The quest for practice-based, evidence-based tools continues, and progress is being made, said director of the AMA s PRA policy Charles Willis at the SACME fall meeting, held Nov. 6 in Boston. Here s what s been happening.
The physician-directed, interactive Internet CME pilot project, started in December of 2000, is an attempt to capture, as learning, use of professional literature at or near the point of care using technology. The four pilot participants SKOLAR Inc., UpToDate Inc., American College of Physicians Physician Information and Education Resource system, and MerkMedicus have been popping along.
The SKOLAR system includes a faculty review of every physician credited under its system. Unfortunately, the company was bought out in the midst of the project, but it is continuing its participation in the program, Willis said.
UpToDate s system, which as of last winter when I last reported on it  awards an hour of credit for each hour spent using the system, has had the highest volume of participation so far, he said. The PIER system, which links PIER s database to an EMR to track physician behavior at the point of interaction, is not certifying for credit at this time. All he had to say about the MerkMedicus system is that it is being offered for free.
Finding a non-time-based metric
The AMA Task Force on Self-Directed Self-Initiated Learning is still interested in finding a metric other than time (i.e., an hour of learning for an hour of credit). Learning instead should be associated with searching on a specific topic, documented through search criteria, with credit increases awarded based on the level of engagement, such as how many sources are consulted through the system, Willis said. So far, the average interaction in a point-of-care search is two to three minutes, so they re using it when they need quick answers.
Physicians would be credited, using time as a gross measure, when they answered several questions, such as describing what the clinical question was, the resources consulted, and how the information was applied to practice. This could be done after the actual interaction, and it would be up to the physician and/or provider to choose how much info they want to provide.
Draft credit metrics
An initial inquiry would be a small increment of PRA Category 1 credit: 0.10. A deeper search would require documented physician response to the above questions on clinical question, resources, and application to practice. This would garner the learner 0.50 credits.
Willis stressed that this would continue to use providers to track and award credit and ensure the integrity of the content according to PRA definitions and ACCME content validation guidelines. While the final stage would link to documented practice cahnge, that would most likely fall into the realm of the performance improvement arena, rather than CME, he said.
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