Editor’s Note: Sheldon Horowitz of the American Board of Medical Specialties (photo and bio above) is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Horowitz’s presentation and supplements his discussion.
With approximately 750,000 of the nation’s physicians certified by one or more of the 24 Member Boards of the American Board of Medical Specialties (ABMS), ABMS has a unique opportunity to further the national agenda set by the U.S. Department of Health and Human Services (HHS) to promote the adoption and meaningful use of health information technology (HIT). By aligning ABMS Maintenance of Certification® (ABMS MOC®) with the meaningful use objectives of HHS, we can enhance the knowledge, skill and use of health IT by physicians to improve performance and patient outcomes.
About Maintenance Of Certification
First approved as a concept by the ABMS Member Boards in 2000, MOC has now been implemented by all 24 ABMS Member Boards. Rather than the traditional recertification process, which relies on the demonstration of competency via methods such as periodic tests or the accumulation of CME credits at educational meetings, MOC reflects the principle that medical education is most effective as a continuum rather than an isolated learning event. It requires physician participation in lifelong learning and continuous professional development and includes patient experience of care and peer surveys, assessment of physician practice performance and patient outcomes, and assessment of knowledge with a secure exam. MOC provides a framework, systems, and tools to ensure physician standards and accountability.
In general, to meet the HHS requirements for meaningful use, physician electronic health records (EHRs) need to demonstrate that they:
- improve quality, safety and efficiency, and reduce health disparities;
- engage patients and families;
- improve care coordination;
- improve population and public health;
- ensure adequate privacy and security protection for personal health information; and
- report on clinical quality measures.
These objectives overlap with the six core competencies that are continually measured through participation in MOC, in which health IT plays an increasingly important role. These include:
- Patient Care that is compassionate and appropriate; effective treatment that promotes health.
- Medical Knowledge about established and evolving biomedical, clinical and related sciences and their application in patient care.
- Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families and professional associates.
- Professionalism that demonstrates a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.
- Systems-based Practice that shows an awareness of and responsibility to the larger context and systems of healthcare, and the ability to call on system resources to provide optimal care (e.g. coordinating care across sites or serving as the primary case manager when care involves multiple specialties, professions or sites).
- Practice-based Learning and Improvement, including physicians’ ability to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their practice of medicine.
MOC and Meaningful Use
To align MOC with the federal meaningful use criteria, ABMS initially will foster the development of new measurement tools or enhancement of existing activities, starting with the three ABMS primary care Member Boards: the American Board of Family Medicine (ABFM), the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP).
These three boards have certified 369,000 practicing physicians in the United States. Examples of such efforts might include developing two new knowledge self-assessment modules to evaluate:
- a physician’s knowledge of HIT for incorporating evidence-based medicine into his or her practice, decision support and data acquisition, and analysis and reporting related to the correct use of HIT; and
- a physician’s knowledge of the uses of HIT to promote patient safety, such as computerized physician order entry, medication reconciliation, e-prescribing and coordination of care.
Other examples include:
- Augmenting the knowledge self-assessment modules described above with the addition of simulation, creating patient scenarios that demonstrate EHR functionality, including the development and use of a registry for quality improvement that will provide “hands-on” experience for physicians in gaining the skills they need to apply HIT effectively in quality improvement efforts.
- Developing data interchange utilities to enable submission of Physician Reporting Quality Initiative (PQRI) and HIT meaningful use measures directly to the Boards in the same format used by the Centers for Medicare & Medicaid Services (CMS). This will enable certified physicians to satisfy both PQRI and MOC requirements, and qualify for the PQRI meaningful use bonuses, without redundant data submissions.
- Expanding and enhancing practice improvement modules (PIMs), which are Web-based self-evaluation tools that guide physicians through data collection from their own practice using medical chart reviews, patient surveys and a practice system survey to create a comprehensive assessment of current practice performance in a specific clinical area. Select PIMs will be enhanced to enable physicians to use EHRs to track their practice data and improve care.
Why MOC Matters to Meaningful Use
MOC, the largest and most comprehensive program of its kind, is an active process of assessment and continuous professional development that requires participants to demonstrate ongoing competency and keep pace with advances in their field of medicine throughout their entire careers. The meaningful use of EHRs – a skill that was virtually unheard of when many of today’s practicing physicians were first Board Certified – is an excellent example of the importance of physician commitment to lifelong learning and the value of MOC.