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Innovations in Online CME: Convergence of Clinical Practice Data and CME in “Real Time”
John Donovan, R.Ph. John Donovan, R.Ph. Annette Boyer, R.Ph.Annette Boyer, R.Ph.WellPoint Pharmacy ManagementWellPoint Pharmacy Management CECity.com, Inc.CECity.com, Inc.
Michael Lemon, MBAMichael Lemon, MBA Michael Reilly, MSMichael Reilly, MSPostgraduate Institute for MedicinePostgraduate Institute for Medicine Merck & Co. Inc.Merck & Co. Inc.
Alliance for Continuing Medical EducationAlliance for Continuing Medical Education
January 28, 2006
Discussion Topics
• Overview and Business Need• Program Goals & Business Strategy
• Program Methodology & Design
• Program Outcomes
• Questions
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Growth of eLearning in Medical EducationPhysician Use of Web vs. Growth of
online Medical Education Market1470000
222000
6100011000013,115
365000
652866
995000
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1997 1998 1999 2000 2001 2002 2003 2004
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
% Physician Use of Web ProfessionallyCME Participants-Online
AMA Study: Physicians’ use of internet steadily rising; AMA News Report; ACCME Annual Report 2001-2005;Boston Consulting Group Vital Signs Report
Online Medical Education is the Fastest Growing Segment of ALL
•2002 – 6%•2004 – 14%
AMA News Report-Predicts 50% of all Medical Education online in near future
On-line CME Programs: Do they work?
– 46% of physicians use the Internet for CME at least monthly, if not more frequent
– 55% of physicians agree the Internet improves clinical knowledge which improve upon their practice
– Physicians want more interactivity and a greater variety of online CME options.
*Manhattan Research July 2004
2004 Study results:
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eCME Continues to Gain Validation & Credibility
Physicians who use eCME tend to be high prescribersManhattan Research, “Taking the Pulse, Ver 5.0, June 2005
S.C.O.P.E (Study of Continuing Online Physician Education)Landmark & Award Winning Outcomes Study in eCME; Demonstrated physician knowledge delta (pre vs. post) and
knowledge retention in online formats JCEHP, Vol. 24; 2004
Baylor Study showing eCME more effective than live“Comparison of the Instructional Efficacy of Internet-Based
CME With Live Interactive CME Workshops”; JAMA, September 7, 2005
“Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines”
The “Output” of the CME enterprise is evolving…
SeatTime
Changein
Attitude
Changein
Knowledge
Changein
Behavior
Changein
PracticePatterns
Certificationof
Competency
ImprovedPublicHealth
Stakeholders:ACCME
StateBoardsofLicensure
Specialty/SubspecialtyBoards
ProfessionalSocieties
Payors
Typical CME (Passive Engagement)
Live/EnduringTraditional Programs
Best Practice(Active Engagement)
Quality Improvement, CPD, Dynamic CME
What value do certificates really have?
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Influences of Treatment Behaviors
Underlying Influences– Published literature– Continuing education programs – Pharmaceutical industry contact– Peer Influence– Advertisements
Physician Personal Influences– Fear of malpractice– Societal concerns of cost and outcomes– Patients perceived and real demand– Financial incentives
Kaplan J. The Emerging Managed Care Paradigm, Health Care in Transition. Med Interface Sept 1994: 58-59.Avron J, Soumerai SB. Principles of Educational Outreach to Improve Clinical Decision Making. JAMA. 1990;263:549-556.
Provider Education - What works?Overall
– Concise educational materials– Evidence-based and unbiased – Highlight and repeat essential messages– Specific recommendations or patient profiles for intervention– Positive reinforcement– Multi-faceted approach*– Aligned with financial incentives**
Web-based– Short and concise courses– Level of interactivity– Quality of content– Ease of use
*Linda Casebeer, PhD, et al “Standardizing Evaluation of On-line Continuing Medical Education: Physician Knowledge, Attitudes, and Reflection on Practice” J Contin Educ Health Prof 2004; 24(2):68-75 **Avron J, Soumerai SB. Principles of Educational Outreach to Improve Clinical Decision Making. JAMA. 1990;263:549-556.
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Health Care Industry Needs
Continued Evidence of Non-Compliance with Practice Guidelines*– Even in current educational environment– Lack of educational tools that connect guidelines to practice
Need for High Level CME Outcomes
Need for Unique Provider Based Educational Platform– To reach rural physician– To tie educational message with clinical practice
Phillips LS, Branch WT, Cook BC, et al. Clinical Inertia. Ann Intern Med. 2001;135:825-834.McGlynn EA, Asch SM, Adams J, et al. The Quality of Health Care Delivered to Adults in the United States. N Engl J Med. June 2003;348:2635-45.
Level 1Professional Attendance
at the Meeting
Level 2Meeting
Satisfaction
Level 3Completion
of a Post-test for CME Credit
Level 4Pre & Post-
test Impact on Provider Behavior
Level 5Impact on
Patient Health
Level 6Impact on Population
Health
Progression of CME Outcomes
TraditionalCME
Subjective
Objective
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A Physician Focused Personal Intervention Tool– Synchronizes high quality CME programs with health
plan specific initiatives– Uses state of the art technology available at the
physician’s convenience– Decreases the gap between theory and the physician
practice through the use of “real” claim data – Provides a “teachable” moment for behavior
reinforcement– Gains physician confidence by providing evidence-
based guidelines supported by individual practice pattern data
What is DynamicCME?
