Jain’s Innovators: Building the Convergence Between CME and Performance Improvement

      by Sachin Jain, MD

A visit to the average medical meeting in the United States provides adequate insight into the need to innovate our system of continuing medical education (CME). Canned PowerPoint presentations are delivered in stale conference rooms on topics that are typically marginally relevant to one’s clinical practice. Attendance numbers rarely match up with registrants.

Lloyd Myers, RPh, President and CEO of CECity, has been working to change that. A registered pharmacist and co-founder of CECity, Mr. Myers has been working to revolutionize CME for most of his professional life. In his worldview, CME should be linked directly to learning opportunities identified through careful analysis of clinical data. In this way, CME is delivered a la carte, targeted to specific educational needs—as opposed to a buffet curriculum.

I spoke recently with Myers who is on the verge of announcing a new social networking and performance improvement platform that CECity developed in collaboration with the American College of Physicians, the Johns Hopkins Armstrong Institute for Patient Safety and Quality, and other key partners.

What do you perceive as the problems with the current model of continuing medical education (CME)?

Simply put, physicians don’t know what they don’t know, and the current CME construct hasn’t consistently provided them the opportunity to self-assess and improve on quality in those areas that they and their patients need most. CME has traditionally been developed using perceived “one-size-fits-all” needs assessments and then delivered to physicians as standalone activities that are disconnected from the physician’s true professional and practice-based needs. Currently, physicians choose to participate in activities from time to time based on topics that interest them or to achieve credit to maintain their license. As a result, there may be little relevance to practice and learning only occurs sporadically. It isn’t surprising, then, that traditional CME has had only a marginal impact on improving physician performance.

However, the national quality movement is about to change all of this and the implications reach way beyond CME.

What do you see changing and when?

The future is all about quality, including measurement, reporting, and most importantly, improving performance. And although many physicians may not be fully aware, the future is already here. Measurement is happening everywhere, and on most everything, including patient satisfaction, quality of care, clinical practice performance, and financial performance, while quality reporting, which is at the heart of payment reform, has developed into a system that is here to stay. The goal however, should not be to measure for the sake of measuring, but rather to understand where we each stand in order to get better. CME can play a tremendous role here, but only if it is the right education, made available at the right time and place.

Going forward, it will be essential for physicians to be in a position to continuously assess their performance in practice and then efficiently engage in CME, as well as a host of other types of intervention, to help them improve by closing the gap on measures that are relevant. In other words we need to move from “checking the CME box” once every few years, to what the Institute of Medicine terms a “learning health system,” in which a culture of “practice-based learning and improvement” occurs daily and builds competency throughout one’s professional career.

Beyond being the right thing to do, the pressure to move in this direction is already present in the form of medical specialty board requirements for Maintenance of Certification® (MOC) and in the near future, requirements for maintaining state licensure (MOL). Health care payment reform is also driving the need for ongoing improvement, as value-based purchasing, accountable care organizations (ACOs) and other risk-share models, pay for performance (including the Patient Quality Reporting System [PQRS]), and other financial programs emerge that put great pressure on physicians, health systems and payors to deliver high quality care to survive.

What kinds of solutions do you see coming in the next several years?

First, we see the need for a ton of education to help a generation of physicians and other health care professionals who were taught little if anything about quality improvement. We also see this becoming part of medical school curricula and spreading to allied health care professionals who will be repositioned in the emerging paradigm to support the national quality agenda. Consulting solutions will emerge to help reorganize and realign quality and education departments within organizations such as academic medical centers, hospitals, medical specialty societies, and others that have operated for years in silos.

We also see a new class of health IT solution emerging that, like the outer layers of an onion, wraps around EHRs and other existing IT systems, to provide various stakeholders with a framework for performance management, including access to a robust toolkit for quality measurement, reporting, and improvement. We expect the quality toolkit to include access to patient registries, connectivity to EHRs for data exchange, physician electronic portfolios, practice profiles, population health management tools, performance measurement and comparative analysis tools, patient surveys, self-assessment products, personalized CME pathways, and more.

Developing one integrated platform to serve as this next generation performance improvement (PI) solution is something that we have been focused on at CECity over the past decade.

CECity will soon launch MedConcert, a social networking site around performance improvement, with the ACP as the foundation partner. What is the concept behind MedConcert?

MedConcert combines the first cloud-based platform for performance improvement, with our own private social network that allows physicians, as well as health care organizations, to securely collaborate and communicate “in concert” with colleagues and other health care provider organizations “across walls.” MedConcert also includes the MedConcert App store, which offers member access to apps from world-class partners that allow them to leverage MedConcert as a platform to do a whole lot more.

MedConcert is secure, HIPAA-compliant, and multi-tenant, which means that any number of professional and patient-care organizations can cost-effectively live and collaborate inside. The American College of Physicians (ACP) is the first foundation tenant in MedConcert. As a forward-thinking organization, the ACP has already developed valuable products that can reach their members, and other health care professionals, at the point of practice via ACP-branded apps, CME, and their own ACP community quality network.

What services will be available to MedConcert when it is fully functional?

