Joyce Frieden

A public-private institution that has been proposed by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“Academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists too,” he said. For example, physicians and physical therapists can work together to develop the best exercises for patients in pain.

Leery of a Government Committee

On the other hand, there are several report recommendations that gave Dr. Cleeman pause. “To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body.

Instead, “It's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The IOM report is available online at www.iom.edu/continuinged

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on continuing “education” requirements for internists and other health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education.

Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries.

However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

A public-private institution that has been proposed by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“Academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists too,” he said. For example, physicians and physical therapists can work together to develop the best exercises for patients in pain.

Leery of a Government Committee

On the other hand, there are several report recommendations that gave Dr. Cleeman pause. “To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body.

Instead, “It's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The IOM report is available online at www.iom.edu/continuinged

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on continuing “education” requirements for internists and other health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education.

Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries.

However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

A public-private institution that has been proposed by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“Academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists too,” he said. For example, physicians and physical therapists can work together to develop the best exercises for patients in pain.

Leery of a Government Committee

On the other hand, there are several report recommendations that gave Dr. Cleeman pause. “To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body.

Instead, “It's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The IOM report is available online at www.iom.edu/continuinged

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on continuing “education” requirements for internists and other health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education.

Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries.

However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

Medical organizations are closely examining the long-awaited, proposed “meaningful use” criteria developed by the Department of Health and Human Services.

The final criteria, to be phased in starting in 2011, will be crucial for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health record (EHR) systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS' national coordinator for health information technology, said in a conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for public comment until March 15.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced,” according to a CMS statement.

Dr. Blumenthal emphasized that the regulations were still awaiting public comment. “These standards are intended to be iterative,” he said. “We'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA) objected to the proposed criteria as being overly complex and likely to pose significant challenges to medical practices trying to meet the program requirements. MGMA's statement also objected to a requirement that physician offices provide patients and others with electronic copies of medical records.

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

Dr. David Blumenthal calls on the IT industry to develop useful EHR software.

Source Courtesy HHS.gov

Medical organizations are closely examining the long-awaited, proposed “meaningful use” criteria developed by the Department of Health and Human Services.

The final criteria, to be phased in starting in 2011, will be crucial for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health record (EHR) systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS' national coordinator for health information technology, said in a conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for public comment until March 15.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced,” according to a CMS statement.

Dr. Blumenthal emphasized that the regulations were still awaiting public comment. “These standards are intended to be iterative,” he said. “We'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA) objected to the proposed criteria as being overly complex and likely to pose significant challenges to medical practices trying to meet the program requirements. MGMA's statement also objected to a requirement that physician offices provide patients and others with electronic copies of medical records.

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

Dr. David Blumenthal calls on the IT industry to develop useful EHR software.

Source Courtesy HHS.gov

Medical organizations are closely examining the long-awaited, proposed “meaningful use” criteria developed by the Department of Health and Human Services.

The final criteria, to be phased in starting in 2011, will be crucial for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health record (EHR) systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS' national coordinator for health information technology, said in a conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for public comment until March 15.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced,” according to a CMS statement.

Dr. Blumenthal emphasized that the regulations were still awaiting public comment. “These standards are intended to be iterative,” he said. “We'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA) objected to the proposed criteria as being overly complex and likely to pose significant challenges to medical practices trying to meet the program requirements. MGMA's statement also objected to a requirement that physician offices provide patients and others with electronic copies of medical records.

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

Dr. David Blumenthal calls on the IT industry to develop useful EHR software.

Source Courtesy HHS.gov

The best way to raise standards and quality for continuing health education would be for the Department of Health and Human Services to launch a public-private institution, according to a report issued by the Institute of Medicine.

There are serious flaws in the way in which continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the report. “The science underpinning continuing education for health professionals is fragmented and underdeveloped,” they added.

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” they said. The 200-page report, “Redesigning Continuing Education in the Health Professions,” was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. It also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair, Dr. Gail Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference.

“We believe academic institutions need to be much more engaged than they have been in continuing education. The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety,” she noted.

Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model. There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“For us as orthopedic surgeons, we deal with physical therapists all the time,” he said. “We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists, too.”

Leery of a Government Committee

Several of the recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each should be determined by its own governing body … I think you're going to scare away innovation.” Instead, “it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

'There have been a lot of changes in CME … that were completely overlooked by the committee.'

Source DR. KENNISON

My Take

Examine Effectiveness and Cost

Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve outcomes for patients, it's difficult to assess the value of single interventions on outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve outcomes evaluation and active learning, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and device industries. But in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

The best way to raise standards and quality for continuing health education would be for the Department of Health and Human Services to launch a public-private institution, according to a report issued by the Institute of Medicine.

