MedBiquitous Orientation

1
MedBiquitous Orientation

• Valerie SmothersMedBiquitous
• MedBiquitous Annual Conference
• May 13, 2008

2
Objectives

• At the conclusion of the workshop, participants
  will be able to
• Describe the benefits of standards in healthcare
  education and competence assessment.
• Identify opportunities for participating in the
  standards development process.

3
Before we start

• How many are planning to attend Virtual Patients
  in a Nutshell at 11?

4
Overview

• Introductions
• What is MedBiquitous?
• Why standards?
• Major Activities
• Summary
• How to participate

5
Introductions
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What is MedBiquitous?
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MedBiquitous Mission

• To advance healthcare education through
  technology standards that promote professional
  competence, collaboration, and better patient
  care.
• Not-for-profit, member-driven, standards
  development organization

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The Fragmented Healthcare Industry
Industry
Universities
Societies
?
CertifyingBoards
LicensingBoards
Government
Publishers
AccreditingBodies
9
How it all started
And it kept growing
10
MedBiquitous Technology Standards for
Healthcare Education

• 74 member organizations
• 7 Working Groups
• ANSI process
• Openness
• Transparency
• Consensus
• Due process
• Work with leading organizations that can drive
  adoption

Professional Profile
Learning Objects
Activity Reporting
Metrics
Virtual Patients
Point of Care Learning
Competencies
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ANSI Accredited Standards Developer

• MedBiquitous develops information technology
  (XML) standards for
• Healthcare education and training
• Healthcare professional competence assessment,
  certification, and licensure
• Healthcare professional and scientific
  publications
• Healthcare professional online communities and
  portals

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MedBiquitous Goals

• Better tracking and evaluation of professional
  education and certification activities
• Easier discovery of relevant education and
  information resources when and where needed
• Interoperability and sharing of high quality
  online education
• Coordination and tracking of competence
  assessment data

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ltCompetenciesgt
Identify gaps in competency
ltlomgt
Identify relevant resources
Identify learner
ltMembergt
ltActivityReportgt

• John Does Portfolio
• CME
• Course 1
• Course 2
• Course 3

Track accomplishments
Learner Portfolio
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MedBiquitous Process

• Approves new standards projects
• Meets via telco, in person
• Develops specifications
• Consensus body
• Votes
• Final approval

Executive committee
Working groups
Standards committee
ANSI
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Working Groups

• Professional Profile
• Standard for describing a healthcare professional
• Credentials verification, administration,
  identification
• Competencies
• Standard for describing competency framework
• Working with IEEE
• Learning Objects
• Healthcare LOM (describing learning activities)
• SCORM for Healthcare (running e-learning)

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Working Groups

• Virtual Patient
• Standards for interactive computer programs that
  simulate real life clinical scenarios
• Activity Report
• Tracking CE/MoC activities
• Metrics
• Aggregate evaluation data
• Point of Care Learning
• Integration with clinical systems
• Tracking needs assessment and inquiry data

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Working Group Meetings

• Activity Report WGThur, 330 PM
• Competency WGThur, 12 PM
• Learning Objects WG, Thur, 730 AM
• Metrics WG Thur, 12 PM

• Point of Care Learning WGThur, 730 AM
• Professional ProfileThur, 330 PM
• Virtual Patient WGToday, 330 PM

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Why standards?
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Why standards?

• Activity
• You are designing your own searchable cookbook
  for all of the recipes you download from the
  internet.
• Develop a data structure for a cooking recipe.
  Describe some of the benefits of having this
  standard.

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Why standards?

• To facilitate exchange of data and resources
• To enable collaboration
• To create economies and networks of scale

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(No Transcript)
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Your Challenges

• Activity
• What information exchange, coordination, or
  integration challenges do you have?
• 5 min

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Major Activities
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Coordinating Professional Healthcare

• Professional Profile
• Coordinating clinician data
• Competencies
• Coordinating competency data

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Professional Profile Working Group

• Mission to develop XML standards and Web
  services descriptions to enable the exchange of
  clinician profile information across
  organizations and systems

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Participants

• Mike Zarski, American Osteopathic Association,
  Chair
• Archana Aida, American Board of Pediatrics
• Skip Bartolanzo, American Board of Pediatrics
• Tom Brantigan, TMA Resources
• Annette Van Veen Gippe, American Osteopathic
  Association
• David Hooper, Federation of State Medical Boards
• Jim Jahrling, American Board of Medical
  Specialties
• Paul Jolly, Association of American Medical
  Colleges
• Don Jones, American College of Chest Physicians

