January 28, 2013
7 PST/8 MST/9 CST/10 EST
Call in Number
Attending: Francis Kwakwa, Chair; Doris Auth, Mark Baczkowski, Jennifer Baumgartner, Rod Campbell, Jemma Contreras, Stephanie Cordato, Jennifer Dunleavy, Lisa Fennell, Amy Holthusen, Cynthia Kear, Edward Kennedy, Linda Kitlinski, Joanna Krause, Anjum Malkana, Sue McGuinness, Tom McKeithen, Valerie Smothers, Lorraine Spencer, Brian Sullivan, John Sweeney, Dimitra Travlos, Emma Trucks, John West, and Julie White.
- Review minutes of last meeting
The minutes were accepted as submitted.
2. Discuss professions and specialties document
Francis mentioned we aren’t quite where we want to be so Valerie worked on the specification and sent around another document to the working group prior to the call. Valerie commented that the document was a collaboration with Julie and Linda. On the last call there were many questions raised about the applicability of healthcare lom specialties to different health professions as well as questions about which professions to use.
The first part of the document proposes a revised list of professions. Boston is interested in collecting data on nurses and a few other non-prescriber professions. But that doesn’t mean they would send that data to their accreditors. The list shown is what they would send to accreditors. You can collect data that is more detailed than what we ask for in the standard and implementation guidelines, but when data has to go from point A to point B, it would focus reflect the list of professions in this document. We did add an “Other” category and removed veterinarians as the education is not targeting them.
Julie commented they are interested in nurses that may not be prescribers, as they are an important part to the health care team. The list is what they will report but it doesn’t restrict them in collecting other information. Valerie noted this is something we would point people to from our standard, the implementation guidelines would be more specific.
The rest of the document addresses the fact that specialties that we had derived from ABMS specialties weren’t applicable across health professions. We found quite a lot of variation in the level of formal specialization. In advance practice nursing, it seemed appropriate to use same list as we use for physicians. Regarding pharmacist’s, Jennifer Baumgatner spoke with Valerie and recommended omitting specialty data for pharmacists. It’s such a small percentage of pharmacists that are certified as specialists. Practice types also aren’t appropriate for pharmacists. The classifications they do use for pharmacist are not going to be helpful in REMS. Jennifer Baumgatner added that given the goal of REMS, she was not sure capturing that specialty data would add much value.
Valerie commented that specialty list for dentists pointed to the American Dental Association’s list of specialists; they added general dentistry. Julie indicated that classifying dentists by specialty would be helpful for their purposes. Regarding Optometrists, Valerie corresponded with Lisa, who stated that there are no optometrist specialties at this point. The physician assistants have a slightly different list of specialties that APA uses. Valerie recommended using the Healthcare LOM specialty list for physician assistants to promote consistency across the professions. Podiatry specialties are a little muddy because there are multiple certification bodies for podiatry. She asked Julie if this is going to be useful data. Julie didn’t think it was. There are a small number of podiatrists participating in Opioid CE activities. Valerie asked the group if anyone was either for or opposed to indicating podiatry specialties. Doris commented they used to have podiatrist performing a number of surgeries would they be appropriate for the CE activity. Valerie responded that we would still capture their participation, but we wouldn’t classify them by specialty. No one objected.
The last note was about practice types. We can note that this doesn’t apply for all professions, but for those where it does apply, we can use the following practice types: primary care, specialist, pain specialist, non-pain specialist. A new element has been added to the specification.
Francis asked how much time the group would have for comments on the changes. Valerie replied that CME providers need to develop the systems to collect data by March first, so the sooner the better. Linda commented that they have to check in with accreditors to ensure the feasibility.
Jennifer Dunleavy commented they had a chance to discuss the document within the ACCME and they felt that practice type would be the most relevant information. There are a lot of specialties that physicians can self identify with. They thought practice types were the more practical solution and simpler for providers to collect. Valerie thought that was very helpful. Linda thought that made sense. She asked Jennifer if they are OK with the short list of professions as well? Jennifer stated the ACCME only collects data on physician and non-physician participants; if they need to modify their system to collect non-physician types, that would need to be included in our specification and implementation guidelines.
Valerie asked what other accreditors think about going with practice types and not collecting data on specialty. Pam commented that practice type is easier to organize. Dimitra agreed. Valerie asked the providers their opinion. Julie mentioned they are still struggling with how to ask the question. Would they ask physicians to select one of the four categories? Valerie commented that was a good point, it relates to the way we implement it. Would we allow for one person to be more than one practice type. Linda commented you could ask the learner if they are said, primary care or specialist, and if they select specialist, they could select pain specialist verses non-pain specialist. Valerie stated it wouldn’t necessarily be exclusive, a learner could be two of those four categories. We can make it very clear how that should be in the implementation guidelines. Dimitra asked Jennifer Dunleavy if the ACCME had any idea of what it would like to collect. Jennifer replied it was as Linda described: either primary care or specialist, non pain or pain specialist. Cynthia mentioned there was a CORE meeting later today to bring more clarity to this topic. Primary care and specialist could happen at the same time, and that approach would not be able to capture that. Valerie suggested leaving details of whether or not these terms are exclusive out of the specification and clarifying in the inmplementation guideline. She recommended considering those categories non-exclusive, and providing further guidance in the implementation guidelines when we write the REMS CE.