There are serious flaws in the way in which continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the report. “The science underpinning continuing education for health professionals is fragmented and underdeveloped,” they added.

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” they said. The 200-page report, “Redesigning Continuing Education in the Health Professions,” was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. It also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair, Dr. Gail Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference.

“We believe academic institutions need to be much more engaged than they have been in continuing education. The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety,” she noted.

Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model. There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“For us as orthopedic surgeons, we deal with physical therapists all the time,” he said. “We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists, too.”

Leery of a Government Committee

Several of the recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each should be determined by its own governing body … I think you're going to scare away innovation.” Instead, “it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

'There have been a lot of changes in CME … that were completely overlooked by the committee.'

Source DR. KENNISON

My Take

Examine Effectiveness and Cost

Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve outcomes for patients, it's difficult to assess the value of single interventions on outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve outcomes evaluation and active learning, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and device industries. But in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

The best way to raise standards and quality for continuing health education would be for the Department of Health and Human Services to launch a public-private institution, according to a report issued by the Institute of Medicine.

There are serious flaws in the way in which continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the report. “The science underpinning continuing education for health professionals is fragmented and underdeveloped,” they added.

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” they said. The 200-page report, “Redesigning Continuing Education in the Health Professions,” was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. It also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair, Dr. Gail Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference.

“We believe academic institutions need to be much more engaged than they have been in continuing education. The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety,” she noted.

Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model. There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“For us as orthopedic surgeons, we deal with physical therapists all the time,” he said. “We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists, too.”

Leery of a Government Committee

Several of the recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each should be determined by its own governing body … I think you're going to scare away innovation.” Instead, “it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

'There have been a lot of changes in CME … that were completely overlooked by the committee.'

Source DR. KENNISON

My Take

Examine Effectiveness and Cost

Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve outcomes for patients, it's difficult to assess the value of single interventions on outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve outcomes evaluation and active learning, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and device industries. But in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

Physicians in Montana may legally assist terminally ill patients in hastening death, according to a ruling by the Montana Supreme Court.

The decision in the case of Baxter v. State of Montana concerned Robert Baxter, a retired truck driver from Billings, who was terminally ill with lymphocytic leukemia with diffuse lymphadenopathy. As a result of the disease and its treatment, Mr. Baxter suffered from symptoms including “infections, chronic fatigue and weakness, anemia, night sweats, nausea, massively swollen glands, significant ongoing digestive problems, and generalized pain and discomfort,” according to the decision.

The court said further, “The symptoms were expected to increase in frequency and intensity as the chemotherapy lost its effectiveness. There was no cure for Mr. Baxter's disease and no prospect of recovery. Mr. Baxter wanted the option of ingesting a lethal dose of medication prescribed by his physician and self-administered at the time of Mr. Baxter's own choosing.”

Mr. Baxter, along with four physicians and Compassion & Choices, a pro-aid-in-dying group, filed suit in Montana's district court for the first judicial district, challenging the constitutionality of Montana homicide statutes' being applied to physicians who provide aid in dying to mentally competent, terminally ill patients. Mr. Baxter's attorneys contended that the right to die with dignity was constitutional under Montana law.

The district court ruled in favor of Mr. Baxter, but the state appealed the ruling to the Montana Supreme Court. On Dec. 31, 2009, that court also ruled in favor of Mr. Baxter, by a vote of 5–2, although it declined to comment on whether aid in dying complied with the Montana constitution. Mr. Baxter had died in December 2008.

“This court is guided by the judicial principle that we should decline to rule on the constitutionality of a legislative act if we are able to decide the case without reaching constitutional questions,” wrote Justice W. William Leaphart. “We find nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy. … Furthermore, the Montana Rights of the Terminally Ill Act indicates legislative respect for a patient's autonomous right to decide if and how he will receive medical treatment at the end of his life. … We therefore hold that under [Montana law], a terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a charge of homicide against the aiding physician when no other consent exceptions apply.”

Justice James Rice, one of the two dissenting judges, argued that under current Montana law, a physician can be prosecuted for helping a patient commit suicide—if the patient survives, the crime falls under the category of aiding suicide; if the patient dies, the crime is homicide.

“Importantly, it is also very clear that a patient's consent to the physician's efforts is of no consequence whatsoever under these statutes,” he wrote. “[The majority] ignores expressed intent, parses statutes, and churns reasons to avoid the clear policy of the State and reach an untenable conclusion: that it is against public policy for a physician to assist in a suicide if the patient happens to live after taking the medication; but that the very same act, with the very same intent, is not against public policy if the patient dies. In my view, the Court's conclusion is without support, without clear reason, and without moral force.”

