeXAM review course without having any conflict with NBE, which oversees the writing of the examination questions. Of course, no person associated with NBE within the past 6 years can serve as a faculty member for the review course. Similarly, ASE can (and is currently in the process of) develop an on-line offering on the reporting standards required for accreditation of an echocardiography laboratory without any conflict with ICAEL. In another example, the Echo Toolbox was developed by ASE to make the laboratory accreditation steps easier for our members; these helpful tools were later incorporated into the ICAEL on-line platform to the benefit of all laboratories working to achieve this standard.

Despite the independence of these organizations, there is some interaction. For example, ASE is very concerned that if the physician certification examination currently offered by NBE is taken over by the American Board of Internal Medicine (ABIM) it could be lessened and diluted for political expediency. Based on 15 years of experience, we believe that the NBE examination is constructed so that a trainee who has received COCATS II training in echocardiography in a good laboratory can qualify for and pass the examination. Thus, it is ideally suited to test competency in echocardiography. ASE is therefore very active in making sure that any accreditation examination that tests competency in echocardiography among physicians insures a competency level at least as high as that required by NBE.

Similarly, ASE has just the American Society of Echocardiography Recommendations for Quality Echocardiography Laboratory Operations , which has published in JASE in January 2011 and recommendations that laboratories develop standards consistent with the recently published ICAEL accreditation requirements ( http://www.icael.org/icael/reaccreditation/icael_standards.htm ). It is important to note that both documents provide minimum standards for an echocardiography laboratory. While these standards are obviously relevant to our members, we have also been requested to develop a document that reflects “Optimal Echocardiography”, reflecting practice in an advanced echocardiography laboratory that our members and others practicing echocardiography would aspire towards. ASE is in the process of developing such a document. With time, as new technologies receive widespread adoption, optimal practices become minimal requirements, and the field advances.

It was prescient of ASE to establish and support the development of NBE and ICAEL, and it reflects ASE’s commitment to support and advance quality. It is very likely that accreditation/certification by these bodies will be a requirement for the practice of echocardiography in the near future. ASE believes it is best that physicians regulate their own practices and work to increase the quality of patient care. Ignoring the requirements and recommendations set forth by NBE and ICAEL may not be wise for the practice of echocardiography. ASE continues to be committed to excellence and quality.