Quality measurement across borders: needs and options.

It is very clear that, when given a choice, patients will travel across national borders to obtain healthcare. Cost, access and proximity are the most frequently sited reasons. It is less clear however, to policy makers, the payer for the services and health professionals, what the level of quality will be when patients cross borders. The traditional regulatory approaches such as licensure, accreditation and certification vary within and between countries, and private sector approaches to quality vary as frequently. The source of this variation is that private and public quality evaluation systems vary widely and produce non-comparable quality data. A survey conducted by Joint Commission International demonstrated wide country variation exists in use of the electronic medical record, the best source of quality data and in the collection of adverse event information, a rich source for understanding the frequency and type of unwanted events. The use of international standards that focus on the processes that most directly determine outcomes is described for understanding risks and quality across borders.