In the wake of the court ruling, which cannot be appealed, opinions vary as to whether more Montana physicians will now provide aid in dying to terminally ill patients. Chicago health care attorney Miles J. Zaremski, who wrote a “friend of the court” brief in support of Mr. Baxter in the Montana case, said that even though the decision came out in favor of the plaintiff, physicians in Montana will be reluctant to aid terminally ill patients in dying until legal protocols for the procedure have been established.

“In Montana, if the patient gives the doctor consent to provide aid in dying, the physician can escape homicide laws,” said Mr. Zaremski, who is also a former president of the American College of Legal Medicine. “Well, how was that consent given? Were there witnesses to it? Did you wait 10 days? I think you need protocols and standards in place.”

Oregon and Washington, the only states with aid-in-dying statutes, have protocols written into their laws, he noted. As to who would write the Montana protocols, “I think the legislature should, with input from the medical community,” he said.

Kathryn Tucker, legal director of Compassion & Choices, noted that another aid-in-dying case with which her group is involved is being litigated in Connecticut. Ms. Tucker disagreed with the idea that Montana physicians would not immediately feel freer to provide aid in dying to terminally ill patients in the wake of the state supreme court decision.

“Montana physicians can feel safe that in providing aid in dying, they don't run risk of criminal prosecution,” she said. “We know aid in dying happens in every state, even where the legality is unclear. In Montana, this [decision] brings clarity to this issue.”

Ms. Tucker added that most medical care “is not governed by statute; it's governed by the standard of care and best practices. So most physicians will approach aid in dying in Montana as something regulated by the standard of care. I think what's going to happen with Montana [is that this case] will move aid in dying into normal medical practice that's governed by the standard of care, and we'll get away from the notion that there need to be elaborate statutes.”

How Much Do RA Patients Suffer?

Most rheumatologic disorders do not meet the standard of terminal diseases. However, they can involve a level of intractable suffering that leaves them on the ethical edge of consideration of assisted suicide.

A case presented by the University of Washington's Ethics in Medicine Web site discusses a recently divorced 55-year-old man with severe rheumatoid arthritis who comes in for a routine visit, complaining of insomnia. “He requests a specific barbiturate, Seconal, as a sleep aid, asking for a month's supply. On further questioning, he states that he wakes up every morning at four, tired but unable to go back to sleep. He admits that he rarely leaves his house during the day, stating that he has no interest in the activities he used to find enjoyable.”

The Web site ((

http://depts.washington.edu/bioethx/topics/pasc1.html

It then states that he falls outside the qualifying diseases: “The request for a specific quantity of a specific barbiturate suggests that this patient is contemplating suicide. This concern should be addressed explicitly with the patient. His sleep pattern (early morning awakening) and lack of interest in previously enjoyable pastimes (anhedonia) suggest major depression. This should be fully evaluated and treated. In addition, pain management and long-term care options should be fully revisited in a patient with complaints such as his.

“Even if the patient were fully competent, most proponents of [physician-assisted suicide] would object to aiding his suicide as he is not terminally ill. This said, rheumatoid arthritis can be a painful and debilitating chronic condition and it is unclear whether there is any relevant ethical or legal distinction between such a patient and one who is terminally ill.”

—Sally Koch Kubetin

Physicians in Montana may legally assist terminally ill patients in hastening death, according to a ruling by the Montana Supreme Court.

The decision in the case of Baxter v. State of Montana concerned Robert Baxter, a retired truck driver from Billings, who was terminally ill with lymphocytic leukemia with diffuse lymphadenopathy. As a result of the disease and its treatment, Mr. Baxter suffered from symptoms including “infections, chronic fatigue and weakness, anemia, night sweats, nausea, massively swollen glands, significant ongoing digestive problems, and generalized pain and discomfort,” according to the decision.

The court said further, “The symptoms were expected to increase in frequency and intensity as the chemotherapy lost its effectiveness. There was no cure for Mr. Baxter's disease and no prospect of recovery. Mr. Baxter wanted the option of ingesting a lethal dose of medication prescribed by his physician and self-administered at the time of Mr. Baxter's own choosing.”

Mr. Baxter, along with four physicians and Compassion & Choices, a pro-aid-in-dying group, filed suit in Montana's district court for the first judicial district, challenging the constitutionality of Montana homicide statutes' being applied to physicians who provide aid in dying to mentally competent, terminally ill patients. Mr. Baxter's attorneys contended that the right to die with dignity was constitutional under Montana law.

