1. ® MedBiquitous Orientation Valerie Smothers MedBiquitous MedBiquitous Annual Conference May 13, 2008

2. ® Objectives At the conclusion of the workshop, participants will be able to: Describe the benefits of standards in healthcare education and competence assessment. Identify opportunities for participating in the standards development process.

3. ® Before we start How many are planning to attend Virtual Patients in a Nutshell at 11?

4. ® Overview Introductions What is MedBiquitous? Why standards? Major Activities Summary How to participate

5. ® Introductions

6. ® What is MedBiquitous?

7. ® MedBiquitous Mission To advance healthcare education through technology standards that promote professional competence, collaboration, and better patient care. Not-for-profit, member-driven, standards development organization

8. ® The Fragmented Healthcare Industry UniversitiesSocieties Certifying Boards Licensing Boards Government Publishers Industry Accrediting Bodies ?

9. ® How it all started… And it kept growing…

10. ® MedBiquitous: Technology Standards for Healthcare Education 74 member organizations 7 Working Groups ANSI process Openness Transparency Consensus Due process Work with leading organizations that can drive adoption Professional Profile Learning Objects Activity Reporting Competencies Virtual Patients Metrics Point of Care Learning

11. ® ANSI Accredited Standards Developer MedBiquitous develops information technology (XML) standards for: Healthcare education and training Healthcare professional competence assessment, certification, and licensure Healthcare professional and scientific publications Healthcare professional online communities and portals

12. ® MedBiquitous Goals Better tracking and evaluation of professional education and certification activities Easier discovery of relevant education and information resources when and where needed Interoperability and sharing of high quality online education Coordination and tracking of competence assessment data

13. ® Identify gaps in competency Identify relevant resources Identify learner Track accomplishments What is the correct answer? oChoice 1 oChoice 2 oChoice 3 oChoice 4 Self-assessment General Competencies in Family Practice Competency 1 Competency 2 Competency 3 Competencies QICME John Doe’s Portfolio CME Course 1 Course 2 Course 3 Learner Portfolio Certifying board Licensing board

14. ® MedBiquitous Process Approves new standards projects Meets via telco, in person Develops specifications Consensus body Votes Final approval Working groups Standards committee ANSI Executive committee

15. ® Working Groups Professional Profile Standard for describing a healthcare professional Credentials verification, administration, identification Competencies Standard for describing competency framework Working with IEEE Learning Objects Healthcare LOM (describing learning activities) SCORM for Healthcare (running e-learning)

16. ® Working Groups Virtual Patient Standards for interactive computer programs that simulate real life clinical scenarios Activity Report Tracking CE/MoC activities Metrics Aggregate evaluation data Point of Care Learning Integration with clinical systems Tracking needs assessment and inquiry data

17. ® Working Group Meetings Activity Report WG Thur, 3:30 PM Competency WG Thur, 12 PM Learning Objects WG, Thur, 7:30 AM Metrics WG Thur, 12 PM Point of Care Learning WG Thur, 7:30 AM Professional Profile Thur, 3:30 PM Virtual Patient WG Today, 3:30 PM

18. ® Why standards?

19. ® Activity You are designing your own searchable cookbook for all of the recipes you download from the internet. Develop a data structure for a cooking recipe. Describe some of the benefits of having this standard.

20. ® Why standards? To facilitate exchange of data and resources To enable collaboration To create economies and networks of scale

22. ® Your Challenges Activity What information exchange, coordination, or integration challenges do you have? 5 min

23. ® Major Activities

24. ® Coordinating Professional Healthcare Professional Profile Coordinating clinician data Competencies Coordinating competency data

25. ® Professional Profile Working Group Mission: to develop XML standards and Web services descriptions to enable the exchange of clinician profile information across organizations and systems

26. ® Participants Mike Zarski, American Osteopathic Association, Chair Archana Aida, American Board of Pediatrics Skip Bartolanzo, American Board of Pediatrics Tom Brantigan, TMA Resources Annette Van Veen Gippe, American Osteopathic Association David Hooper, Federation of State Medical Boards Jim Jahrling, American Board of Medical Specialties Paul Jolly, Association of American Medical Colleges Don Jones, American College of Chest Physicians Laura Martin, American Board of Pediatrics Joe O’Conner, Educational Comission for Foreign Medical Graduates Monica Quiroz, American Medical Association Kelly Reddick, American Board of Pediatrics Michael Rowan, Learn Something Pam Shellner, American Association of Critical-Care Nurses Cyndi Streun, Federation of State Medical Boards Howard Tanzman, American College of Surgeons Todd Tischendorf, CECity Toby Vandermark