The MedConcert Platform itself provides all of the basic services needed to communicate, collaborate, share, and improve online. MedConcert includes electronic portfolios for each member to support lifelong learning, and an easy to use PI solution to help individual professionals, health care team members, and even entire health systems, continuously measure, roll-up, compare, and then scale improvement (See Figure). The private communication tools support referrals, secure messaging, and care coordination, and we have personalized newswires that enable instant sharing of news and best practices across community learning and action networks to enable peer-driven improvement. Members can develop relationships with their colleagues, including teams, for social, professional, and patient care purposes. And, we also provide enterprise tools that allow organizations of any size to create their own private network inside MedConcert to collaborate with one another, as well as other organizations across walls.

The system provides a variety of ways to get data onboard, including web-based data entry forms, patient-entered survey data, data upload services that map data from EHRs, and direct connections with some large data providers and payors. We are also providing interfaces for an increasing number of EHR vendors who see MedConcert as the next logical step to help their clients with meaningful use, PQRS, and other quality-reporting activities.

Finally, we have the App Store in MedConcert where our partners, are building or integrating their third-party applications, CME, and other interventions into MedConcert to address an endless variety of clinical, process, safety, financial, and other needs. Initial apps include disease-specific patient registries, patient satisfaction surveys, a coordination of care management system, a Turbo-Tax™ like quality reporting tool for PQRS and Meaningful Use, quality improvement analysis tools (think Six Sigma), and access to the ACP’s patient-centered Medical Home Builder®. Many more apps are in development, including apps from the Armstrong Institute for Patient Safety and Quality at Johns Hopkins.

How can cardiologists use MedConcert to improve care?

We see cardiology as a very important community in MedConcert, and expect that members of this community will be key innovators in determining how MedConcert is used and developed. We already have cardiology practices looking to use the private messaging services and Care Coordination app to communicate between hospitals, primary care physicians, pharmacies and patients in an effort to reduce hospital readmissions related to heart failure. Prior to MedConcert, we really have not had a secure platform to connect such a diverse set of providers and stakeholders.

We also see cardiologists as leaders in PI. Early programs from the ACC like Door to Balloon® and the PINNACLE Registry® demonstrated cardiology’s commitment to quality. The cardiology community is probably best prepared to plug existing data sources, including their registries, into the standardized MedConcert platform to begin scaling continuous performance improvement, care coordination, and quality reporting. In addition, we see our partners in cardiology developing a variety of apps for cardiologists and for cardiology in primary care.

Social networking sites like Facebook and LinkedIn work because they bring people back to meet regular interests and needs. What will bring physicians back to use MedConcert every day?

Think about the physician’s MedConcert account as his or her windshield. In the past we have had measure dashboards that we check on from time to time, like a gas gauge, but with MedConcert we see a constant flow of activities and information that physicians will want to look through to see where they are heading on a continuous basis.

Whether to monitor performance, access quality alerts for patient outliers, or use the community and communication tools, we see physicians touching base with MedConcert frequently. We also expect many of the apps to become the norm in daily practice for coordination of care, health data exchange, patient surveys, and patient registries, which will require continuous use by physicians and care teams.

How do you think social networking will change interaction between physicians, other health care providers, and patients?

Everything driving health care today, including patient-centered care, meaningful use of EHRs, shared-risk financial models, and the need to improve performance, is pressuring health care providers to collaborate and communicate across wide area communities of practice like never before.

Social networks represent a cost-effective solution that I believe have the power to change everything, including how patients make appointments, how providers share medical information with their patients, and one another, how we educate physicians, and patients, and how patients inform physicians of changes in their health status and their outcomes.

However, so far non-health care social sites like Facebook, haven’t worked due to their lack of structure and privacy, and the few health care social sites that have popped up to offer anonymous physician-to-physician discussion boards, or physician-to-physician communications, have demonstrated that physicians are interested in social networks, but have demonstrated limited sustainability and value due to their limited scope.

We hope to change all that by offering MedConcert as a “platform” that can grow and expand based on the needs of physicians, systems, payors, employers, and patients. Once physicians have access to one solution that integrates all of the quality tools they need and the structure that gives both physicians and patients control of their information, we trust that social networking will really take off.

Sachin H. Jain, MD, MBA, is a physician at Brigham
and Women’s Hospital and Harvard Medical School and
Senior Institute Associate at Harvard Business School’s
Institute for Strategy and Competitiveness. He was previously
a key official in the Obama Administration, where
he helped launch the Center for Medicare and Medicaid
Innovation and the HITECH Act’s Meaningful Use provisions.
He is a leading national authority on healthcare
delivery reform.

Keywords: Value-Based Purchasing, Referral and Consultation, Patient Satisfaction, Patient Safety, Specialty Boards, Patient-Centered Care, Self-Assessment, Quality Improvement, Registries, Patient Readmission, American Recovery and Reinvestment Act, Accountable Care Organizations, Medicare, Health Status, United States, Cooperative Behavior, Health Care Reform, Needs Assessment, Physicians, Primary Care, Meaningful Use, Medicaid, Reimbursement, Incentive, National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division, Health Insurance Portability and Accountability Act, Delivery of Health Care, Heart Failure, Curriculum, Primary Health Care

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