Pam clarified that professions will be kept. Valerie confirmed. Linda asked if there was a safety measure to not count individuals twice. Valerie clarified that if practice type is non-exclusive, the totals for different practice types will not add up to the number of participants. Francis commented there are ways to distinguish by individual people and multiple choices. Valerie noted a lot of the contents of specialty by professions probably aren’t relevant to the REMS education. Practice type data is more practical than specialty data. Valerie will post the information on the website for those who wish to collect specialty data for internal evaluation purposes.
Valerie continued with the MEMS illustrative powerpoint document dated Jan 27, 2013. Slide 7 includes an illustration of participants by practice type; it includes how many people are pain specialist and non pain specialists. This example adds up to the number of specialists, but it wouldn’t have to be that way. Slide 8 includes practice type as an example in multiple categories. That chink of data is intended to answer the question “how many physicians in Internal Medicine who are ER/LA Opioid prescribers and have a practice type of primary care participated in the activity?”Multiple categories answers complex demographic questions. We can use these various elements together to convey data that is sliced and diced according to multiple categories.
Jennifer provided feedback that the ACCME won’t use the audit consent field shown on slide 5. If they know that the activity is marked as REMS compliant and support by the RPC has taken place, then the activity would be eligible for audit consent and they wouldn’t need to add an additional field to the specification. Valerie noted the ACCME requested this initially, now they don’t need it. She asked the group if we should just take this out or is there an organization who would like to use the consent field.
Linda said her understanding of the REMS document is at least ten percent of RPC supported REMS compliant activity would need to be audited. Another section said that REMS compliant activities not supported by the RPC need to be subject to audit. She does know that there is still interest by accreditors to capture full effect of REMS education whether RPC supported or not. Whatever the mechanism is for that, the activities not receiving commercial support still have to be eligible for audit. Jennifer commented it doesn’t matter whether it’s compliant or not, an activity can be audited for compliance with ACCME standards. Valerie asked if there are other accreditors that want this field in there. Dimitra commented any activity is open for audit and we don’t necessarily need it. She agreed to go with the approach proposed by her medicine colleagues. Pam concurred. Valerie took as an action item, to remove audit consent from the specification. Valerie encouraged group to send her emails with further questions.
Valerie continued with changes to the specification. On page 85 she added a practice type. The definition points to the vocabulary on our website. On page 89, it shows that practice type has been added to multiple categories, conveying data about participants, profession, specialty, practice types. On pages 90 and 92, there is a description added for sub elements of multiple categories, based on existing definitions. Valerie will remove audit consent.
Valerie plans to reformat the standard. Julie asked Valerie what will be the next step. Valerie shared she will make edits to the specification today and to the schema and distribute to the group. Linda commented the next step for the RPC is to identify specific data points that will meet FDA requirements, communicate the data points required in the FDA REMS document that have been integrated into MedBiq specification and confirm the accreditors can capture the data in their data bases. She will follow up with them to see if they can serve as independent auditors. The RPC will specify data points and communicate with accreditors. MedBiquitous would do the implementation guidelines for CE providers.
Linda asked if they can’t wait for implementation guidelines, how you would address that problem. From Julie and Cynthia’s standpoint they will not be asking for anything that hasn’t been indicated here or included in the specification. Profession is required, specialty is not. Valerie asked if there are any points providers have issues or problems with. Julie answered she thinks this is fine and they can work with this. Linda doesn’t want to assume it is feasible with accreditors. Cynthia suspects that it is fine but they are having a meeting later today and she will respond following that meeting. They will get back to Valerie right away. Linda suggested Cynthia copy the whole working group, so we’re all on the same page. Linda asked the group if any other providers had comments to share.
Francis asked what the timeframe is for the RPC. Linda answered they want a quick turnaround and Valerie will send out the document as an attachment to accreditors to get their standpoint. Julie thanked Valerie for all her hard work on the project.
- The group accepted the list of posted professions (http://medbiq.org/mems/vocabularies)
- Specialty data will not be circulated as part of REMS CE evaluation. For those that choose to collect specialty data for internal purposes, they may use the details on what specialties to use for each prescribing profession noted in the document SpecialtyByProfession.docx, but that is not necessary.
- Practice Type data will be circulated as part of REMS CE evaluation. We will clarify the professions for which practice type is applicable and whether any terms in the vocabulary are exclusive in the implementation guidelines.
- (NOTE: subsequent to the call, the ACCME proposed omitting the term “specialist” and making the terms non-exclusive, allowing learners to select multiple practice types. No objections have been raised, and this modification has been made to the posted vocabulary.)
- The group will provide comments on the decisions and specification changes as soon as possible.
- Valerie will remove audit consent from the specification.
- The RPC will identify specific data points that will meet FDA requirements, communicate those to accreditors and confirm the accreditors can capture the data in their data bases. The RPC will follow up with accreditors to see if they can serve as independent auditors.
- Valerie will draft an implementation guideline based on the RPC data points.
- Valerie will work with staff to reformat the specification.