27. ® Professional Profile Use Case Common format for exchanging information about healthcare professionals Contact Education Training Certification License Disciplinary action Academic appointments Memberships Facilitates cross- organization collaboration

28. ® Benefits Faster to process standardized data Faster to develop new applications Easier to work with partner organizations Able to automate many business processes Users: ABMS, AOA for faster credentialing

29. ® Status of Professional Profile Undergoing Public Review Complete Ballot complete Standards Implementation Clinician credentialing Data collection Developing implementation guide and services documentation Working groups Standards committee ANSI Executive committee

30. ® Competencies Competency = any educational objective or educational outcome that results from knowledge, skills, or beliefs.

31. ® Competencies Working Group Co-chairs: Rosalyn Scott, MD and Tim Willett, MD Mission: develop a standardized framework to represent competency data Existing work: IEEE Learning Technology Standards Committee (LTSC) has convened a Competency study group

32. ® Uses for a Competency Standard Allow learners to track their accomplishments against a list of relevant competencies Enable educators to see how their curriculum fits into a competency framework Enable content developers to tie educational activities to a competency framework

33. ®

34. ® Coordinating in Primary Care Activity Exchanging membership data Promoting a core curriculum 7 min

35. ® Finding Educational Activities and Content Healthcare Learning Object Metadata (Healthcare LOM) Finding learning activities

36. ® Healthcare Learning Object Metadata (LOM) Metadata Definition: the data that describes a resource. Example: card catalog information for a book: author, title, publication date, topic, etc. Problem: many organizations use completely different metadata schemes. Example: keyword = “Renal Failure” vs. Topic = “Renal Failure”

37. ® Healthcare LOM Working Group Mission To develop XML and Web services standards to enable interoperability, accessibility and reusability of Web-based medical learning content.

38. ® Healthcare LOM Uses Health Education Title: Aresenic Toxicity Keyword: Environmental medicine, MeSH D019550 Target audience: Physician, registered nurse Credits:: CME 1.5 AMA PRA Category 1; CNE 1.7 contact hours Database B Title: Preventing sports injuries Target audience: Patient

39. ® Healthcare LOM Uses CE Evaluation Evidence based practice Quality improve- ment Inform- atics Patient centered care

40. ® Learning Objects Working Group Morgan Bantly, Department of Veterans Affairs, Chair Patti Abbott, Johns Hopkins University Trupti Bakrania, St George's University of London Ravi Teja Bhupatiraju, Oregon Health and Sciences University Gabrielle Campbell, Association of American Medical Colleges Chris Candler, M.D., Association of American Medical Colleges Dawn Carroll, Department of Veterans Affairs David Davies, Ph.D., University of Warwick Nancy Davis, Ph.D., National Institute for Quality Improvement and Education Sharon Dennis, M.S., HEAL Shona Dippie, HEAL Rachel Ellaway, Northern Ontario School of Medicine Nancy Gathany, Centers for Disease Control and Prevention Stuart Gilman, M.D., Department of Veterans Affairs William Hersh, M.D., Oregon Health and Sciences University Lorena Hitchens, HighWire Press Julie Lambla, American Association of Critical- Care Nurses Tao Le, M.D., Johns Hopkins University Joy Leffler, WEMOVE Ross Martin, M.D., Pfizer Jim Martino, Ph.D., Johns Hopkins University Sandra McIntyre, M.Ed., HEAL Don O'Guin, Pfizer Jennifer Ott, Healthstream Beth Powell, Centers for Disease Control and Prevention Andrew Rabin, CECity Mike Rowan, LearnSomething Chris Rueger, Healthstream Deborah Sher, Department of Veterans Affairs Damon Silver, HighWire Press Carl Singer, CECity Sebastian Uijtdehaage, Ph.D., HEAL David Ward, American Association of Critical- Care Nurses Walter Wolyniec, Boehringer Ingelheim Dan Rehak, Ph.D. Jorge Ruiz, M.D., University of Miami Charles Willis, American Gatroenterological Association