• Laura Martin, American Board of Pediatrics
• Joe OConner, Educational Comission for Foreign
  Medical Graduates
• Monica Quiroz, American Medical Association
• Kelly Reddick, American Board of Pediatrics
• Michael Rowan, Learn Something
• Pam Shellner, American Association of
  Critical-Care Nurses
• Cyndi Streun, Federation of State Medical Boards
• Howard Tanzman, American College of Surgeons
• Todd Tischendorf, CECity
• Toby Vandermark

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Professional Profile Use Case

• Common format for exchanging information about
  healthcare professionals
• Contact
• Education
• Training
• Certification
• License
• Disciplinary action
• Academic appointments
• Memberships
• Facilitates cross-organization collaboration

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Benefits

• Faster to process standardized data
• Faster to develop new applications
• Easier to work with partner organizations
• Able to automate many business processes
• Users ABMS, AOA for faster credentialing

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Status of Professional Profile

• Undergoing Public Review Complete
• Ballot complete
• Standards Implementation
• Clinician credentialing
• Data collection
• Developing implementation guide and services
  documentation

Executive committee
Working groups
Standards committee
ANSI
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Competencies

• Competency any educational objective or
  educational outcome that results from knowledge,
  skills, or beliefs.

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Competencies Working Group

• Co-chairs Rosalyn Scott, MD and Tim Willett, MD
• Mission develop a standardized framework to
  represent competency data
• Existing work IEEE Learning Technology Standards
  Committee (LTSC) has convened a Competency study
  group

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Uses for a Competency Standard

• Allow learners to track their accomplishments
  against a list of relevant competencies
• Enable educators to see how their curriculum fits
  into a competency framework
• Enable content developers to tie educational
  activities to a competency framework

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(No Transcript)
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Coordinating in Primary Care

• Activity
• Exchanging membership data
• Promoting a core curriculum
• 7 min

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Finding Educational Activities and Content

• Healthcare Learning Object Metadata (Healthcare
  LOM)
• Finding learning activities

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Healthcare Learning Object Metadata (LOM)

• Metadata Definition the data that describes a
  resource.
• Example card catalog information for a book
  author, title, publication date, topic, etc.
• Problem many organizations use completely
  different metadata schemes.
• Example keyword Renal Failure vs. Topic
  Renal Failure

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Healthcare LOM Working Group Mission

• To develop XML and Web services standards to
  enable interoperability, accessibility and
  reusability of Web-based medical learning
  content.

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Healthcare LOM Uses
Title Aresenic Toxicity Keyword Environmental
medicine, MeSH D019550 Target
audience Physician, registered nurse Credits
CME 1.5 AMA PRA Category 1 CNE 1.7
contact hours
Title Preventing sports injuries Target
audience Patient
Health Education
DatabaseB
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Healthcare LOM Uses
CE
Evaluation
Interdisciplinary teams
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Learning Objects Working Group

• Morgan Bantly, Department of Veterans Affairs ,
  Chair
• Patti Abbott, Johns Hopkins University
• Trupti Bakrania, St George's University of London
  
• Ravi Teja Bhupatiraju, Oregon Health and Sciences
  University
• Gabrielle Campbell, Association of American
  Medical Colleges
• Chris Candler, M.D., Association of American
  Medical Colleges
• Dawn Carroll, Department of Veterans Affairs
• David Davies, Ph.D., University of Warwick 
• Nancy Davis, Ph.D., National Institute for
  Quality Improvement and Education
• Sharon Dennis, M.S., HEAL
• Shona Dippie, HEAL
• Rachel Ellaway, Northern Ontario School of
  Medicine
• Nancy Gathany, Centers for Disease Control and
  Prevention
• Stuart Gilman, M.D., Department of Veterans
  Affairs
• William Hersh, M.D., Oregon Health and Sciences
  University
• Lorena Hitchens, HighWire Press

• Julie Lambla, American Association of
  Critical-Care Nurses
• Tao Le, M.D., Johns Hopkins University
• Joy Leffler, WEMOVE
• Ross Martin, M.D., Pfizer
• Jim Martino, Ph.D., Johns Hopkins University
• Sandra McIntyre, M.Ed., HEAL
• Don O'Guin, Pfizer
• Jennifer Ott, Healthstream
• Beth Powell, Centers for Disease Control and
  Prevention
• Andrew Rabin, CECity
• Mike Rowan, LearnSomething
• Chris Rueger, Healthstream
• Deborah Sher, Department of Veterans Affairs
• Damon Silver, HighWire Press
• Carl Singer, CECity
• Sebastian Uijtdehaage, Ph.D., HEAL
• David Ward, American Association of Critical-Care
  Nurses
• Walter Wolyniec, Boehringer Ingelheim
• Dan Rehak, Ph.D.

