Healthcare providers face complex decisions every day. Some studies show that a clinician has a question for about every other patient they see.  With the growing use of Electronic Health Records, there is an opportunity to leverage computer technologies to assist clinicians as they make decisions. Decision support, which provides clinicians with clinical knowledge and patient-related information, is increasingly used to inform and guide clinician decisions on many topics. But what if the clinician doesn't have the background needed to best use the support offered? Or if the clinician's question is on a topic for which there is no decision support in place? Implementing point-of-care learning specifications into an EMR could provide benefits to the clinician user by streamlining the tracking process and rewarding continuous learning. 

Many clinicians use point-of-care learning products  to search for answers on their clinical questions. The American Medical Association (AMA) and the American Academy of Family Physicians (AAFP) have defined point of care learning as "practice-based learning that takes place in support of specific patient care." Both have provisions for CME credit for physicians who use point of care learning products and evidence-based literature to answer clinical questions at the point of care, meaning, within the context of their practices. The Accreditation Council of Continuing Medical Education reports that in 2007, over 100,000 physicians participated in over 15,000 point of care learning CME activities.

Electronic Health Record systems may build support for point of care learning into their systems, making it easier for clinicians to find the information they need, when they need it and allowing clinicians to earn CE credit for providing better patient care.  Awarding of CME credit is dependent on the physician documenting his or her search as a learning activity.  Many companies and professional organizations are developing search-based point of care learning tools. Standards for the credit data can facilitate integrating and supporting point-of-care learning from within Electronic Health Records. The HL7 infobuttons standard provides a mechanism for sending search queries to a database.  The MedBiquitous Activity Report specification provides a mechanism for tracking learner activity and credit information, including all of the point of care learning documentation required by the  AMA and AAFP. This specification is particularly helpful when a technology provider that provides access to content is working with a separate organization that is the accredited provider of the CME activity.  Further, standards for this form of credit can integrate with recordkeeping systems for other types of CME-certified programming.

This streamlined offering and tracking of learning activities is beneficial to clinicians for many reasons.

1. It helps clinicians answer their clinical questions quickly, when they need the information. If the learning opportunity is built into the EHR , the process of searching for information is streamlined and promotes fast and easy searching.
2. It allows clinicians to access the resource that best fits their needs. Because standards provide a way to access many resources instead of linking to just a single resource, it allows clinicians of different specialties and backgrounds to access the best sources of information to meet their need.
3. It promotes tracking of practice-based learning, allowing the clinician to get a better sense of their practice and follow up key topics with more in depth learning. It can be difficult to remember the clinical questions that require more follow up. By tracking the questions and resources accessed, clinicians can follow up with further learning when they have more time.
4. It gives the clinician CE credit for taking the time to take care of the patient, without adding an administrative burden.
5. Standard data formats allow Accredited Providers to assess aggregate needs for additional information and/or education suggesting subjects for additional education and/or reference material.

Implementing point-of-care learning specifications into EMRs provides added benefits to the clinican end users lof the EMR system. By integrating with existing learning tools and tracking systems within the enterprise, EMRs implementing the specification allow clinicians to be rewarded for engaging in learning to answer their clinical questions and improve patient care, streamlining the documentation of these activities in the process. This allows clinicians the opportunity to seek out additional information while relieving them of the burden of maintaining documentation.

The MedBiquitous Point of Care Learning Working Group develops 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. Its members include leaders from professional medical societies, publishing, academia, technology, and quality improvement. All MedBiquitous specifications and standards are available without charge under the MedBiquitous Consortium XML Public License and Terms of Use. For more information about MedBiquitous and the point of Care Learning Working Group, visit http://www.medbiq.org or contact Valerie Smothers, Deputy Director, at vsmothers@medbiq.org.