The district court ruled in favor of Mr. Baxter, but the state appealed the ruling to the Montana Supreme Court. On Dec. 31, 2009, that court also ruled in favor of Mr. Baxter, by a vote of 5–2, although it declined to comment on whether aid in dying complied with the Montana constitution. Mr. Baxter had died in December 2008.

“This court is guided by the judicial principle that we should decline to rule on the constitutionality of a legislative act if we are able to decide the case without reaching constitutional questions,” wrote Justice W. William Leaphart. “We find nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy. … Furthermore, the Montana Rights of the Terminally Ill Act indicates legislative respect for a patient's autonomous right to decide if and how he will receive medical treatment at the end of his life. … We therefore hold that under [Montana law], a terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a charge of homicide against the aiding physician when no other consent exceptions apply.”

Justice James Rice, one of the two dissenting judges, argued that under current Montana law, a physician can be prosecuted for helping a patient commit suicide—if the patient survives, the crime falls under the category of aiding suicide; if the patient dies, the crime is homicide.

“Importantly, it is also very clear that a patient's consent to the physician's efforts is of no consequence whatsoever under these statutes,” he wrote. “[The majority] ignores expressed intent, parses statutes, and churns reasons to avoid the clear policy of the State and reach an untenable conclusion: that it is against public policy for a physician to assist in a suicide if the patient happens to live after taking the medication; but that the very same act, with the very same intent, is not against public policy if the patient dies. In my view, the Court's conclusion is without support, without clear reason, and without moral force.”

In the wake of the court ruling, which cannot be appealed, opinions vary as to whether more Montana physicians will now provide aid in dying to terminally ill patients. Chicago health care attorney Miles J. Zaremski, who wrote a “friend of the court” brief in support of Mr. Baxter in the Montana case, said that even though the decision came out in favor of the plaintiff, physicians in Montana will be reluctant to aid terminally ill patients in dying until legal protocols for the procedure have been established.

“In Montana, if the patient gives the doctor consent to provide aid in dying, the physician can escape homicide laws,” said Mr. Zaremski, who is also a former president of the American College of Legal Medicine. “Well, how was that consent given? Were there witnesses to it? Did you wait 10 days? I think you need protocols and standards in place.”

Oregon and Washington, the only states with aid-in-dying statutes, have protocols written into their laws, he noted. As to who would write the Montana protocols, “I think the legislature should, with input from the medical community,” he said.

Kathryn Tucker, legal director of Compassion & Choices, noted that another aid-in-dying case with which her group is involved is being litigated in Connecticut. Ms. Tucker disagreed with the idea that Montana physicians would not immediately feel freer to provide aid in dying to terminally ill patients in the wake of the state supreme court decision.

“Montana physicians can feel safe that in providing aid in dying, they don't run risk of criminal prosecution,” she said. “We know aid in dying happens in every state, even where the legality is unclear. In Montana, this [decision] brings clarity to this issue.”

Ms. Tucker added that most medical care “is not governed by statute; it's governed by the standard of care and best practices. So most physicians will approach aid in dying in Montana as something regulated by the standard of care. I think what's going to happen with Montana [is that this case] will move aid in dying into normal medical practice that's governed by the standard of care, and we'll get away from the notion that there need to be elaborate statutes.”

How Much Do RA Patients Suffer?

Most rheumatologic disorders do not meet the standard of terminal diseases. However, they can involve a level of intractable suffering that leaves them on the ethical edge of consideration of assisted suicide.

A case presented by the University of Washington's Ethics in Medicine Web site discusses a recently divorced 55-year-old man with severe rheumatoid arthritis who comes in for a routine visit, complaining of insomnia. “He requests a specific barbiturate, Seconal, as a sleep aid, asking for a month's supply. On further questioning, he states that he wakes up every morning at four, tired but unable to go back to sleep. He admits that he rarely leaves his house during the day, stating that he has no interest in the activities he used to find enjoyable.”

The Web site ((

http://depts.washington.edu/bioethx/topics/pasc1.html

It then states that he falls outside the qualifying diseases: “The request for a specific quantity of a specific barbiturate suggests that this patient is contemplating suicide. This concern should be addressed explicitly with the patient. His sleep pattern (early morning awakening) and lack of interest in previously enjoyable pastimes (anhedonia) suggest major depression. This should be fully evaluated and treated. In addition, pain management and long-term care options should be fully revisited in a patient with complaints such as his.