41. ® Healthcare LOM Structure

42. ®

43. ® Benefits Save money – don’t reinvent, reuse Improve access to content – internally or across organizations Use content in innovative ways Users – HEAL, MedEdPortal, VA Ballot complete - In ANSI review

44. ® Break – 10 minutes

45. ® Sharing and Reuse of Educational Resources SCORM for Healthcare Self-directed Web-based learning Virtual Patients Web-based simulations of clinical encounters

46. ® S hareable C ontent O bject R eference M odel SCORM An e-learning model that enables accessibility, reuse, and interoperability of learning objects and tracking of learner progress. Standards for running, packaging, and describing learning content Broad international adoption

47. ® SCORM for Healthcare Profile of SCORM Leverages extensions to SCORM metadata called Healthcare Learning Object Metadata (Healthcare LOM) Developed by MedBiquitous All SCORM for Healthcare content is conformant with SCORM

48. ® Challenges in Defense Training Content not portable / interoperable Content monolithic and not easily updated Content cannot be shared

49. ® Goals of SCORM SCORM Content is… DefinitionExample Accessible Easily discovered and located. Searching an education repository for hemorrhagic fever brings relevant results. Reusable Independent of learning context. Can be used for multiple situations. Module on effects of radiation exposure can be included in multiple courses. Interoperable Can function in multiple hardware/software environments. Module run in one LMS can be shared with other organizations and run on their systems. Durable Will continue to function as systems are upgraded. This year’s course on asthma will run on the LMS you buy next year.

50. ® Status of SCORM for Healthcare Draft specification available Users – VA co-developing content in conjunctions with other government agencies

51. ® Virtual Patients Definition: An interactive computer simulation of real-life clinical scenarios for the purpose of medical training, education, or assessment. Several schools are developing Very costly to create No common framework that would allow these virtual patients to be shared across systems

53. ® Virtual Patient Working Group Mission To develop XML standards and Web services requirements to enable interoperability, accessibility and reusability of Web-based virtual patient learning content.

54. ® Virtual Patients Working Group Soeren Huwendiek, University of Heidelberg Patrik Jonsson, Karolinska Institute Peter Kant, University of Pittsburgh Joy Leffler, WE MOVE Sandra McIntyre, M.Ed., HEAL Dick Moberg, Moberg Research Beth Powell, Centers for Disease Control Narain Ramluchumun, St. George's University of London Kathie Rose, National Board of Medical Examiners Deborah Sher, Department of Veterans Affairs Arnold Somasunderam, St. George's University of London Chris Toth, University of Pittsburgh Dan Walker, Tufts University Pat Youngblood, Stanford Nabil Zary, Karolinska Institute Grace Huang, M.D., Harvard University Carol Kamin, University of Colorado Yanko Michea, M.D., University of Connecticut Nancy Posel, McGill Dan Rehak, Ph.D. Gurjeet Shokar, University of Texas Medical Branch Scott Stern, University of Chicago Kevin Souza, University of California, San Francisco Marc Triola, M.D., New York University Rachel Ellaway, Co-chair JB McGee, Co-chair Spenser Aden, Healthstream Susan Albright, Tufts University Ben Azan, MedBiquitous Dmitriy Babinchenko, University of Pittsburgh Chara Balasubramaniam, St. George's University of London Matthias Bauch, University Children's Hospital Heidelberg Linda Bell, American Association of Critical-Care Nurses Chris Candler, M.D., Association of American Medical Colleges Emily Conradi, St. George's University of London David Davies, Ph.D., University of Warwick Parvati Dev, Stanford University Jeroen Donkers, University of Maastricht Shona Dippie, HEAL Uno Fors, D.D.S., Ph.D., Karolinska Institute Robert Galbraith, M.D., National Board of Medical Examiners Dennis Glenn, American Board of Surgery Michael Hagen, American Board of Family Medicine Frank Hess, University of Heidelberg Jörn Heid, University of Heidelberg Matthias Holzer, University of Munich

