In the drive toward meaningful use, the Chicago-based American Board of Medical Specialties (ABMS) plans to add health information technology tools to their Maintenance of Certification (MOC) program. ABMS is the umbrella organization for 24 medical specialty boards that certify more than 750,000 practicing physicians. ABMS’ special advisor to the president, Sheldon D. Horowitz, M.D., spoke with HCI Associate Editor Jennifer Prestigiacomo about the new program and what physicians can expect.
HCI: Can you tell me about the ABMS Maintenance of Certification program and what it entails?
Horowitz, M.D.: In 1969 we introduced recertification. Back then it was just an exam every six to 10 years. Recently, in 2006 the boards got their plans approved to introduce the maintenance of certification [program], which is a more ongoing, continuous professional development program. So, more and more doctors are entering this maintenance of certification program, and that is the way to ensure that doctors deliver quality care through this continuous professional development and lifelong learning program. For developing tools for meaningful use of HIT for MOC, we intend to start with the primary care boards, family medicine, internal medicine, and pediatrics, and eventually we can spread to all specialties.
There are four parts to the maintenance of certification program. The fourth part is physician practice performance. That’s where the boards have been developing tools to assess physician performance and patient outcomes. And they use evidence-based medicine and nationally approved performance measures. For some of the boards, there’s Web-based activities, and for others, there’s registries. For some of the boards without a lot of patient contact there may be peer feedback about how they’re reading [for instance] breast biopsies. Some of these tools for this physician performance part, we’re getting pretty sophisticated.
I’ll give you an example of a Web-based tool: For diabetes, I can take a look at how I’m doing and how my patients think I’m doing and what my systems are like, and then let’s say I want to work on the blood pressure control of my diabetics. I’d submit a plan to say how I’d intend to improve that and then the board would approve, and then I’d eventually re-measure to see if I was making any headway. As we move forward instead of doing a disease at a time, some of the boards are starting to work on comprehensive tools that work on chronic, acute, and, preventative care all at once.
HCI: How will these HIT modules be integrated into MOC?
Horowitz: What we intend to do is develop some knowledge self assessment exams in the self-assessment section to enhance physician knowledge and effective use of information technology and data management. Presumably, that will be ready in 2011. The idea would be knowledge of meaningful use requirements built in—the basics of decision support, data acquisition, analysis, and reporting—giving physicians knowledge on how to use EHRs. So this would be part of the options of MOC. We can incentivize them so physicians get more points for doing these, and that will drive use.
We are starting with primary care to align MOC and meaningful use of HIT, and we will build appropriate tools and activities that will promote this into MOC. And as I mentioned we intend to start with primary care physicians with the intention to spread to other specialties. We think if we could target all these specialties then we could have a significant impact.
HCI: Tell me more about what physicians will have to complete in the two new self-assessment modules.
Horowitz: One knowledge self assessment tool we’re intending to develop is the use of health information technology to promote patient safety including knowledge of how to use computerized physician order entry, medicine reconciliation, and e-prescribing in coordination of care. Doctors need a lot of assistance in both practice and skills in how to use these EHRs for meaningful use and to improve patient outcomes.
Another thing we propose to do is augment these knowledge modules with simulation to provide a hands-on experience for physicians using EHRs. These are pretty sophisticated simulations. The American Board of Family Medicine has been working on simulation for MOC for quite some time. It will give [doctors] experience developing and using registries and using data for improvement.
HCI: What will physicians be able to gain from the practice improvement modules?
Horowitz: A part of maintenance of certification is where we assess physician practice performance. Again, we intend to start this one with internal medicine and move to other boards. We plan to enhance selected board Web-based, self-directed practice improvement modules—we call them PIMs—to enable physicians to use EHR to track practice data and improve care. There’s a ‘comprehensive care’ PIM that looks at seven different chronic care states, four acute care conditions, and six preventative care conditions. That’s a broad biopsy of what an internal medicine specialist would do. And it also has a patient feedback and system-based practice feedback built into it. What we intend to do in these comprehensive care PIMs is embed the EHRs so doctors have to use the EHR to track the practice data and improve care.
The second Web-based PIM we intend to work on is called ‘care transition,’ and this focuses on the transition of care between the primary care physician and the specialist. We’re going to have EHR embedded in it. We intend to look at the effectiveness of health information technology tools in managing transitions.
HCI: What will the data interchange for the Physician Reporting Quality Initiative (PQRI) look like?
Horowitz: Right now the data from the certified physician to the board and the board to other places is not aligned and harmonized. This will require some work on the board’s part and will enable certified physicians to satisfy PQRI and MOC requirements, and also qualifies for PQRI and potentially meaningful use bonuses without redundant data submissions. What we intend to do is to create the XSLT [Extensible Stylesheet Language Transformations] structures to enable the boards to accept data electronically in the same formats that they would use to send to CMS [Centers for Medicare & Medicaid Services].