“Even if the patient were fully competent, most proponents of [physician-assisted suicide] would object to aiding his suicide as he is not terminally ill. This said, rheumatoid arthritis can be a painful and debilitating chronic condition and it is unclear whether there is any relevant ethical or legal distinction between such a patient and one who is terminally ill.”

—Sally Koch Kubetin

Physicians in Montana may legally assist terminally ill patients in hastening death, according to a ruling by the Montana Supreme Court.

The decision in the case of Baxter v. State of Montana concerned Robert Baxter, a retired truck driver from Billings, who was terminally ill with lymphocytic leukemia with diffuse lymphadenopathy. As a result of the disease and its treatment, Mr. Baxter suffered from symptoms including “infections, chronic fatigue and weakness, anemia, night sweats, nausea, massively swollen glands, significant ongoing digestive problems, and generalized pain and discomfort,” according to the decision.

The court said further, “The symptoms were expected to increase in frequency and intensity as the chemotherapy lost its effectiveness. There was no cure for Mr. Baxter's disease and no prospect of recovery. Mr. Baxter wanted the option of ingesting a lethal dose of medication prescribed by his physician and self-administered at the time of Mr. Baxter's own choosing.”

Mr. Baxter, along with four physicians and Compassion & Choices, a pro-aid-in-dying group, filed suit in Montana's district court for the first judicial district, challenging the constitutionality of Montana homicide statutes' being applied to physicians who provide aid in dying to mentally competent, terminally ill patients. Mr. Baxter's attorneys contended that the right to die with dignity was constitutional under Montana law.

The district court ruled in favor of Mr. Baxter, but the state appealed the ruling to the Montana Supreme Court. On Dec. 31, 2009, that court also ruled in favor of Mr. Baxter, by a vote of 5–2, although it declined to comment on whether aid in dying complied with the Montana constitution. Mr. Baxter had died in December 2008.

“This court is guided by the judicial principle that we should decline to rule on the constitutionality of a legislative act if we are able to decide the case without reaching constitutional questions,” wrote Justice W. William Leaphart. “We find nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy. … Furthermore, the Montana Rights of the Terminally Ill Act indicates legislative respect for a patient's autonomous right to decide if and how he will receive medical treatment at the end of his life. … We therefore hold that under [Montana law], a terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a charge of homicide against the aiding physician when no other consent exceptions apply.”

Justice James Rice, one of the two dissenting judges, argued that under current Montana law, a physician can be prosecuted for helping a patient commit suicide—if the patient survives, the crime falls under the category of aiding suicide; if the patient dies, the crime is homicide.

“Importantly, it is also very clear that a patient's consent to the physician's efforts is of no consequence whatsoever under these statutes,” he wrote. “[The majority] ignores expressed intent, parses statutes, and churns reasons to avoid the clear policy of the State and reach an untenable conclusion: that it is against public policy for a physician to assist in a suicide if the patient happens to live after taking the medication; but that the very same act, with the very same intent, is not against public policy if the patient dies. In my view, the Court's conclusion is without support, without clear reason, and without moral force.”

In the wake of the court ruling, which cannot be appealed, opinions vary as to whether more Montana physicians will now provide aid in dying to terminally ill patients. Chicago health care attorney Miles J. Zaremski, who wrote a “friend of the court” brief in support of Mr. Baxter in the Montana case, said that even though the decision came out in favor of the plaintiff, physicians in Montana will be reluctant to aid terminally ill patients in dying until legal protocols for the procedure have been established.

“In Montana, if the patient gives the doctor consent to provide aid in dying, the physician can escape homicide laws,” said Mr. Zaremski, who is also a former president of the American College of Legal Medicine. “Well, how was that consent given? Were there witnesses to it? Did you wait 10 days? I think you need protocols and standards in place.”

Oregon and Washington, the only states with aid-in-dying statutes, have protocols written into their laws, he noted. As to who would write the Montana protocols, “I think the legislature should, with input from the medical community,” he said.

Kathryn Tucker, legal director of Compassion & Choices, noted that another aid-in-dying case with which her group is involved is being litigated in Connecticut. Ms. Tucker disagreed with the idea that Montana physicians would not immediately feel freer to provide aid in dying to terminally ill patients in the wake of the state supreme court decision.

“Montana physicians can feel safe that in providing aid in dying, they don't run risk of criminal prosecution,” she said. “We know aid in dying happens in every state, even where the legality is unclear. In Montana, this [decision] brings clarity to this issue.”

Ms. Tucker added that most medical care “is not governed by statute; it's governed by the standard of care and best practices. So most physicians will approach aid in dying in Montana as something regulated by the standard of care. I think what's going to happen with Montana [is that this case] will move aid in dying into normal medical practice that's governed by the standard of care, and we'll get away from the notion that there need to be elaborate statutes.”

