Effectiveness of

Point-of-Care
Continuing Medical
Education credit
(EPOC-CME)
Presented by Raju Datla
HI 698

Instructor
Dr. Eta Berner

Advisors:

Dr. Jeroan Allison, Assistant Dean and Director,

UAB-CME

Ms. Katie Crenshaw, Assistant Director,

UAB-CME
 In this presentation….
 Literature review of Point-Of-Care Information Seeking
Behavior of Physicians and Online CME. (Information
seeking trends in the past decade, barriers, improvement
techniques)
 Statement of the problem
 Methods (Overview, recruitment protocol, description of
the website)
 Results and Discussion (User login information, site
usage, link popularity, CME credit earned etc.,)
 Conclusions

September 7th 2007 EPOC-CME

 Literature review in brief
Introduction to key terms
What is CME credit?
What is Point-of-care?
What is evidence based medicine?

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 Information seeking trends - I
October 1996 (Information retrieval patterns and needs among
practicing general surgeons: a statewide experience.)
• Study involving practicing general surgeons in New Mexico
• Top answers – Patient Care (98%), CME (83%)
• On-line resources used were less (6%)
• Primary source of CME – Professional meetings (97%)

2001-2002 – American Medical Association (AMA) survey

• 78% physicians with internet connectivity at offices. Purposes
ranged from e-mail to prescription writing.
• Hours spent on-line/ week
1997 2000
4.3 7.1

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 Information seeking trends - II
2002 (“Physician Internet Medical Information-seeking and On-line
Continuing Education Use Patterns”, Casebeer et al, )

• Top ranking answers – Email (90%), personal use (86%)

• 31 % “CME activities online”
• 29 % “patient specific information”

2006 (“Information-seeking
behaviors and reflective
practice”, Bennett et al )

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 Information seeking trends - III
2004 (“An evaluation of information-seeking behaviors of general
pediatricians”, D’Alessandro et al)
• Efficiency of on-line resources same as that of traditional resources
(books, journals)
• Group 1 – Used all resources
• Group 2 (one year later) – Used online resources after initial training
• Surveyed – 71.8 % believed finding an answer to the question affected
patient care.
• Time taken to find an answer

Control/Group 1 Intervention/Group 2

19.6 min 8.3 min

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 Information seeking trends - IV
2005 (“Information-seeking behaviors of practitioners in a primary
care practice-based research network”, Andrews et al)

• Preferred print resources to online resources

• However, Internet usage was not discouraging (58% searched on-
line for information several times a week, 18% used internet daily)

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 Information seeking trends outside
the US
UK, Norway, Sweden
• 95% respondents claimed access to internet
• Norway had 90% internet connectivity at
physician offices
Germany
• No mandatory CME, authors however conclude
with a recommendation to make CME
mandatory
• Strong support for on-line CME
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 Summary of the advantages of
on-line resources
Advantages of online resources
• Better time efficiency, when on-line resources are used.
• Availability of a wide range of information and the latest
information, compared to printed resources.
• Ease of access and search functionality for on-line information.
• On-line resources are cheaper than text books and some other
traditional resources.
• Availability of various tools, both customized and non-customized
for physicians comfort in using them.
• Ease of maintaining resources when they are on-line compared to
storing books and printed material.

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 Summary of the advantages of
traditional resources
• Habituated to using books, journals and conferences
• Break from practice atmosphere
• Detailed information available on fewer but specific topics (When
search engines were still not as effective as they were in the late
90’s)

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Barriers to seek information on-line.
Summary
1996
• Isolation from medical schools
• Practice demands
• Computer Illiteracy

2004
• Lack of time
• Cost
• “format” of resources
• Information-seeking skills
• Software incompatibilities
• Lack of availability of specific information

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 Barriers to Physicians across the
world
Australia
• lack of proper infrastructure (lesser or
insufficient number of computers at
required areas, outdated computers
without printer access, slow connections)
• software problems (access issues like
password, too many security procedures)
• computer illiteracy
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 Barriers to Physicians across the
world
Norway
• Having to use two separate computers, one for storing or
accessing patient data, and the other for the Internet
usage

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 Overcoming Barriers
• Lack of infrastructure
– Return on Investment (ROI)
– Increase in throughput
• User resistance
– Training
– Incentives
– “Project Champion”
• Lack of search skills
– Training
– Usage of better tools to account for poorer search skills
• Lack of time
– Better tools
– Improved efficiency
– Importance of looking for information
• Software incompatibilities
– Platform independent technology

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 Questions
• Can complete or partial CME credit as an
incentive, help overcome any of the barriers and
serve as a motivating factor to physicians to look
for information at the point of patient care?
• Can we evaluate the efficiency of complete CME
credit vs. partial CME credit?
• What is the general state of knowledge of
resources available on-line?
• Additionally, what factors can be included in the
definition of point-of-care?