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Healthcare LOM Structure
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Healthcare LOM Structure
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Benefits

• Save money dont reinvent, reuse
• Improve access to content internally or across
  organizations
• Use content in innovative ways
• Users HEAL, MedEdPortal, VA
• Ballot complete - In ANSI review

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Break 10 minutes
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Sharing and Reuse of Educational Resources

• SCORM for Healthcare
• Self-directed Web-based learning
• Virtual Patients
• Web-based simulations of clinical encounters

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SCORM

• An e-learning model that enables accessibility,
  reuse, and interoperability of learning objects
  and tracking of learner progress.
• Standards for running, packaging, and describing
  learning content
• Broad international adoption

• Shareable
• Content
• Object
• Reference
• Model

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SCORM for Healthcare

• Profile of SCORM
• Leverages extensions to SCORM metadata called
  Healthcare Learning Object Metadata (Healthcare
  LOM)
• Developed by MedBiquitous
• All SCORM for Healthcare content is conformant
  with SCORM

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Challenges in Defense Training

• Content not portable / interoperable
• Content monolithic and not easily updated
• Content cannot be shared

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Goals of SCORM
SCORM Content is Definition Example
Accessible Easily discovered and located. Searching an education repository for hemorrhagic fever brings relevant results.
Reusable Independent of learning context. Can be used for multiple situations. Module on effects of radiation exposure can be included in multiple courses.
Interoperable Can function in multiple hardware/software environments. Module run in one LMS can be shared with other organizations and run on their systems.
Durable Will continue to function as systems are upgraded. This years course on asthma will run on the LMS you buy next year.
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Status of SCORM for Healthcare

• Draft specification available
• Users VA co-developing content in conjunctions
  with other government agencies

51
Virtual Patients

• Definition An interactive computer simulation of
  real-life clinical scenarios for the purpose of
  medical training, education, or assessment.
• Several schools are developing
• Very costly to create
• No common framework that would allow these
  virtual patients to be shared across systems

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(No Transcript)
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Virtual Patient Working Group Mission

• To develop XML standards and Web services
  requirements to enable interoperability,
  accessibility and reusability of Web-based
  virtual patient learning content.

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Virtual Patients Working Group

• Soeren Huwendiek, University of Heidelberg
• Patrik Jonsson, Karolinska Institute
• Peter Kant, University of Pittsburgh
• Joy Leffler, WE MOVE
• Sandra McIntyre, M.Ed., HEAL
• Dick Moberg, Moberg Research
• Beth Powell, Centers for Disease Control
• Narain Ramluchumun, St. George's University of
  London
• Kathie Rose, National Board of Medical Examiners
• Deborah Sher, Department of Veterans Affairs
• Arnold Somasunderam, St. George's University of
  London
• Chris Toth, University of Pittsburgh
• Dan Walker, Tufts University
• Pat Youngblood, Stanford
• Nabil Zary, Karolinska Institute
• Grace Huang, M.D., Harvard University
• Carol Kamin, University of Colorado
• Yanko Michea, M.D., University of Connecticut
• Nancy Posel, McGill

• Rachel Ellaway, Co-chair
• JB McGee, Co-chair
• Spenser Aden, Healthstream
• Susan Albright, Tufts University
• Ben Azan, MedBiquitous
• Dmitriy Babinchenko, University of Pittsburgh
• Chara Balasubramaniam, St. George's University of
  London
• Matthias Bauch, University Children's Hospital
  Heidelberg
• Linda Bell, American Association of Critical-Care
  Nurses
• Chris Candler, M.D., Association of American
  Medical Colleges
• Emily Conradi, St. George's University of London
• David Davies, Ph.D., University of Warwick
• Parvati Dev, Stanford University
• Jeroen Donkers, University of Maastricht
• Shona Dippie, HEAL
• Uno Fors, D.D.S., Ph.D., Karolinska Institute
• Robert Galbraith, M.D., National Board of Medical
  Examiners
• Dennis Glenn, American Board of Surgery
• Michael Hagen, American Board of Family Medicine

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Virtual Patient Architcture

• Component based approach
• Enables sharing and reuse of entire virtual
  patient or components
• Engaging and relevant
• Provides feedback on practice
• Hewlett funded grant for VP player (Tufts)
• Basis of eViP project

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The MVP Architecture
SCORM package
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VP Working Group Status