How Much Do RA Patients Suffer?

Most rheumatologic disorders do not meet the standard of terminal diseases. However, they can involve a level of intractable suffering that leaves them on the ethical edge of consideration of assisted suicide.

A case presented by the University of Washington's Ethics in Medicine Web site discusses a recently divorced 55-year-old man with severe rheumatoid arthritis who comes in for a routine visit, complaining of insomnia. “He requests a specific barbiturate, Seconal, as a sleep aid, asking for a month's supply. On further questioning, he states that he wakes up every morning at four, tired but unable to go back to sleep. He admits that he rarely leaves his house during the day, stating that he has no interest in the activities he used to find enjoyable.”

The Web site ((

http://depts.washington.edu/bioethx/topics/pasc1.html

It then states that he falls outside the qualifying diseases: “The request for a specific quantity of a specific barbiturate suggests that this patient is contemplating suicide. This concern should be addressed explicitly with the patient. His sleep pattern (early morning awakening) and lack of interest in previously enjoyable pastimes (anhedonia) suggest major depression. This should be fully evaluated and treated. In addition, pain management and long-term care options should be fully revisited in a patient with complaints such as his.

“Even if the patient were fully competent, most proponents of [physician-assisted suicide] would object to aiding his suicide as he is not terminally ill. This said, rheumatoid arthritis can be a painful and debilitating chronic condition and it is unclear whether there is any relevant ethical or legal distinction between such a patient and one who is terminally ill.”

—Sally Koch Kubetin

A public-private institution, launched by the Department of Health and Human Services, would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest.

The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing medical education (CME) to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference.

New Report for Old CME Model?

CME vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

A large problem with the report is that the committee reviewed CME as it used to be, Dr. Kennison said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

Some CME vendors have moved to performance-improvement CME, which is a goal outlined in the report. This approach involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on CME requirements. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of CME models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

BARBARA SCHUSTER, M.D., is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens. She reports no relevant conflicts of interest.

A public-private institution, launched by the Department of Health and Human Services, would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest.

The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing medical education (CME) to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference.

New Report for Old CME Model?

CME vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

A large problem with the report is that the committee reviewed CME as it used to be, Dr. Kennison said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

Some CME vendors have moved to performance-improvement CME, which is a goal outlined in the report. This approach involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on CME requirements. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of CME models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

BARBARA SCHUSTER, M.D., is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens. She reports no relevant conflicts of interest.

A public-private institution, launched by the Department of Health and Human Services, would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest.

The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing medical education (CME) to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference.

New Report for Old CME Model?

CME vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

A large problem with the report is that the committee reviewed CME as it used to be, Dr. Kennison said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

Some CME vendors have moved to performance-improvement CME, which is a goal outlined in the report. This approach involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on CME requirements. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of CME models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

BARBARA SCHUSTER, M.D., is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens. She reports no relevant conflicts of interest.

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is about three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000.

The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under PQRI, providers receive incentive payments for reporting data on quality measures. The payments amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

The CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008. The measures were developed in cooperation with physician and health care quality organizations.

Providers also had the option in 2008 of reporting to the CMS through use of one of the 31 qualified medical registries. Many providers already were using registries to report data to researchers dealing with disease management and preventive medicine. Nearly 8% of the PQRI participants in 2008 attempted to use a registry to submit data; of these, 96% were successful and received an incentive payment.

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is about three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000.

The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under PQRI, providers receive incentive payments for reporting data on quality measures. The payments amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

The CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008. The measures were developed in cooperation with physician and health care quality organizations.

Providers also had the option in 2008 of reporting to the CMS through use of one of the 31 qualified medical registries. Many providers already were using registries to report data to researchers dealing with disease management and preventive medicine. Nearly 8% of the PQRI participants in 2008 attempted to use a registry to submit data; of these, 96% were successful and received an incentive payment.

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is about three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000.

The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under PQRI, providers receive incentive payments for reporting data on quality measures. The payments amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

The CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008. The measures were developed in cooperation with physician and health care quality organizations.

Providers also had the option in 2008 of reporting to the CMS through use of one of the 31 qualified medical registries. Many providers already were using registries to report data to researchers dealing with disease management and preventive medicine. Nearly 8% of the PQRI participants in 2008 attempted to use a registry to submit data; of these, 96% were successful and received an incentive payment.

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

Serious flaws exist in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report, “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.

“Establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity, the Continuing Professional Development Institute, that would involve the full spectrum of stakeholders in health care delivery and continuing education. It would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said Dr. Gail Warden, committee chair.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

A big problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and doesn't involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“As orthopedic surgeons, we deal with physical therapists all the time,” he said. “We felt strongly about developing a community that is really across disciplines.”

Leery of a Government Committee

Several report recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body. So the idea of having one government committee saying, 'This is continuing education for all fields of health care'—that is going to be a problem. I think you're going to scare away innovation.”

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

For example, he added, the organization could say, “'Here are some metrics for how you evaluate continuing education.'” He continued, “If they could come up with metrics, either through surveys or some other tested metric, that would be great. Then you can always be improving your continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

Serious flaws exist in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report, “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.

“Establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity, the Continuing Professional Development Institute, that would involve the full spectrum of stakeholders in health care delivery and continuing education. It would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said Dr. Gail Warden, committee chair.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

A big problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and doesn't involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“As orthopedic surgeons, we deal with physical therapists all the time,” he said. “We felt strongly about developing a community that is really across disciplines.”

Leery of a Government Committee

Several report recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body. So the idea of having one government committee saying, 'This is continuing education for all fields of health care'—that is going to be a problem. I think you're going to scare away innovation.”

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

For example, he added, the organization could say, “'Here are some metrics for how you evaluate continuing education.'” He continued, “If they could come up with metrics, either through surveys or some other tested metric, that would be great. Then you can always be improving your continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

Serious flaws exist in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report, “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.

“Establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity, the Continuing Professional Development Institute, that would involve the full spectrum of stakeholders in health care delivery and continuing education. It would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said Dr. Gail Warden, committee chair.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

A big problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and doesn't involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

“As orthopedic surgeons, we deal with physical therapists all the time,” he said. “We felt strongly about developing a community that is really across disciplines.”

Leery of a Government Committee

Several report recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body. So the idea of having one government committee saying, 'This is continuing education for all fields of health care'—that is going to be a problem. I think you're going to scare away innovation.”

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

For example, he added, the organization could say, “'Here are some metrics for how you evaluate continuing education.'” He continued, “If they could come up with metrics, either through surveys or some other tested metric, that would be great. Then you can always be improving your continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at

www.iom.edu/continuinged

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS' national coordinator for health information technology, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” said an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal stressed that the standards are subject to comment, “and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments”

The American College of Cardiology noted on its Web site that only non–hospital-based physicians, that is, those who furnish less than 10% of their services in a hospital setting, are eligible for the incentives (www.acc.org

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA), however, was more direct. The proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements,” the group said in a statement. It cites “unreasonable thresholds” for some criteria, including computerized physician order entry and electronic claims submission, and a requirement that physician offices provide patients and others with electronic copies of medical records among its objections.

“We were pleased to see that the CMS and ONC rules include some flexibility,” said MGMA president and CEO Dr. William Jessee. “However, we firmly believe that the government should make additional changes to achieve wide-spread adoption by professionals in all types of clinical settings.”

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

'We've tried to build in flexibility in these standards and certification criteria.'

Source DR. BLUMENTHAL

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS' national coordinator for health information technology, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” said an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal stressed that the standards are subject to comment, “and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments”

The American College of Cardiology noted on its Web site that only non–hospital-based physicians, that is, those who furnish less than 10% of their services in a hospital setting, are eligible for the incentives (www.acc.org

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA), however, was more direct. The proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements,” the group said in a statement. It cites “unreasonable thresholds” for some criteria, including computerized physician order entry and electronic claims submission, and a requirement that physician offices provide patients and others with electronic copies of medical records among its objections.

“We were pleased to see that the CMS and ONC rules include some flexibility,” said MGMA president and CEO Dr. William Jessee. “However, we firmly believe that the government should make additional changes to achieve wide-spread adoption by professionals in all types of clinical settings.”

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

'We've tried to build in flexibility in these standards and certification criteria.'

Source DR. BLUMENTHAL

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS' national coordinator for health information technology, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” said an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal stressed that the standards are subject to comment, “and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments”

The American College of Cardiology noted on its Web site that only non–hospital-based physicians, that is, those who furnish less than 10% of their services in a hospital setting, are eligible for the incentives (www.acc.org

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA), however, was more direct. The proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements,” the group said in a statement. It cites “unreasonable thresholds” for some criteria, including computerized physician order entry and electronic claims submission, and a requirement that physician offices provide patients and others with electronic copies of medical records among its objections.

“We were pleased to see that the CMS and ONC rules include some flexibility,” said MGMA president and CEO Dr. William Jessee. “However, we firmly believe that the government should make additional changes to achieve wide-spread adoption by professionals in all types of clinical settings.”

