CMA Today Article

On March 31, 2016, the Certifying Board (CB) of the American Association of Medical Assistants (AAMA) was awarded accreditation for Bodies Operating Certification of Persons (AC474) by the International Accreditation Service (IAS). By virtue of this accreditation, the CB of the AAMA demonstrated compliance with ISO/IEC Standard 17024:2012 (also referred to as ISO 17024, or 17024), the global benchmark for personnel certification bodies.

The magnitude of this accomplishment is difficult to overstate. The CB of the AAMA is one of only 10 health care certifying bodies that has been accredited as having met the rigorous requirements of ISO 17024. The other accredited certifying bodies include the American Society for Clinical Pathology, the American Registry for Diagnostic Medical Sonography, and the National Board for Certification in Occupational Therapy. The CB is the only credentialing body for medical assistants that has obtained this international recognition.

The CMA (AAMA) Certification Program remains accredited by the National Commission for Certifying Agencies (NCCA)—an accrediting arm of the Institute for Credentialing Excellence (ICE)—under its Standards for the Accreditation of Certification Programs. Consequently, the CB and its CMA (AAMA) Certification Program are the only medical assisting certifying body and certification program (respectively) that hold accreditation under both ISO 17024 and the NCCA.

What are ISO and ISO 17024?

Established in 1947 and headquartered in Geneva, Switzerland, the International Organization for Standardization (abbreviated “ISO” from the Greek isos, meaning “equal”) is “an independent, nongovernmental international organization with a membership of 161 national standards bodies.”¹ With this membership in 161 countries, ISO has published more than 21,000 International Standards.¹ There are 3,368 technical bodies throughout the world that assist the ISO with standards development. According to the ISO, these International Standards “give world-class specifications for products, services, and systems, to ensure quality, safety, and efficiency.”¹

ISO 17024 is one of these International Standards. The official name of 17024 is “Conformity Assessment—General Requirements for Bodies Operating Certification of Persons.” The first version of ISO 17024 was published in 2003, and the current version was issued in 2012. Note the following from the introduction of 17024:

This International Standard has been developed with the objective of achieving and promoting a globally accepted benchmark for organizations operating certification of persons. Certification for persons is one means of providing assurance that the certified person meets the requirements of the certification scheme [program]. Confidence in the respective certification schemes for persons is achieved by means of a globally accepted process of assessment and periodic re-assessments of the competence of certified persons. …

… [T]his International Standard can serve as the basis for recognition of certification bodies for persons and the certification schemes under which persons are certified, in order to facilitate their acceptance at the national and international levels. Only the harmonization of the system for developing and maintaining certification schemes for persons can establish the environment for mutual recognition and the global exchange of personnel.

This International Standard specifies requirements which ensure that certification bodies for persons operating certification schemes for persons operate in a consistent, comparable and reliable manner.²

What are some of the key elements of compliance required by ISO 17024? How did the CB meet these requirements?

Management of impartiality

ISO 17024 requires a certification body to “document its structure, policies, and procedures to manage impartiality and to ensure that the certification activities are undertaken impartially.”² A certification body must “act impartially in relation to its applicants, candidates, and certified persons.”² The certification body must “identify threats to its impartiality on an ongoing basis,” and must “analyze, document, and eliminate or minimize the potential conflict of interests arising from its certification activities.”² The CB has always observed these principles, as has been stated in the “About the Exam” section of the AAMA website:

The CB of the AAMA is committed to impartiality, objectivity, and fairness in all aspects of its CMA (AAMA) Certification Program. This commitment is reflected in all policies of the CB, and the execution of all policies.³

Now, with ISO 17024, the CB has verifiable documentation of this commitment in all aspects of its CMA (AAMA) Certification Program.

Confidentiality and conflict of interest

All personnel involved with the certification program must sign confidentiality, nondisclosure, and conflict of interest agreements. These agreements must be legally enforceable. The ongoing observance of these important issues by the CB is now documented in accordance with IAS AC474 and ISO 17024.

Examination development

The assessment instrument (i.e., examination) of the certification program must be based on a psychometrically sound job-task analysis (also known as an occupational analysis or role delineation study). The required competencies to perform the tasks identified by the job-task analysis must be specified, and the content of the examination must measure attainment of these competencies.

The Content Outline of the CMA (AAMA) Certification Examination is linked to the most recent occupational analysis conducted by the AAMA.⁴ It is the responsibility of the CB of the AAMA and the National Board of Medical Examiners (NBME)—the test development and delivery contractor for the CMA (AAMA) Certification Examination—to provide evidence of this linkage. This important psychometric requirement for a valid examination was satisfied.

Prerequisites

ISO 17024 requires any prerequisites for taking the certification examination to be in alignment with competence requirements for the tasks identified by the job-task analysis.² Thus, it was necessary to demonstrate that graduation from a medical assisting program accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) is an appropriate prerequisite for the CMA (AAMA) Certification Examination. The IAS approved the eligibility pathways for the CMA (AAMA) Certification Examination.

Examination process

Examination data must be collected and analyzed in order to show that the certification examination is fair, valid, and reliable.² The expertise of the NBME was essential for proving compliance with this requirement of IAS AC474 and ISO 17024.

Recertification

The certification body must show that the recertification requirements confirm continued competence of the certificants.² The Item Relevance Rating Study completed by the NBME in 2014 provided evidence of compliance with this standard.⁵

Management system

ISO 17024 states that the “certification body shall establish, document, implement, and maintain a management system that is capable of supporting and demonstrating the consistent achievement of the requirements of this International Standard.”² Compliance with this part of ISO 17024 requires evidence of documentation of the management system, control of documents, management review, and internal audits. The Certification Department of the AAMA fulfilled these requirements.

What is the significance of ISO 17024 compliance?

In addition to obtaining this worldwide indicator of certifying excellence, and thus distinguishing the CB of the AAMA and its CMA (AAMA) designation from all other medical assisting credentialing bodies and credentials, accreditation by the IAS under ISO 17024 will enable CMAs (AAMA) to more readily obtain medical assisting or similar positions outside of the United States. Furthermore, ISO 17024 recognition provides assurance to the public and all members of the health care community that CMAs (AAMA) are truly qualified to contribute to improved, more accessible patient care, and therefore have the ability to work at the top of their scope of practice.

Please join me in thanking the CB of the AAMA and Director of Certification and Associate Executive Director Anna L. Johnson, CAE, for their indispensable roles in obtaining IAS accreditation and compliance with ISO 17024.