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Doctor bill format for Quality Assurance

I started with NASA in 1998 I was detailed I was in the Air Force I was an air force officer for 27 years retired from the Air Force and was hired as chief medical officer of NASA in 2002 but my last assignment the Air Force was to headquarters NASA started in 1998 and when I got here I came out of mainstream medical practice I had been a surgeon for many years and I was very familiar with the health care administration and medical care management and the superstructure if you will both in the military in the civilian world that drives that system of audits and certifications and accreditations and quality assurance of medical care and what I found was that in NASA the the health care was so mission-driven that a lot of all attention had really been levied toward the the care and the mission and the crew and itself and the usual infrastructure that you would find for medical quality assurance didn't exist so one of the first things we did when when I became chief medical officer and formed my little team was to develop medical quality assurance policy and put in place a watchdog system if you will standards of medical care system that the agency has operated on or under for the past two decades really and that that system would stand external review has it improved practice I can't really say that it has you know space medicine is a very unique entity but I will say if we did have an untoward event we have mechanisms in place none untoward health care event we have mechanisms in place to thoroughly evaluate that now and those mechanisms and our infrastructure would stand scrutiny I think if certain audited were investigated by any entity on the planet so that's the kind of the first contribution I may after that we we developed a very close personal relationships with colleagues at the Johnson Space Center and at the Kennedy Space Center and here at headquarters both in life sciences and in health care practice we agreed between leadership at Johnson Space Center and here at headquarters in the medical world we recognized that that we were a team and I'm not saying that our predecessors didn't recognize that but but but we we very much did we recognized the relationship between research and medical practice that we talked about earlier with the standards to requirements to deliverables Circle Circle if you will we collaborated and learn to express that in systems engineering terms we and we built a health care system that is collaborative and the organization of which could be easily recognized and appreciated by by program managers and I think that that approach in one of the things that drove us to do that was the recommendation from the Institute of Medicine in a publication called safe passage they actually evaluated our health care system in the year 2000 the institute of medicine did they evaluated our health care system and its suitability to support a mission to mars so in the year 2000 when space shuttle was as height and international space station was in its formative stages couple of modules had been launched we were looking ahead to a Mars mission even at that time and their recommendation that we take an occupational health approach to astronaut healthcare we took to heart and and that resulted in translation of our whole system to to a configuration that is collaborative mutually supportive and integrated and when then the effort to that with that continues to this day integrated with with programs and engineering as much as we can so I think that that was a that was a sentinel accomplishment and I think indeed if we had not done that I don't know if our engineering and safety colleagues would have been comfortable vesting us with technical authority that that's a big that that's a big Authority and I think in no small measure our our work gained is the credibility to be able to to exercise that responsibly