Stephen C. Shannon, DO, MPH

MedBiquitous and the Standardization of Everything


Everywhere we look in the complex world in which we live, things are being standardized. They are an important part of our everyday lives, from web-based standards, to standards of weight and measure, to standardized testing. In the field of healthcare, standards have become increasingly important as well, as they factor into how electronic health records are administered; how diseases and conditions are coded; how research results are shared; how E-learning is conducted; and much more. The latter are especially important in the field of medical education, and exciting work is being done to advance the development and adoption of these types of standards.

As with many applications in medical technology and informatics, E-learning standards provide a foundation that can be used productively in healthcare, but additional attributes unique to healthcare must be added to make them usable. E-learning standards answer the question, “How do we describe learning content, discover, and reuse that content, and assure that content is fully interoperable[1] when moving from one administrative system to another?” Founded by Johns Hopkins Medicine and leading professional medical societies, the MedBiquitous Consortium ( is the ANSI-accredited developer of information technology standards for healthcare education and quality improvement, working on developing a technology blueprint for these kinds of E-learning standards. AACOM staff have been regularly involved with the MedBiquitous Consortium as it seeks to provide a neutral forum for educators and industry alike to exchange ideas about innovative uses of Web technologies for health professions education and quality improvement. Medbiquitous’ mission is to develop and promote technology standards for the health professions that advance lifelong learning, continuous improvement, and better patient outcomes.

Future Directions for E-Learning and Medical Education Standards

MedBiquitous standards and development efforts are many and varied. Of all the initiatives they are involved in, the following are the most relevant to osteopathic medical education, and represent areas of interest for AACOM:

  • Activity Reporting - provides a common format for reporting professional education and certification related accomplishments. 
  • Competencies - provides a common format for representing a list of competencies relevant to a profession or specialty. 
  • Curriculum Inventory - provides a common format for curriculum data for benchmarking and educational research. 
  • Educational Achievement - provides a common format for documenting learner competency and entrustment across the continuum of health professions education. 
  • Educational Trajectory - supports the tracking, planning, and audit of learners’ educational trajectory across medical schools and national organizations. 
  • Healthcare Learning Object Metadata - based on the IEEE standard, provides a standard way of describing healthcare educational resources and activities. 
  • Medical Education Metrics (MEMS) - provides a common format for gathering and communicating evaluation data on healthcare education activities, including REMS CE activities. 
  • Performance Framework - provides a common format for the expected levels of performance related to a competency framework. 
  • Professional Profile - provides a common format for exchanging clinician contact, education, training, certification, and membership information. 
  • SCORM for Healthcare - a version of the Advanced Distributed Learning Initiative's SCORM model for online learning that implements Healthcare Learning Object Metadata. 
  • Virtual Patients - provides a common format for sharing interactive computer programs that simulate real life clinical scenarios for education and assessment purposes.
As progress is made in each of these areas, AACOM will report on significant developments that have implications for COMs via this newsletter as well as our other communications channels.

AACOM Active in Setting Standards

Although it is important, E-learning is not the only standards area that is relevant for osteopathic medical education. AACOM has long been involved in setting standards in many areas, as we work with other organizations to develop appropriate standards for the accreditation of colleges of osteopathic medicine through the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation; as our faculty and representatives participate in osteopathic graduate medical education standard-setting on the AOA’s Council on Osteopathic Postgraduate Training, Council on Osteopathic Postdoctoral Training Institutions, and the Bureau of Education; and as our nominees will begin to participate in the standard-setting bodies within the Accreditation Council on Graduate Medical Education (ACGME) as Single GME Accreditation is implemented over the coming months and years.

 In addition, AACOM’s member faculty have worked on the development of curriculum competencies for osteopathic medical students and for all health professions’ students. We collaborate with policy makers at the federal level in their own establishment of laws, rules, regulations and definitions related to health care, medicine, and medical education. The faculty of our colleges are a part of the network of expertise working with the National Board of Osteopathic Medical Examiners (NBOME) to develop multiple levels and mechanisms of testing students and residents for the purpose of physician licensure, and they participate in the “standards setting” process for implementing such assessment. And AACOM and itsEducation Council for Osteopathic Practice (ECOP) was responsible for creating and is responsible for maintaining the Glossary of Osteopathic Terminology to establish common definition and understanding about terminology unique to our profession—thus enabling unified curriculum, testing, research, medical record standardization and—ultimately—third-party payment for osteopathic manipulative medicine services.

Healthcare Standards Development Organizations (SDOs): The Value of Nurturing Collaboration

Although the initiatives described above by MedBiquitous, AACOM, and others represent an impressive scope of work, there is just as much value to be realized from the process of developing standards, as from the products that result from those processes. As the number of SDOs  in the healthcare domain grows, collaboration and coordination among them will become even more important. 

Such collaboration will reduce redundant efforts, save the standards community valuable resources, and improve the quality of the standards that they develop. Just as we are seeing an increase in collaborative and team-facilitated approaches to the provision of inter-professional healthcare by providers such as nurses, physician assistants, MDs, and DOs, we are also seeing the integration of many types of organizations in the movement to develop standards that can cut across technical, professional, and cultural barriers in order to facilitate interoperability within the healthcare technology area. This type of collaboration not only leads to better understanding and relationships among the various groups, but results in the development of standardized tool sets and software interfaces that benefit the entire user community, in addition to the standardized “product” itself.

How can we persuade users to adopt newly developed standards? That’s a very good question. Within academic and governmental research organizations, sharing of research data and information is being encouraged through grant mechanisms which serve to encourage improvement in the way biomedical research is conducted and promote the engagement of communities in clinical research. For example, an R01 grant from NIH that requires sharing of data and the use of standards that promote interoperability is a very powerful incentive for awardees to adopt standards that they might not otherwise consider. 

As one of AACOM’s strategic goals moving forward is to “demonstrate the distinctive value and approach of osteopathic medical education by providing opportunities for collaborative research and scholarship,” we will increase our chances for success by being familiar with these collaborative processes and working with these SDOs that are currently in play within academia, industry groups, and government agencies.

To date, the most effective means of exchanging research data is through the use of common standards. Standards “harmonization” that enables the secure flow of clinical information from EHRs can benefit clinical research studies, safety reporting, and other use cases. But as we all move toward the healthcare ecosystem of the future and work to have the osteopathic profession play an appropriate role in those developments, we can be sure that technology standards will be an ever important element in the connectivity and collaboration that will be necessary.

[1] Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user
Inside OME Header
June 2014
Vol. 8, No. 6