A recent editorial in Academic Medicine, which is a publication of the Association of American Medical Colleges, argues that continuing medical education (“CME”) courses that are sponsored by electronic health record (“EHR”) vendors can lead to bias and potentially negative impacts on patient care and safety. As such, the authors recommend that the Accreditation Council for Continuing Medical Education (“ACCME”) treat EHR-vendors as a “commercial interest,” and prohibit them from sponsoring CME presentations.
The perspective article, which is entitled Commercial Interests in Continuing Medical Education – Where Do Electronic Health Record Vendors Fit?, lead author Pesha Rubinstein, MPH of the American Medical Informatics Association, reviewed several EHR-sponsored CME courses and found that they are akin to pharmaceutical-company sponsored events. Specifically, the authors found that EHR vendors with large market shares typically hold multiday CME events that offer health care providers a variety of gifts, including free food and drink, social programs, and discounted or free CME credits. In addition, these events usually focus exclusively on the sponsor’s EHR product, while omitting information about competing products, and about the intrinsic limitations of the sponsor’s own product. Further, EHR vendors only present solutions that are specific to their systems, and prefer that their customers wait until they develop and introduce new services to the market. This functions to divert providers’ attention away from competitors’ solutions, which may already be on the market and could improve care immediately.
The authors drew similarities to pharmaceutical industry-sponsored events, noting that those events altered physicians’ prescribing behaviors such that the providers increased their prescribing of drugs produced by the sponsor, and that “might not be in the best interest of patients, payers and society.” As a result, the ACCME designated pharmaceutical manufacturers as “commercial interests” which are not eligible to be accredited organizations offering CME to providers. The authors note that the ACCME does not currently recognize EHR vendors as commercial interests, but urges them to do so in the future and thus “remove them from the list of accredited CME providers” in an effort to prevent these vendors from negatively influencing patient safety and care.
Some argue that such a comparison is unfair as potential reciprocation by individual providers in terms of altered prescribing practices is not comparable to the purchase of an EHR system, which is a large project involving many groups of people. Thus, the argument goes “no single attendee of a vendor-sponsored CME event alone can affect the purchasing of an EHR system.” However, the authors disagree, noting that tens or hundreds of providers from a single institution may attend the same EHR vendor-sponsored CME event and that may include high level decision makers, such as Chief Medical Informatics Officers. In addition, the authors note that providers may further disseminate information to their peers after the CME event has ended, but they may not disclose their conflicts (e.g., receiving free CME) in so doing.
The authors conclude by noting that EHR vendor-sponsored events “are potentially biased, and they pose a risk to patient care and safety,” and by calling on the ACCME to recognize such vendors as commercial interests. They also note that there is a process in place for commercial interests to support unbiased CME events, and if such EHR vendors wish to support CME events, they can do so through that process.
The timing coincides with the call for comments with the ACCME Standards for Commercial Support. Though the ACCME did not recommend adding EHR vendors to their list of non eligible entities, it will be interesting to see ACCME does with this new data.