CME provider tries to target what you treat

The next time you synchronize your handheld computer with your server, you may see this message -- "If you see a 64-year-old patient with a history of fractures, what do you do?"

The message will be sent via ePocrates' medical information database software and is intended for physicians who are most interested in continuing medical education on osteoporosis.

Advanced Concepts Institute, a business unit within the University of the Sciences in Philadelphia, will use the ePocrates messaging system to find out if it can successfully target physicians for particular CME topics based on their patients' insurance claims history.

They also want to know whether messaging physicians via handhelds is an effective way to promote CME. If such a practice catches on, physicians may find a number of CME offers targeted to issues more suitable to their practices.

"A lot of CME offers that go out to physicians are a complete blanket mailing," said Erin L. Murphy, senior research analyst for ACI. "Why offer osteoporosis CME to pediatricians? We're trying to reduce noise. This will go to primary care physicians who are treating adults and [to] ob-gyns."

The research group is using claims data from Aetna, scanning it for patients with particular problems, then targeting the patients' physicians to receive CME related to those conditions. Eli Lilly and Co. is sponsoring the study.

The physicians targeted will be further limited to ePocrates subscribers, since that will be the only software used to contact physicians during the pilot.

Targeting osteoporosis

For this study, Aetna's claims data will be searched for women who are 60 and older and who are not taking any medication for the treatment or prevention of osteoporosis. The data will also be queried for women in this age group who are taking an oral corticosteroid.

At least 15,000 of the 70,000 physicians in Aetna's network, who are ePocrates users, will be targeted. It has not yet been determined how many potentially at-risk patients a doctor needs to have before he or she would be put on the target list.

The targeted doctors will see a headline from ACI among the three DocAlerts they get each time they synchronize their handhelds with ePocrates. If they respond to the message, they'll receive an e-mail with a link to the Web site and the option to go through 10 fictional case studies to help them improve their osteoporosis screening skills. If they pass the mini-test they'll get 0.25 CME credits. Next they can decide if they want to take the full online CME course for 1.75 CME credits. All credits are approved for AMA Physician's Recognition Award credit.

The full online course is interactive, with streaming video of a physician speaking alongside a PowerPoint slideshow, according to Bob Colnes, PhD, senior director of operations for ACI. The DocAlert messages will be sent out through March.

Michael Ross, MD, MHA, vice president of strategic businesses for the University of the Sciences and lead executive of ACI, said he's watching to see how physicians respond.

"What this is about is to better understand if this type of alerting mechanism can in fact result in physicians doing CME, and particularly CME that may be more relevant to them based on their claims experience," he said.

George Shannon, MD, a family physician in Columbus, Ga., is a member of the American Academy of Family Physicians' CME commission and also a user of ePocrates. He reads his DocAlerts and screens them for ads. "If it looks like marketing, I discard it, If it looks like something I need to know, I get it, " he said. "We get inundated with CME offers."

If he was being targeted because he may have patients at risk for osteoporosis, he'd rather to be told directly, Dr. Shannon said, so he could look up those patients' charts.

The targeted physicians won't get that much detail, but the effectiveness of the CME in changing physician behavior will be looked at down the road.

Other CME projects on the calendar, such as one that targets physicians with patients who have diabetes and may be at risk for high cholesterol, could track physician response through pharmaceutical claims for lipid-lowering medications, Murphy said.