DynamicCME Program Goals
Develop Unique Educational Platform that:• Promotes physician best practices• Demonstrates learning• Improves patient outcomes• Demonstrates measureable change in physician behavior
Meet/exceed accreditation and regulatory guidelines
Aligned with ACCME goals and objectives
Provide high quality and interactive CME activities
Obtain high usability
Provide program flexibility
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DynamicCME Program Strategy
Leverage current web base technology to construct new educational platform
Identify and construct strong partnership for program success• Technical Vendor• Accredited provider• Pharmaceutical supporter• Health care provider
Leverage knowledge and process of integrated medical and pharmacy claims database
Construct high quality CME educational platform
Develop process to measure results
Key Step #1: Construct Key Partnerships
Merck– Program supporter
Postgraduate Institute for Medicine– CME certification
WellPoint– Educational design (Gap learning principle)– Integrate database and outcomes analysis
CECity– Technical provider of CME eLearning & Outcome Solutions– Provider for National Health Care Distribution
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Key Step #2:Construct Education Platform and Design
• Based on gap learning principles and eLearning system
• Built within CME technology framework– embedded and post-test questions
• Ensure educational component around physician data validation
• Constructed peer group benchmarking• Developed actionable steps for intervention
Key Step #3: Construct Integrated Database & Profile System
Pharmacy Claims Data
Medical Claims Data (where available)
Eligibility Data
Physician File
Dynamic Database of relevant claims and other data
•Lipid lowering Rx claims
•Diabetes, hypertension, and CHD-related Rx claims
•Physician zip code
•Diagnosis of hyperlipidemia, hypertension, diabetes
Identify Patient Population (Denominator) for each question
1. Patients receiving lipid lowering therapy
2. Patients with CHD, CHD risk equivalent, multiple risk factors
3. Patients with diabetes
4. New start patients taking statintherapy
Identify Target Population (Numerator) for each question
1. Patients with CHD, CHD risk equivalent, or multiple risk factors receiving lipid lowering therapy
2. Calculate % LDL lowering therapy for monotherapy patients
3. Patients with diabetes receiving lipid lowering therapy
4. Calculate PDC for new start patients on statin therapy
Calculate data for chart
•Physician
•Benchmark (i.e., group practice, peers, regional benchmark, clinical data, etc.)
Populate Data Tables and FTP to CECity
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DynamicCME Architecture
Healthplan 1
Healthplan 2
Collect Utilization Data Aggregate Utilization Data Present Utilization Datain DynamicCME
user
user
user
user
user
user
CECity
Healthplan n
users
WellPoint
reports
DynamicCME Pre test
DynamicCME Database
Medical / Rx Claims DynamicCME Post test
0102030405060708090
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Peer’s Data
Practice Data
DynamicCME Engine Dynamic Post Test Results Box
Educational Content
based evidencebased
evidence
Patient Profiles
DynamicCME Backend Engine
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DynamicCME Behavior
Network Physician Data displayed is the individual physician’s
utilization data compared to the Health Plan, the practice and/or peers.
Health Plan Network Data displayed is
aggregate Health Plan, practice and/or peer
utilization. Not related to an
individual physician.
Physician at LargeNo physician practice
data or Health Plan data.Data displayed is the
responses of those whoparticipated in the eCME
activity.
Health Plan LogoHere
Health Plan Logo Here
DynamicCME in Action
Program Spotlight
Professional Management Tools
Direct access to other featured CME activities
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User is presentedwith an InteractiveCME question
User is shown answer
Evidence-based Resource link provided for further Information(Guidelines, Clinical Trials, etc.)
DynamicCME Interactivity
Physician utilizationdata is displayed withbenchmarksestablished by theHealth Plan
Data provided by Health Plan database
Link is available to send a request for specific patient
information
DynamicCME Reinforcement
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Closes educational loop by providing actual patient data for intervention
DynamicCME Interventions
DynamicCME DistributionDynamicCME Activity is Repurposed Online One Time
DynamicCME Activity is Distributed via a National Professional
Distribution Network
Associations (i.e. AOA, AMCP)
CME Portals(i.e.CE Medicus)
WellPoint Health Plans
Chain Pharmacies (i.e. Eckerd/Brooks, Kmart, etc.)
…and more!
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Measurable Outcomes
• Exceeds Level 1 & 2 Outcomes– Measures beyond # of users and satisfaction
• Understanding of the gaps in knowledge• NCQA and HEDIS measures• Measures outcomes of specific interventions
– Examples:• Change in aggressive lipid lowering prescribing patterns• Change in combination therapy prescribing for high risk patients
• Improvement in tx/rx compliance• Measure influence of Dynamic vs Non-Dynamic• Risk populations• Compliance with national guidelines• Changes in inappropriate prescribing• Ability to analyze geographic variations
The Sphere of Health Care Outcomes
Identification of Health Care
Best Practices
Quality Improvement
Awareness ofClinical Best Practices
& Guidelines
Consistent Education Relevant to Health Care
Appropriate Prescribing & Utilization Management
HEDIS & NCQA
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Dynamic CME"Standard of Excellence"
2005 Web Award Competition
DynamicCME.com Awarded the 2005 "Standard of Excellence" WebAward for Outstanding Achievement in Website Development
QUESTIONS?