55. ® Virtual Patient Architcture Component based approach Enables sharing and reuse of entire virtual patient or components Engaging and relevant Provides feedback on practice Hewlett funded grant for VP player (Tufts) Basis of eViP project

56. ® The MVP Architecture SCORM package

57. ® VP Working Group accomplishments Draft schemas available Draft data and player specifications available Being implemented by several universities Benefits: scale costly virtual patient development across institutions Users: EViP participants, Tufts, U of Pittsburgh, NYU, Northern Ontario School of Medicine VP Working Group Status

58. ® Reusing Content Activity Some have referred to educational materials as “legos” that may be reconfigured to form a variety of useful educational resources. What are the various ways that the following resources may be used, alone or in combination with other resources? 5 min

59. Video of an Abnormal Gait Brain MRI Brain Tissue Labeled Diagram of the Nervous System

60. ® Tracking and Evaluation of Learning Activities Activity Report Tracking CE and certification activities across organizations Point of Care Learning Tracking clinical questions, resources searched, and application to practice Medical Education Metrics Reporting aggregate evaluation data

61. ® Activity Report Working Group Mission: develop XML standards and Web services requirements and descriptions to enable tracking of the learning and certification activities of physicians and other healthcare professionals.

62. ® Participants Toby Vandemark, Chair Spencer Aden, Healthstream Archana Aida, American Board of Pediatrics Dawn Ainger, Genova Technologies Mary Pat Aust, American Association of Critical-Care Nurses Skip Bartolanzo, American Board of Pediatrics Ray Everngam, CTSNet Scott Foutz, American Academy of Pediatrics Cyndi Grimes, Medscape Monica Hanks, American Association of Critical-Care Nurses Jeanette Harmon, American Medical Association Lorena Hitchens, HighWire Press Rachel Makleff, American Thoracic Society Laura Martin, AMerican Board of Pediatrics Spencer Moore, Radiological Society of North America Christie Morales, American Heart Association Bryan Pawlak, American Osteopathis Association Monica Quiroz, American Medical Association Kelly Reddick, American Board of Pediatrics Shelly Rodrigues, California Academy of Family Physicians Barb Rosenthal, American Board of Medical Specialties Mike Rowan, LearnSomething Taranmg Shah, American Osteopathic Association Carl Singer, CE City Leah Wang, Medscape Scott Weber, Med-IQ Todd Tischendorf, CE City Mike Zarski, American Osteopathis Association Edward Kennedy, Accreditation Council for Continuing Medical Education Charles Willis, American Gastroenterological Association

63. ® Current Problems with CE Tracking and Measurement We aren’t tracking CE We don’t help the learner assess gaps We can’t tell if CE matches learner’s practice-based needs We don’t measure CE value consistently We don’t verify claimed credits for certification or licensure

64. ® Reporting and Tracking CE/MoC Provider A Provider B Dr. John Doe’s CE Tracker A: Asthma Management.5 cr B: Bronchodialators.5 cr A: Pain Management.5 cr Report to Board Activity report CE Tracker Activity report

65. ® Benefits Enables centralized tracking of CE and Certification activities Increases accountability of all parties Reduces administrative burden on professional

66. ® Status of Activity Report Schema, spec, and servivces available ABP and AAP are piloting the use of the standard for use in MOC American Heart using for integration w/HighWire and others Mesdcape, AOA, and CECity piloting use for CE certificates RSNA using for centralizing radiology ce data Working groups Standards committee ANSI Executive committee

67. ® Point of Care Learning Working Group Mission: to develop XML standards and guidelines to support offering clinicians learning at the point of care, tracking point of care learning, and using point of care learning data for needs assessment.

68. ® Participants Jabin White, Silverchair, Chair Nick Ackerson, Thomson Michelle Adams, American Academy of Dermatology Zalman Agus, M.D., University of Pennsylvania Dawn Ainger, Genova Technologies Scott Bradbury, American Academy of Pediatrics Ron Carovano. METI Bill Deluise, Wiley Nancy Davis, Ph.D., National Institute for Quality Improvement and Education Tom Godden, Wolters Kluwer Cyndi Grimes, Medscape Irina Laghidze, Moberg Research Matt Lewis, Boehringer Ingelheim Rachel Makleff, American Thoracic Society J.B. McGee, M.D., University of Pittsburgh Dick Moberg, Moberg Research Kevin O'Hara, Healthstream Jerry Osheroff, M.D., Thomson Mellie Pouwels, Radiological Society of North America Andrew Rabin, CECity Deborah Samuel, American Academy of Pediatrics Danette Somers, Wiley Robert Stern, MedPage Today Walter Wolyniec, Boehringer Ingelheim Beverly Wood, M.D., American Academy of Pediatrics Jake Zarnegar, Silverchair Laird Kelly, RSi Paul Martin, eeds Charles Willis, American Gastroenterological Association

