CME Technological Trends: Overview of Online CME and Handheld Computers in Medical Education
By Tamar Hosansky, Editor, Medical Meetings Magazine

MONTREAL—Despite the potential of the Internet to offer convenient and cost-effective CME that crosses national boundaries, there are still many impediments to physician usage, said Bernard M. Sklar, MD, MS, Graduate Fellow in Medical Information Science, University of San Francisco in California.

Dr. Sklar, who created an online CME database for his Master's thesis in June 2000, updated it in June 2002, and shared his latest findings with the meeting attendees. Currently, his database has 209 e-CME sites, comprising 10,952 activities and 18,266 hours—compared to only 13 e-CME sites in April 1997. Nevertheless, the usage of online CME is still low. According to the Accreditation Council for CME's 2000 data report, only 3.5 percent of CME hours are earned online. Dr. Sklar theorized that many physicians are still uneasy with computers and the Internet, are unaware of online CME, and/or don't know how to find online CME.

There are also a number of "hassle factors" that prevent physicians from using online CME. They must pass through a series of gates, download and install plug-ins, and deal with registration and password procedures. Doctors are wary of giving out their license, DEA, or credit card numbers, and are reluctant to pay in advance for content they can't view.

Although e-CME has the potential to be highly interactive, the largest percentage of sites (34%) still rely solely on text and graphics. Only six sites (2%) feature question-and-answer instruction; however Sklar noted that the number of hours was larger (7%).

Nonetheless, Dr. Sklar predicts that online CME will be totally integrated into physicians' daily practice life in the future. He forecasts the development of computer programs that will know when a physician is making a mistake or needs additional information, and will present instruction on the spot to help physicians do the right thing. For more information, visit his database at

CME in the Palm of Your Hand

Handheld computing represents the future of physician education, said Goutham Rao, MD, Director of Medical Informatics and Predoctoral Education, University of Pittsburgh School of Medicine, in Pennsylvania.

Dr. Rao made that assertion despite the numerous limitations to handheld computers—small screens, expense, and the need for a wireless connection. The driving force behind the trend toward handheld computing is HIPAA, the Health Insurance Portability and Accountability Act, which has mandated national standards for electronic data interchange and the protection of patient privacy.

But if you just give physicians handheld devices and produce online CME—and don't teach them how to use the devices—they won't use them, Dr. Rao said. The University of Pittsburgh Medical Center-St. Margaret's developed a program to teach participants how to use handheld computers for tasks such as accessing drug prescribing information and keeping track of patient laboratory test data. The program consisted of four training modules, each of which combined hands-on presentations and multiple-choice quizzes. An important part of the initiative was that it provided a powerful incentive for physicians to finish the program, Dr. Rao pointed out. Participants completing all four modules were permitted to keep their devices, while those who did not complete the program had to return them. Sixty of the 62 participants successfully completed the training; their mean score on quizzes was 90%.

While acknowledging that the project did not assess how the physicians used the device after their training or how it influenced patient management, he said there's no question that the introduction helped the participants use the devices to their full potential.

Physician use of handheld computers is not without controversy, noted Dr. Rao, citing an example of a medical student who left his PDA on a bar where it was stolen. Privacy and security problems will have to be addressed with various encryption and password systems.