• VP Working Group accomplishments
• Draft schemas available
• Draft data and player specifications available
• Being implemented by several universities
• Benefits
• scale costly virtual patient development across
  institutions
• Users
• EViP participants, Tufts, U of Pittsburgh, NYU,
  Northern Ontario School of Medicine

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Reusing Content

• Activity
• Some have referred to educational materials as
  legos that may be reconfigured to form a
  variety of useful educational resources.
• What are the various ways that the following
  resources may be used, alone or in combination
  with other resources?
• 5 min

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Video of an Abnormal Gait
Labeled Diagram of the Nervous System
Brain Tissue
Brain MRI
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Tracking and Evaluation of Learning Activities

• Activity Report
• Tracking CE and certification activities across
  organizations
• Point of Care Learning
• Tracking clinical questions, resources searched,
  and application to practice
• Medical Education Metrics
• Reporting aggregate evaluation data

61
Activity Report Working Group

• Mission develop XML standards and Web services
  requirements and descriptions to enable tracking
  of the learning and certification activities of
  physicians and other healthcare professionals.

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Participants

• Toby Vandemark, Chair
• Spencer Aden, Healthstream
• Archana Aida, American Board of Pediatrics
• Dawn Ainger, Genova Technologies
• Mary Pat Aust, American Association of
  Critical-Care Nurses
• Skip Bartolanzo, American Board of Pediatrics
• Ray Everngam, CTSNet
• Scott Foutz, American Academy of Pediatrics
• Cyndi Grimes, Medscape
• Monica Hanks, American Association of
  Critical-Care Nurses
• Jeanette Harmon, American Medical Association
• Lorena Hitchens, HighWire Press
• Rachel Makleff, American Thoracic Society
• Laura Martin, AMerican Board of Pediatrics
• Spencer Moore, Radiological Society of North
  America
• Christie Morales, American Heart Association

• Bryan Pawlak, American Osteopathis Association
• Monica Quiroz, American Medical Association
• Kelly Reddick, American Board of Pediatrics
• Shelly Rodrigues, California Academy of Family
  Physicians
• Barb Rosenthal, American Board of Medical
  Specialties
• Mike Rowan, LearnSomething
• Taranmg Shah, American Osteopathic Association
• Carl Singer, CE City
• Leah Wang, Medscape
• Scott Weber, Med-IQ
• Todd Tischendorf, CE City
• Mike Zarski, American Osteopathis Association
• Edward Kennedy, Accreditation Council for
  Continuing Medical Education
• Charles Willis, American Gastroenterological
  Association

63
Current Problems with CE Tracking and Measurement

• We arent tracking CE
• We dont help the learner assess gaps
• We cant tell if CE matches learners
  practice-based needs
• We dont measure CE value consistently
• We dont verify claimed credits for certification
  or licensure

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Reporting and Tracking CE/MoC
Provider A
Activity report
ltxmlgt
Dr. John Does CE Tracker A Asthma Management
.5 cr B Bronchodialators .5 cr A Pain
Management .5 cr Report to Board
CE Tracker
Activity report
ltxmlgt
Provider B
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Benefits

• Enables centralized tracking of CE and
  Certification activities
• Increases accountability of all parties
• Reduces administrative burden on professional

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Status of Activity Report

• Schema, spec, and servivces available
• ABP and AAP are piloting the use of the standard
  for use in MOC
• American Heart using for integration w/HighWire
  and others
• Mesdcape, AOA, and CECity piloting use for CE
  certificates
• RSNA using for centralizing radiology ce data

Executive committee
Working groups
Standards committee
ANSI
67
Point of Care Learning Working Group

• Mission to develop XML standards and guidelines
  to support offering clinicians learning at the
  point of care, tracking point of care learning,
  and using point of care learning data for needs
  assessment.

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Participants

• Dick Moberg, Moberg Research
• Kevin O'Hara, Healthstream
• Jerry Osheroff, M.D., Thomson
• Mellie Pouwels, Radiological Society of North
  America
• Andrew Rabin, CECity
• Deborah Samuel, American Academy of Pediatrics
• Danette Somers, Wiley
• Robert Stern, MedPage Today
• Walter Wolyniec, Boehringer Ingelheim
• Beverly Wood, M.D., American Academy of
  Pediatrics
• Jake Zarnegar, Silverchair
• Laird Kelly, RSi
• Paul Martin, eeds
• Charles Willis, American Gastroenterological
  Association

• Jabin White, Silverchair, Chair
• Nick Ackerson, Thomson
• Michelle Adams, American Academy of Dermatology
• Zalman Agus, M.D., University of Pennsylvania
• Dawn Ainger, Genova Technologies
• Scott Bradbury, American Academy of Pediatrics
• Ron Carovano. METI
• Bill Deluise, Wiley
• Nancy Davis, Ph.D., National Institute for
  Quality Improvement and Education
• Tom Godden, Wolters Kluwer
• Cyndi Grimes, Medscape
• Irina Laghidze, Moberg Research
• Matt Lewis, Boehringer Ingelheim
• Rachel Makleff, American Thoracic Society
• J.B. McGee , M.D., University of Pittsburgh

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Point of Care Learning Uses
?