69. ® Point of Care Learning Uses Common format for exchanging point of care learning activity data Clinical question Search parameters Resource used Application to practice Allows providers to collect data for credit and needs assessment Draft specification and schema Piloted by U Penn and MedPage Today POC System ? CME Provider Transcript

70. ® MEMS: Medical Education Metrics Technology standard for core evaluation data Users Educators want best practices, ability to compare Funders want to measure reach and efficacy Accreditors want to measure success of activity and provider

71. ® MEMS Data Activity Description What’s being evaluated Participant Activity Evaluation What did participants think Participation Metrics How many people participated Learner Demographics

72. ® Metrics Working Group Mission: to develop XML standards and Web services requirements and descriptions for the exchange of aggregate evaluation data and other key metrics for health professions education.

73. ® Metrics Participants Linda Casebeer, Outcomes, Inc., Co- Chair Francis Kwakwa, RSNA, Co-Chair Robin Bay, WEMOVE Craig Bowen, Ph.D., Johns Hopkins University David Cook, M.D. Mayo Clinic Bill Deluise, Wiley Ray Everngam, CTSNet Michael Fordis, M.D., Baylor College of Medicine Stuart Gilman, M.D., Department of Veterans Affairs Monica Hanks, American Association of Critical-Care Nurses Sean Hayes, Ph.D., AXDEV Group Jack Kues, Ph.D., University of Cincinnati Tao Le, M.D., Johns Hopkins University Matt Lewis, MPA, Boehringer Ingelheim Jackie Mayhew, Pfizer Suzanne Murray, Ph.D., AXDEV Group Kevin O'Hara, Healthstream Veronica O'Quinn, METI Mellie Pouwels, Radiological Society of North America Andrew Rabin, CECity Michael Saxton, M.Ed., Pfizer Hillary Schmidt, Ph.D., Sanofi-Aventis Donna Schoonover, Department of Veterans Affairs Scott Weber, Med-IQ Walter Wolyniec, Boehringer Ingelheim Edward Kennedy, Accreditation Council for Continuing Medical Education James Lesit, Alliance for Continuing Medical Education Tim Willet, M.D., CRI Critical Care Education Network Ross Martin, M.D., Bearing Point

74. ® MEMS Use Case Program Evaluation Dashboard Online activities Jointly sponsored activities Journal-based ce In person activities Outcomes DB

75. ® MEMS Status Flexibility of instruments Draft specification and schema Developing survey item specification Moving to higher levels of evaluation

76. ® Exchanging CE Data Activity Streamlining CME Reporting and Administration 10 min

77. ® Summary

78. ® MedBiquitous Goals Better tracking and evaluation of professional education and certification activities Activity Report Point of Care Learning Medical Education Metrics Easier discovery of relevant education and information resources when and where needed Healthcare LOM

79. ® MedBiquitous Goals Interoperability and sharing of high quality online education SCORM for Healthcare Virtual Patients Coordination and tracking of competence assessment data Professional Profile Competencies

80. ® Back to your challenges Can existing standards address any of the challenges you face? Are there needs for other standards?

81. ® Questions for you Are standards a good idea? Should you develop them within your own organization? What are the benefits of standards to your organization?

82. ® How to Participate

83. ® Working Group Meetings Activity Report WG Thur, 3:30 PM Competency WG Thur, 12 PM Learning Objects WG, Thur, 7:30 AM Metrics WG Thur, 12 PM Point of Care Learning WG Thur, 7:30 AM Professional Profile Thur, 3:30 PM Virtual Patient WG Today, 3:30 PM

84. ® Contact Valerie Smothers valerie.smothers@medbiq.org valerie.smothers@medbiq.org