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Meeting Information


June 5, 2013



Attending:  James Fiore, co-chair; Jyothi Holla, Don Kooker, Ed Kennedy, Jen Michael, Valerie Smothers

Agenda Items

1 Review minutes of 4/8 and 2/20

The minutes were approved.

2 Potential use cases/requirements arising from 4/8 and recent discussions

a Tracking teams (ie team-based participation in quality improvement projects)

James explained that we talked about Emergency medicine and their team based approach to maintenance of certification activities at the in person meeting in May. We’d like to discuss the use cases and how we could further develop the standard. He asked Jen to go into more detail about how the activity report might be changed.

Jen commeted that she is not familiar with all the details. They are seeing more requirements for assessment and tracking to be based on team activities. One is the emergency room, surgery is another. They work in a team environment. You are never seen in an ER by one person. There is the triage nurse, resident, attending, etc. To try and do a patient survey assessing one care provider is difficult. For example, the patient doesn’t know which person was which type of professional. Emergency Medicine brought a request to do survey and quality indicators based on a team approach rather than individual. There were concerns that it might allow poor performer get a better grade and vice versa. There are a lot of nuances about how one could track the activities. We need to ask ourselves if the standard is written to allow the same content to be applicable to multiple people. She doesn’t know if it would look like a duplicate or would there be identifier or field for team activity.

James thanked Jen for the explanation. The team approach puts the standard on its head. Activity report is defined by the professional profile. Looking at it this way spins it around. One thing to consider, we may indicate an activity as a team based activity. Then you would not worry about duplicates; it’s a system level issue. The idea that this is a team based approach, and identifying which professional profiles are linked in is interesting.

Valerie asked if getting in touch with Emergency Medicine was a good next step.

Jen replied that Valerie may want to look at team based activities at Hopkins. She’s not sure how much those processes get to count as activities. If not a lot is passing now, it will be more. She added that she is not sure CME vendors track group activities. She can try to find a write up on Emergency medicine and their request. They asked about the patient survey part of MOC; she doesn’t know if data is captured the same way.

James asked what data structures Jen made up to handle this. Jen replied that the board asked for a particular activity to be approved under MOC. ABMS doesn’t pass that activity data back and forth. The question is better posed to emergency medicine. We would need to know more about what they are doing on their side. They haven’t done a lot of thinking about what it would look like. She can get more specifics from Emergency Medicine.

James commented that we have a uniquely qualified group on the phone. He asked Ed about CME credits that are team based.

Ed commented that in the ACCME system it is up to provider to designate credits. They don’t see which activities are team based. It is a good discussion; team-based activities are becoming more prevalent. It is interesting that it comes up in the context of activity report, which reports on individual participation. It sounds like we need to consider ways of accounting for multiple person participation. Identities of other participants might be relevant information. If we include other folks in the activity report, would that butt up against privacy concerns?

Jen replied that was a good point. This particular request is data from patients, the survey. But if the survey results say the team is incompetent, who else was involved, was that due to the individual or someone else in the group? What do we do with knowledge of individuals?

Don commented that they have been doing group PIMS for 8 years. They are not using medbiq standards for CECity. They send a separate report for each participant. They are not getting scores per person.

James commented this could link with the linked data concept. You could uniquely identify each activity. The professional might be more than just a professional; it might be a team. Do you need superprofile? Then activity is singular and professional profile links to the team rather than a specific professional.

Jen commented that maybe there is value just identifying an activity as a team activity.

Valerie commented that there are existing team based QI programs, such as NSQIP. In that case participation is at the hospital level.

James commented it is not nationally used. That is one reason they don’t use it. They were interested in getting outcomes on actual cases, but because it was too fragmented as to where and how it was used. He recommend we park this for now and revisit. It is not necessarily needed now. We can add to the minutes and carry over month to month.

b Universal Hub - Identifying instances of an activity and more (see note)

Don explained that they decided to keep out the supporting of group pims for the first release. The concept of universal hub, instead of just getting completion information, they want to integrate and allow boards to share each other’s products. They brought together the primary care boards. In the future, they have talked about opening to anyone who wants to participate. Physicians may start on the board website, and may initiate a product on the ABP site. They got a group together to build a common system design. The Hub sits in middle; each organization interacts with the hub. They get a request to put user into an activity, it passes things through the hub. They mostly use the activity report as the base standard. They have adjusted the standard. They’ve added initiate user transfer to signal that you are taking person from a board site to the host site. To support that, there are three things not part of the standard. There is an Activity instance guid. They have cases where people repeat an activity previously done. They needed to keep track of different instances of the same pim. They’ve also included an optional return URL. Once a user gets into the host, it tells where to put them in that product. Last, they have added an optional launch action. That says what is it the board wants you to do – put in product, or put in claim CME process. If ABIM calls the user initiate transfer service, the hub calls the hosting board. Embedded in the response is an activity url and one time use token, then the board redirects the user to that url. The user work on produst, they get create activity report back. They are using activity status and results: support pass, fail, cancel. They need it at the activity level and module level. Sometime you need to complete 2 of 3, etc. They added elements to make it clear when the person has done the activity.  They are using an API key value as they go back and forth. Each board has a unique key.

