To enroll in the AHA/ASA Mission:Lifeline® program, please complete the registration information, review the Unified Participation Agreement, and complete the electronic signature process below.
PROGRAM ACTION SELECTION
GENERAL REGISTRATION INFORMATION
Hospital Address"Principal Office Location"
GENERAL HOSPITAL/FACILITY INFORMATION
Mission:Lifeline® is the American Heart Association/American Stroke Association (AHA/ASA) collaborative performance improvement program, currently supporting Mission:Lifeline ACS and Stroke Systems of Care demonstrated to improved adherence to evidence-based care of patients hospitalized with time sensitive emergencies, such as STEMI, NSTEMI, and Stroke.
What are the benefits of participating in Mission:Lifeline®- program?
* Effective May 31, 2017.
What is the cost of Mission:Lifeline®?
The program is FREE for 2017! Special 2018 pricing expires November 1, 2018. Price increases for enrollments after that date. See the pricing sheet for the 2018 package options and pricing.
Required agreements for participation in Mission:Lifeline®?
Data Submission Requirements
Program Participant will be responsible for submitting data to AHA Third Party Vendor through abstractions into technology platform, data upload, EHR, HIE, web services, or other identified data repository. Inpatient registries approved for Mission: Lifeline Submission include:
Data Set Descriptions and Requirements:
To conduct quality improvement and scientific research activities, the American Heart Association will require access to certain health information. Mission:Lifeline will require the below listed data elements be included:
Limited Data Set Requirements:
Ownership and Access to Data:
Program Participants retain ownership Individually Identifiable Health Information and Limited Data Sets subject to the rights granted to the designated AHA Third Party Vendor and AHA in this Agreement and the BAA.
Program Benchmarking Information
Information used for placement in benchmarking groups for aggregate comparison reporting purposes.
Program Contact for Mission:Lifeline®
SELECT PACKAGES AND OPTIONS (PRICING)
Hospital shall pay an annual program fee per module ("Annual Fee") to The American Heart Association. The Annual Fee allows up to ten (10) users to access the system per module. For each additional user per year greater than ten (10), Hospital shall pay $99 per module per year ("Additional User Fees").
The Annual Fees listed below shall remain in effect from the date the Hospital accepts the electronic Unified Participation Agreement through December 31, 2018 (the "Initial Term"). After the Initial Term, the Agreement below shall automatically renew for additional periods of one (1) year, at the then-current annual fees, unless either party shall give the other party at least sixty (60) days prior written notice of termination.
The American Heart Association shall invoice Hospital annually and Hospital shall pay such invoice within thirty (30) days of receipt. All payments made for the GWTG-CAD annual subscription fee and additional options are paid directly to The American Heart Association.
QUALITY IMPROVEMENT PROGRAMS PERMISSION FORM
This section allows you to give American Heart Association/American Stroke Association (AHA/ASA) permission to use your hospital name for recognition events, ads, conference banners, and on the AHA website. It allows you to indicate the exact (marketing) name you want used as well as the associated mapping location. This form is typically filled out once by the hospital - and updated only when changes are needed.
Hospital Address(Will be used for showing on Map)
To give American Heart Association/American Stroke Association (AHA/ASA) permission to use our name for:
PARTICIPATION AGREEMENT and ACCEPTANCE
UNIFIED PARTICIPATION AGREEMENT
Downloadable pdf for offline review (UPA & BAA combined).Actual submission must be via this electronic form.
BUSINESS ASSOCIATE AGREEMENT
ELECTRONIC SIGNATURE of Hospital Representative