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Overview
• Duration of the study: 5 weeks.
• Method of conducting the study: Fax based recruitments,
on-line collection of resources, on-line feedback and
surveys
• Phase 1 awarded 4 CME credits for a minimum of 8
logins to the site and completion of the questionnaire by
the user
• Phase 2 involved inviting the users again and users were
awarded 0.5 CME credit every time they logged on, up to
a maximum of 6 CME credits in all. A final questionnaire
was required at the end of phase 2

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 Recruitment - 1
• Approved by Office of the Institutional
Review Board at UAB.

Out of 2091 faxes sent (1817 in AL and 274 in MS)

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 Recruitment - 2

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 Incentives
• 24-hr Access to the website and links to
collection of publicly available resources
• Awarding complete or partial CME credit for
activities that physicians already perform during
routine patient care. CME credits will be
awarded at the end of each phase. A total of 10
CME credits can be issued for complete
participation.
• Search feature for available topics within the site
• On-line access to “The Medical Letter” through
UAB, Division of CME.

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 E-mail Reminders
Phase 1
• Sent every Monday along the duration of the study.
Week 1
• Email containing URL (website address) (first time invite)
• E-mail reminding physicians to log on (for those who have not
logged on yet)
• E-mail reminding physicians to complete survey if they have logged
in 8 times already
Week 2
• Email containing URL (website address) (first time invite)
• E-mail reminding physicians to log on (for those who have not
logged on yet)
• E-mail reminding physicians to complete survey if they have logged
in 8 times already

September 7th 2007 EPOC-CME

 E-mail Reminders
Phase 2
• Sent every Monday along the duration of the study.
Week 1
• E-mail reminding physicians to log on (for those who
have not logged on yet in Phase 2)
• E-mail reminding physicians to complete survey if they
have earned up to 6 CME credits already
Week 2
• E-mail reminding physicians to log on (for those who
have not logged on yet in Phase 2)
• E-mail reminding physicians to complete survey for CME
credits earned.

September 7th 2007 EPOC-CME

 EPOC-CME Website

Website Graphics by MS. Gayathri Sundar, Graduate Assistant, UAB-CME

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 EPOC-CME Website -Registration

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 EPOC-CME – Home page

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 EPOC-CME – Resources
• 12 primary external links
• Framed (inline) websites

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 EPOC-CME – Resources
• Resources section also displayed a list of 63 keywords and 160 links (188 in Phase 2) for the

keywords.

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 EPOC-CME – My CME
Phase 1

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 EPOC-CME – My CME
Phase 2

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 Technical details
• DotNetNuke® – Content management
system
• Microsoft® SQL Server 2000 (Database)
• Forms Master®

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 Evaluation
• Recruitment comparison

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 Results and discussion -1

First login to the website User login count in Phase 1

and Phase 2

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 Results and Discussion - 2

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 Results and Discussion - 3

6 out of 10 eligible users 5 out of 9 eligible users

completed the completed the
questionnaire questionnaire

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 Results and Discussion - 3
Patterns of site usage with respect to CME requirements

Logons Number of participants

<8 logons phase 1 7
8 logons phase 1 1
>8 logons phase 1 9
<12 logons phase 2 5
12 logons phase 2 2
>12 logons phase 2 2

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 Results and Discussion - 4

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 Results and Discussion- 5

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 Results and Discussion - 6
• Time spent on the website
• A sample calculation of the time spent by
all users taken into account 2 to 29
minutes of continuous activity in a single
session yielded an average of 27 minutes
of website use by all users in both the
phases of the study

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 Results and Discussion
Range of total time spent by users
• Minimum 3 minutes
• Maximum 75 minutes

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 Results and Discussion
• There have been 6 instances in phase 1 by 5
users and 4 instances in phase 2 by 4 users who
have logged in more than 3 times in as many
minutes.

• One of the feedback questions was the users

were asked if logging in 8 times was a
reasonable requirement. Six users strongly
agreed and the remaining 3 users agreed with
the statement.

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 Results and Discussion

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 Results and Discussion

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 Results and Discussion

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 Results and Discussion

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 Results and Discussion

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 Results and Discussion

Comments about the website:

“excellent”
“you have connected me to new sites for good information”
“LOVED it!!! Symptom checker was wonderful!!”

September 7th 2007 EPOC-CME

 Conclusion
• It can be concluded that awarding CME credit is
definitely a motivating factor for health care
providers to look for resources at the point of
patient care.
• Users did claim more CME credit hours for more
time spent on the website, in spite of the fact
that the number of users(6) in phase 2 was
lesser than those (9) in phase 1.
• Possible misuse of claiming CME credits by
successively logging on and not using it for a
practical purpose must be discouraged and
checks placed in the system
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 Conclusions
• Users were mostly satisfied with the
quality of the resources provided and
agreed that participation did have an
impact on their professional effectiveness.

September 7th 2007 EPOC-CME

 Conclusions
• Of the users who were asked their view
about definition of point –of-care, all of
them chose at least one factor that was
using the resources within a reasonable
time frame post or prior to a patient visit

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 The End
• Questions

September 7th 2007 EPOC-CME