Jyothi asked if we can take the issues one at a time and see how to implement it.  Don added there are cases where fields are optional. Others they expect all the time. They came up with guidelines for using the hub. Other pieces of the standard are not relevant.

James commented it sounds like work meducator and data commons have done.

Don replied that they did look at one of the other systems using standards. Because each of them is already using activity report, they wanted to stick with that rather than use something else.

James commented that some items don’t seem like modifications so much as extensions. Do you want to include them in spec? Don replied yes, eventually they would like them in the standard.

James asked how the group felt about leaving it in the any element.  Are we open to the idea of moving into the standard? Valerie replied she was certainly open to that. Valerie agreed to work on incorporating the changes in the standard for next month’s call. James asked valerie to update the wiki as well based on these minutes.

c Tracking participation in quality improvement networks

Valerie explained that this discussion came up at the MedBiquitous Board of Directors meeting at the annual conference. Increasingly there are quality improvement networks forming, and participation in those networks differs from participation in other types of QI projects that meet Maintenance of certification requirements.

James asked philosophically, how does a quality improvement activity differ from a regular activity? How or why do you differentiate? Valerie commented that she is still working to understand that. The networks are more community based interventions, where geographically dispersed providers are working together to achieve common goals. In addition, the goal may be a very specific standard of care.

James commented that part of it sounds like competency framework linking. Many people are interested, but there are no practical applications.

James suggested we discuss again in a couple months.

3 Discuss elevator speech (to be written)

Valerie commented she had hoped to write this before the meeting but did not have the time. She apologized. The elevator speech is a quick summary trying to promote use of the standard.

James commented that one email he saw was related to ABMS technet conference in October. Jen commented that ABMS have a board staff conference where they discuss process and objectives. One thing that came up was a section on standards. She told the users she is happy to participate, but after Valerie’s presentation, no one wanted to implement. People replied that they are strapped for staff, but they do have interest in understanding how standards can bring efficiencies. James could discuss pros and cons. An elevator speech would be great, and could help other boards get the punch line.

James recommended that the elevator pitch include Self documenting code as topic , lingua franca for health professions data structures, precision. Also, one key takeaway from last year: how long it took to validate certification information cleansing data. If some of the other boards were using standards it would be cleaner to pull them in. Also, we could include the idea that we all have societies we work with for CME modules. The concept of having activity report repository to feed info to boards for validating is a quick, easy way to get involved with the standards. That would cut down on data entry their office staff has to do to comply with MOC requirements.

Jen commented that she keeps hearing that to switch to standards is a big project. The elevator speech won’t tell you how. We need case studies to get that point across.

Valerie offered to work with James on a case study detailing the steps they went through to implement Activity Report for CE data capture.

4 Update on Technical Steering Committee and linking to competency frameworks

James commented that in our last discussion prior to in person meeting, we discussed ways we could link an activity report to context. We discussed the classification element in healthcare lom, the use of activity report credit focus, URIs to link to competency framework XML, and Dublin core using RDF. The Technical Steering Committee was to come up with a recommendation for linking to competency frameworks form other documents.

Valerie explained that the committee recommended using Dublin core based xml supplemented with some RDF. She is having trouble validating the recommended approach. They are still in discussion with the Technical Steering Committee. Valerie will contact Dublin Core as a follow up.

James explained RDF is a way of defining triplets and relating information. Carl brought up how you can build related information. If you hear about the semantic web, RDF is the protocol. So far it seems to be best hope for how we should be able to link to external sources of information.

5 Open discussion

James will be on vacation week of 6-13. Valerie will get back to the group on the date of the next call.

Parking Lot

  • Representing participation in team-based activities
  • Representing participation in quality improvement networks


Action Items

  • Valerie will update the specification and wiki based on Universal Hub requirements discussed on this call.
  • Valerie and James will develop a case study and elevator pitch for the group to review.
  • Valerie will contact Dublin Core to clarify mechanisms for using Dublin Core with RDF
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