To keep up-to-date with continuing certification requirements, board-certified clinical informaticians should visit the website of the appropriate board, the American Board of Preventive Medicine, or the American Board of Pathology. Please note that “Continuing Certification” is replacing “Maintenance of Certification” when referring to the lifelong learning in which diplomates engage after they have passed their medical board exam.
ABPM Diplomates and Satisfying the IMP through AMIA
Diplomates board-certified through the ABPM must complete an Improvement in Medical Practice (IMP) activity through AMIA during each 10-year reaccreditation cycle.
Currently, the IMP, or MOC-IV, must be a quality improvement/performance improvement activity, or it may be a 360-degree evaluation by colleagues. AMIA is looking into additional formats that may satisfy this requirement. When additional formats are approved by the ABPM, AMIA will inform diplomates of any new formats deemed acceptable.
Here is the template diplomates use to submit the MOC-IV/IMP report to AMIA.
Diplomates who are ready to engage in the IMP project should:
- Review the template and reflect on a project that would demonstrate performance or quality improvement using clinical informatics
- Purchase the AMIA MOC-IV project by logging in at AMIA.org and clicking “Online Store.” Look for “MOC-IV Project” to purchase.
- Engage in the PI/QI project, completing all of the required (asterisked) fields in the Word template; the actual project should take at least three months to complete. (Please do not use the online submission tool as it does not allow for inclusion of images.)
- Email MOC4@amia.org to submit your project. AMIA then puts it into review by the MOC Committee, informs you if it has been approved, and communicates with the ABPM that you have satisfied this requirement
Note: You may contact AMIA’s Director of Continuing and Professional Education at MOC4@amia.org with any questions on completing the template for a performance/quality improvement or 360-degree evaluation type of MOC-IV/IMP project.
MOC-IV/IMP Projects Accepted by ABPM
Below are MOC-IV/IMP projects that illustrate some approaches clinical informaticians took to satisfy the MOC-IV/IMP requirement. Each diplomate identified an area for improvement, provided baseline data, implemented a clinical informatics approach to address the problem, then provided post-project data.
Diplomates submitted their reports to AMIA. AMIA had two reviewers from the AMIA MOC committee review each project and provided acceptance information to the ABPM. The ABPM maintains the database for clinical informatics diplomates and records that the MOC-IV/IMP requirement has been satisfied.
Title: “Keep it Level (Lithium monitoring)”
Diplomate: Kathryn Cillessen, MD
Abstract: The VA North Texas implemented a CROC (Clinical Reminder Order Check) to activate when a prescription for Lithium was ordered and no Lithium level was found in the system in the last six months. The goal was to improve the percentage of patients meeting the minimal lab monitoring guidelines. Once a lab order was placed a letter was mailed to patients needing labs and the Lab staff were educated to look for old orders. While the percentage of patients having the lab done within 6 months improved there were many lab orders placed but not completed. Additional work on the process for education of patients and staff is needed.
Title: “Personal Health Record Operationalization”
Diplomate: Anthony M. Dunnigan, MD
Abstract: Faced with low personal health record (PHR) sign-up and engagement, including a general lack of understanding of PHR features among both patients and staff, and lack of a clear, consistent process for patient sign-up, a project was led to increase sign up, firmly operationalize key processes, and add value to the PHR for both patients and staff. Key data gathered included PHR activation rates by each ambulatory center, communication rates, rates of online scheduling, and patient satisfaction. Clinical leaders were placed in the business ownership role, and through biweekly meetings reviewed data and helped drive the success of the project.
Title: “Reducing Medication Warnings”
Diplomate: Michael Hwa, MD, FACP
Abstract: Electronic Health Records (EHR) adoption is growing rapidly. >95% of acute care hospitals and >90% of office-based physicians have adopted EHR’s. Computerized Physician Order Entry (CPOE) and Clinical Decision Support (CDS) tools have been shown to improve outcomes, but alert fatigue is an increasing concern. Alert fatigue is the phenomenon of end users becoming desensitized due to an excessive number of false positive alerts, leading to dismissing potentially clinically relevant alerts. At Santa Clara Valley Health and Hospital Systems Medication Warnings are the highest firing CDSS tool. For CY 2018, for every 100 medication orders placed, there were 110 warnings. We undertook a quality improvement project involving a multidisciplinary team to systematically evaluate medication warning data in our institution. Using standard tools in our EMR we reduced warnings by ~30% over a 1-year period.
Title: “Early Identification and Treatment of Sepsis”
Diplomate: Julie Massey, MD, MBA
Abstract: Our sepsis project was divided into two parts: Early identification and treatment upon presentation to the Emergency Department and Early identification and treatment in the Inpatient setting. Each initiative included implementation of an alert in the electronic medical record (EMR) and development of subsequent defined protocols and pathways for diagnostic evaluation and treatment. The project required development of education for clinical staff on sepsis, review and revision of order sets, implementation of new workflow processes, and measurement and monitoring performance on key metrics through development and dissemination of dashboards. The sepsis initiative resulted in improved mortality rate and reduced complications, length of stay and direct cost of care.
Title: “Improving patient screening rates for depression and falls risk using inline context aware decision support”
Diplomate: Matthew Rafalski, MD FAAFP
Abstract: My project consisted of looking at several aspects of in-line, context-aware clinical decision support (ICA-CDS), implemented in a commercial EHR at a community health center non-academic practice to improve screening practices. I was able to demonstrate ICD-CDS can effectively improve and maintain routine periodic screening rates for depression in an undiagnosed population. I also showed this technique is intuitive to produce the same improved screening rates in a different population with a different screen (falls risk screen).
Title: “Using Electronic Health Record Template-Based Clinical Decision Support to Reduce Inappropriate Fecal Occult Blood Tests for Colorectal Cancer Screening”
Diplomate: Rachel Sherman, MD
Abstract: Fecal occult blood testing is an accepted screening test for colorectal cancer particularly in patients who refuse colonoscopy. At the James J. Peters VA in 2014, 25% of our screening FOBTs were inappropriate and in the Veterans Health Administration system-wide results were similar at 26% (Powell JGIM 2016). The aim of the project was to determine if an electronic template in the VA’s electronic health record, CPRS, would reduce the rate of inappropriate screening FOBT orders. The template was instituted in 2015 in addition to the preexisting clinical reminder as the only option of ordering screening FOBT tests. Patients were selected through chart review of all FOBTs pre-template (10/14-12/14 n=112) and post-template (10/15-4/16 n=96). The proportion of screening FOBT tests which were inappropriate pre-template was 25% and post-template 7% (p=001). Use of the template was associated with appropriate FOBT ordering by logistic regression (p<0.001).