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

'We've tried to build in flexibility in these standards and certification criteria.'

Source DR. BLUMENTHAL

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

Serious flaws exist in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.” Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms aimed at helping avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, which is a continuing medical education vendor, said he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked.”

The report, sponsored by the Josiah Macy Jr. Foundation, is available at www.iom.edu/continuinged

My Take

Cost, Effectiveness Are Key

The proposed institute could have a dramatic effect on continuing “education” requirements for health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

DR. BARBARA SCHUSTER is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens, Ga. She reports no relevant conflicts of interest.

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

Serious flaws exist in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.” Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms aimed at helping avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, which is a continuing medical education vendor, said he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked.”

The report, sponsored by the Josiah Macy Jr. Foundation, is available at www.iom.edu/continuinged

My Take

Cost, Effectiveness Are Key

The proposed institute could have a dramatic effect on continuing “education” requirements for health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

DR. BARBARA SCHUSTER is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens, Ga. She reports no relevant conflicts of interest.

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

Serious flaws exist in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.” Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms aimed at helping avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, which is a continuing medical education vendor, said he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked.”

The report, sponsored by the Josiah Macy Jr. Foundation, is available at www.iom.edu/continuinged

My Take

Cost, Effectiveness Are Key

The proposed institute could have a dramatic effect on continuing “education” requirements for health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

DR. BARBARA SCHUSTER is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens, Ga. She reports no relevant conflicts of interest.

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping-stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other orthopedic health professionals, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students will pay for courses themselves.

“We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists too,” he said. For example, physicians and physical therapists can work together to develop the best exercises for patients in pain.

Leery of a Government Committee

On the other hand, some of the recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said.

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” Dr. Cleeman said. “Their goal would be to assist in developing goals for continuing education.”

The report, which was sponsored by the Josiah Macy, Jr. Foundation, is available at

www.iom.edu/continuinged

'There have been a lot of changes in CME & that were completely overlooked by the committee.'

Source DR. KENNISON

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on continuing “education” requirements for internists and other health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

BARBARA SCHUSTER, M.D., is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens, Ga. She reports no relevant conflicts of interest.

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping-stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other orthopedic health professionals, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students will pay for courses themselves.

“We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists too,” he said. For example, physicians and physical therapists can work together to develop the best exercises for patients in pain.

Leery of a Government Committee

On the other hand, some of the recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said.

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” Dr. Cleeman said. “Their goal would be to assist in developing goals for continuing education.”

The report, which was sponsored by the Josiah Macy, Jr. Foundation, is available at

www.iom.edu/continuinged

'There have been a lot of changes in CME & that were completely overlooked by the committee.'

Source DR. KENNISON

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on continuing “education” requirements for internists and other health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

BARBARA SCHUSTER, M.D., is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens, Ga. She reports no relevant conflicts of interest.

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

New Report for Old CME Model?

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping-stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other orthopedic health professionals, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students will pay for courses themselves.

“We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists too,” he said. For example, physicians and physical therapists can work together to develop the best exercises for patients in pain.

Leery of a Government Committee

On the other hand, some of the recommendations gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said.

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” Dr. Cleeman said. “Their goal would be to assist in developing goals for continuing education.”

The report, which was sponsored by the Josiah Macy, Jr. Foundation, is available at

www.iom.edu/continuinged

'There have been a lot of changes in CME & that were completely overlooked by the committee.'

Source DR. KENNISON

My Take

Examine Effectiveness, Cost of CME

The proposed institute could have a dramatic effect on continuing “education” requirements for internists and other health care professionals. Through the establishment of a professionally inclusive public-private institute, research on the effectiveness of continuing education models could inform the health professional community about how best to develop educational programs and continuing professional competencies.

Although interdisciplinary health team education might improve health outcomes for patients, it's difficult to assess the value of single interventions on patient outcomes. Also, each profession, such as medicine, nursing, and pharmacy, will continue to have specific needs for professional education.

Several institutions have embraced the newest standards of the Accreditation Council for Continuing Medical Education. Their modified programs involve active learning and outcomes evaluation, and avoid potential conflicts of interest associated with financial support by the pharmaceutical and medical device industries. However, in an era of economic constraints, particularly for primary care providers, new standards developed by any organization must consider not only educational efficacy but also efficiency and cost.

BARBARA SCHUSTER, M.D., is campus dean of the Medical College of Georgia/University of Georgia Medical Partnership, Athens, Ga. She reports no relevant conflicts of interest.