1. Tufts Health Care Institute/Office of Continuing Education 1 Online CME Accreditation for Point-of-Care Learning Marc Edelstein, MD, PhD Chief Medical Officer and Co-Director, Tufts Health Care Institute and Tufts University School of Medicine Office of Continuing Education Ralph Halpern, MSW Director, Content Development & Program Evaluation Tufts Health Care Institute MedBiquitous, April 2007. Point of Care Learning

2. Tufts Health Care Institute/Office of Continuing Education 2 Whats Happening in CME? nCalls for reform in CME nInadequacy of traditional didactic CME to improve practice nCMEs goal: improve patient care –A broader definition of education, from: individual learning to: quality improvement nEvolution from Continuing Education to CPD- Continuous Professional Development

3. Tufts Health Care Institute/Office of Continuing Education 3 CME Providers Mission: Shrink the Quality Gap nMission: Deliver programs that provide physicians with implementable knowledge and skills… nso that measurable changes in competence (knowledge-in-action), performance, or patient outcomes can be demonstrated.

4. Tufts Health Care Institute/Office of Continuing Education 4 ACCMEs Updated Accreditation Criteria, 2006 CME as a Bridge to Quality Accredited providers shall: n Focus on improving one or more of physician competence, physician performance, and/or the physician s patient outcomes. n Provide CME activities based on practice-based and learner-based needs. n Evaluate success at meeting their change mission. n Engage with their environment to enhance the role of their program and of CME in promoting quality and safety.

5. Tufts Health Care Institute/Office of Continuing Education 5 ACCME Expectations CME providers are expected to… n demonstrate progress towards implementation of these updated criteria by November 2008 … n and reach full compliance by 2012.

6. Tufts Health Care Institute/Office of Continuing Education 6 ACCME & AMA Approve New Formats of CME nAccredited CME providers can now designate credit for –internet searching and learning, or point of care learning, –performance improvement activities, –test-item writing, –manuscript review.

7. Tufts Health Care Institute/Office of Continuing Education 7 References nAMA: AMA Physician's Recognition Award Booklet. 2006 revision –http://www.ama- assn.org/ama1/pub/upload/mm/455/pra2006.pdf nACCME: New Formats of Continuing Medical Education. May 2005 –http://www.accme.org/dir_docs/doc_upload/fd31627e -1510-4e6f-90bb- 67b0adca2c38_uploaddocument.pdf

8. Tufts Health Care Institute/Office of Continuing Education 8 Internet point of care (PoC) CME The learner may – nIdentify a question in practice; nAccess new information from trusted source(s); nIntegrate learning into patient care; and nDemonstrate what has been learned. nEarn 0.5 credits per search

9. Tufts Health Care Institute/Office of Continuing Education 9 nStructured, self-directed, practice-based learning in support of specific patient care. nMD uses a computer-based clinical decision-making support tool at the point of care. nA reflective process in which physicians must document 1)their clinical question, 2)the sources consulted and 3)the application to practice. nEven when the recommendation is not appropriate for the patient, the physician still learns something in the process. Examples: Internet point of care (PoC) CME

10. Tufts Health Care Institute/Office of Continuing Education 10 Tufts-InfoPOEMs POC CME nTufts is accrediting searches Using infoPOEMs/InfoRetriever (Wiley) nImplementation requirements: –Contract (specs, funding) –Technical (POC site; credit tracking) –Testing

11. Tufts Health Care Institute/Office of Continuing Education 11 InfoPOEMs® is owned by the publishing company John Wiley & Sons.

12. Tufts Health Care Institute/Office of Continuing Education 12 Treatment Diagnosis Screening & prevention Prognosis Epidemiology Education

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18. Tufts Health Care Institute/Office of Continuing Education 18 Evaluation to claim POC CME n The InfoRetriever search(es) I completed help me make decisions about the care of one or more patients. (strongly agree….strongly disagree) n Compared to other forms of acquiring CME, searching the literature with InfoRetriever and reflecting on the implications for practice is … (more/equally/less valuable) n Overall I would rate this CME activity as … (excellent…poor) n Please give one example of how a search did or did not affect your diagnosis, treatment, and/or patient outcomes. (free text)

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21. Tufts Health Care Institute/Office of Continuing Education 21 Challenges nWas the search truly patient-related? –Option: require additional information from user to identify patient age/sex/diagnosis nWas the information source valid (a trusted source)? –Accreditor must approve the search engines tools and processes nWas the search completed and documented? –Does the accreditor collect complete information from the search engine or just assertions from the user?

22. Tufts Health Care Institute/Office of Continuing Education 22 Contact Information nMarc M. Edelstein, MD, PhD, FAAP Chief Medical Officer and Co-Director Phone: (617) 636-0347 marc_edelstein@tufts-health.com nRalph Halpern, MSW Director, Content Development and Program Evaluation Phone: (617) 636-3991 Email: ralph_halpern@tufts-health.com n http://www.thci.org/ n 617-636-1000