• Common format for exchanging point of care
  learning activity data
• Clinical question
• Search parameters
• Resource used
• Application to practice
• Allows providers to collect data for credit and
  needs assessment
• Draft specification and schema
• Piloted by U Penn and MedPage Today

POC System
CME Provider
Transcript
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MEMS Medical Education Metrics

• Technology standard for core evaluation data

• Users
• Educators want best practices, ability to compare
• Funders want to measure reach and efficacy
• Accreditors want to measure success of activity
  and provider

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MEMS Data

• Activity Description
• Whats being evaluated
• Participant Activity Evaluation
• What did participants think
• Participation Metrics
• How many people participated
• Learner Demographics

72
Metrics Working Group

• Mission to develop XML standards and Web
  services requirements and descriptions for the
  exchange of aggregate evaluation data and other
  key metrics for health professions education.

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Metrics Participants

• Linda Casebeer, Outcomes, Inc., Co-Chair
• Francis Kwakwa, RSNA, Co-Chair
• Robin Bay, WEMOVE
• Craig Bowen, Ph.D., Johns Hopkins University
• David Cook, M.D. Mayo Clinic
• Bill Deluise, Wiley
• Ray Everngam, CTSNet
• Michael Fordis, M.D., Baylor College of Medicine
• Stuart Gilman, M.D., Department of Veterans
  Affairs
• Monica Hanks, American Association of
  Critical-Care Nurses
• Sean Hayes, Ph.D., AXDEV Group
• Jack Kues, Ph.D., University of Cincinnati
• Tao Le, M.D., Johns Hopkins University
• Matt Lewis, MPA, Boehringer Ingelheim
• Jackie Mayhew, Pfizer

• Suzanne Murray, Ph.D., AXDEV Group
• Kevin O'Hara, Healthstream
• Veronica O'Quinn, METI
• Mellie Pouwels, Radiological Society of North
  America
• Andrew Rabin, CECity
• Michael Saxton, M.Ed., Pfizer
• Hillary Schmidt, Ph.D., Sanofi-Aventis
• Donna Schoonover, Department of Veterans Affairs
• Scott Weber, Med-IQ
• Walter Wolyniec, Boehringer Ingelheim
• Edward Kennedy, Accreditation Council for
  Continuing Medical Education
• James Lesit, Alliance for Continuing Medical
  Education
• Tim Willet, M.D., CRI Critical Care Education
  Network
• Ross Martin, M.D., Bearing Point

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MEMS Use Case
Jointly sponsored activities
Journal-based ce
Online activities
In person activities
Outcomes DB
Program Evaluation Dashboard
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MEMS Status

• Flexibility of instruments
• Draft specification and schema
• Developing survey item specification
• Moving to higher levels of evaluation

76
Exchanging CE Data

• Activity
• Streamlining CME Reporting and Administration
• 10 min

77
Summary
78
MedBiquitous Goals

• Better tracking and evaluation of professional
  education and certification activities
• Activity Report
• Point of Care Learning
• Medical Education Metrics
• Easier discovery of relevant education and
  information resources when and where needed
• Healthcare LOM

79
MedBiquitous Goals

• Interoperability and sharing of high quality
  online education
• SCORM for Healthcare
• Virtual Patients
• Coordination and tracking of competence
  assessment data
• Professional Profile
• Competencies

80
Back to your challenges

• Can existing standards address any of the
  challenges you face?
• Are there needs for other standards?

81
Questions for you

• Are standards a good idea?
• Should you develop them within your own
  organization?
• What are the benefits of standards to your
  organization?

82
How to Participate
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Working Group Meetings

• Activity Report WGThur, 330 PM
• Competency WGThur, 12 PM
• Learning Objects WG, Thur, 730 AM
• Metrics WG Thur, 12 PM

• Point of Care Learning WGThur, 730 AM
• Professional ProfileThur, 330 PM
• Virtual Patient WGToday, 330 PM

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Contact

• Valerie Smothersvalerie.smothers_at_medbiq.org