CME On Your Cell or Dell
Robert Lowes May 2009
In-person medical meetings will always have their place, but online CME is clicking with busy doctors
A patient with coronary artery disease recently asked family
physician Floyd “Tripp” Bradd III, MD, in Front Royal, Virginia, about
bare-metal versus drug-coated stents. Dr. Bradd turned to his exam-room
desktop, looked up the subject in an online compendium of
evidence-based articles called UpToDate, and reviewed the fine points
with the patient.
“In today’s economy, I have more of an impetus to do my CME online,” says Dr. Bradd.
He’s not alone. The percentage of CME conducted in cyberspace—as
measured by physician participants—rose from 1 percent in 1998 to 31
percent in 2007, according to the Accrediting Council for Continuing
Medical Education. And one-fourth of doctors in 2007 earned more than
half their credits this way, reports Manhattan Research, a firm that
studies health-care IT. These figures only stand to increase as
doctors cut back on coursework requiring overnight travel—50 percent
say they’ll do so this year, according to the publication Medical
Meetings. The fact that most online CME is free only strengthens the
urge to stay put.
Other trends are contributing to the growth in online CME. The
smartphone revolution—led by the Apple iPhone—gives doctors better
handheld devices for downloaded or browser-based learning activities
(Dr. Bradd uses his iPhone to research clinical issues on hospital
rounds, for example). And the incorporation of medical reference
materials into electronic health records creates opportunities for
exam-room lessons that doctors are more likely to remember than
something they hear in a lecture hall. “It’s education that sticks
with you better,” says Dr. Bradd. Since online CME is becoming more
prevalent, you’ll want to know what the future holds.
LITTLE LESSONS, LOTS OF CREDIT
Much of the written CME material, including the usual post-test
questions, takes only 15 to 30 minutes to complete, yielding one
quarter or one half of an AMA PRA Category 1 credit. Such bite-sized
portions allow internist and pediatrician Sal Volpe, MD, in Staten
Island, New York, to digest the latest research on his Samsung
smartphone while sitting through band rehearsals for his sons Gino and
Salvatore. The little lessons add up. Volpe says he earns about 75
percent of his CME credits through his smartphone, laptop or desktop.
All manner of accredited CME providers, including medical schools,
medical societies, and hospitals, have migrated to the Web, but doctors
obtain the bulk of their online credits from medical publishing and
education companies such as Medscape and MedPageToday.
Epocrates and Skyscape, firms that specialize in medical reference
material for personal digital assistants (PDAs) and smartphones, are
big CME players, too.
Some sources of online CME come with a price tag. It costs $495 to subscribe to UpToDate
for the first year, with annual renewals at $395. Other sites charge a
modest $10 to $15 per credit hour. “But there’s enough free stuff out
there for a doctor to never have to spend a dime,” says psychiatrist
and family physician Bernard Sklar, MD, in Berkeley, California, who
maintains a Web site listing more than 300 sites for online CME.
However, doctors may have to pay for more of their continuing
education in the future as pharmaceutical companies, under increasing
pressure to exert less influence on prescribers, reduce their subsidies
of CME. Commercial support of all CME, which includes pharma dollars,
represented 48 percent of total funding in 2007, down from 55 percent
in 2003, according to the ACCME. About half of that support went to
medical publishing and education companies.
CME IN YOUR POCKET OR PURSE
Fifty-four percent of doctors own a PDA, a smartphone, or both,
according to the latest data from Manhattan Research. Of this group,
about one-third told Manhattan Research that they intended to use their
handhelds for CME in 2008, but for only 6 percent of their total
credits, notes Meredith Ressi, the firm’s vice president of research.
However, Ressi says handheld learning may become more prevalent as more
doctors abandon PDAs for more powerful smartphones, which boast
Internet browsers as well as PDA features. The all-in-one devices
promise to make online CME more inviting.
Consider the trailblazing iPhone, for instance. Flip it
horizontally, and the iPod-style touch screen—one of the largest on the
market—goes to a wider, more eye-comforting view of text and images.
Finger movements let you enlarge or shrink what you see, a valuable
feature if a CME lesson includes an image of a skin rash.
The iPhone’s browser allows doctors to access Web-based CME
activities just as they do with their laptops or desktops. However, CME
and medical reference software from Epocrates and Skyscape are part of
“native” applications that, once installed, run on the iPhone and other
smartphones as opposed to being accessed on a remote computer. “Lots
of doctors want to do CME on an airplane where there’s no wireless
access,” says Jeff Tangney, executive vice president of sales and
marketing and cofounder of Epocrates. Native applications also operate
faster than Web-based counterparts, Tangney adds.
The iPhone’s wireless capability comes in handy for native
applications, though, by allowing doctors to download new CME
activities on the run, either through a cellular or Wi-Fi network.
Wireless PDAs, in contrast, must be in a Wi-Fi hotspot to freshen up,
while those without Wi-Fi must be “synched” to a desktop or laptop
through a docking station or infrared transmissions. And the iPhone’s
ample storage capacity—16 gigs on the 3G model—lets it hold gobs of
video content, which doctors are clamoring for, says Meredith Ressi.
“It’s easier to listen to a lecture/slideshow than read text on the
small screen.”
LIVE CME WON’T GO AWAY
Nevertheless, point-of-care CME could become more popular as EHR
vendors build artificial medical intelligence into their software.
Doctors who buy an EHR from eClinicalWorks, for example, can have
UpToDate and Skyscape’s point-of-care CME tool embedded into their
systems. UpToDate and Skyscape are courting more EHR partners. Dr.
Bernard Sklar envisions extremely smart EHR programs that could analyze
a doctor’s practice patterns, such as his adherence to authoritative
clinical guidelines, and then suggest what he should study. “That would
be the Holy Grail,” he says.
Amid all the computer wizardry, there’s still a future for live,
communal CME. Doctors benefit from the reflective atmosphere possible
when they’re away from the office. Besides that, they’re social
creatures. “It’s good to network with colleagues face to face,” says
Dr. Bradd.
And besides, it’s the best way to compare what smartphones they’re packing.
NET EDUCATION
Online CME as a percentage of all CME in 1998
31 percent
Online CME as a percentage of all CME in 2007
*As measured by physician participants
Source: Accrediting Council for Continuing Medical Education
Award-winning journalist Robert Lowes has reported on the medical profession for 20 years.
