Tuesday, December 04, 2018

Doctors' Right to Privacy: Is MOC Collapsing Under Its Own Weight?

On Saturday, 1 December 2018, the American Board of Internal Medicine (ABIM) suffered a meltdown of its highly touted "Knowledge Check-in" ("KCI") alternative to its mandated Maintenance of Certification® (MOC) program.
At 09:45 AM, Saturday, December 1, 2018, during the ABIM Internal Medicine Knowledge Check-In (KCI) administration, Pearson VUE – ABIM’s exam delivery provider – experienced network instability issues that affected hundreds of physicians scheduled to take the Internal Medicine KCI exam.

As a result of these issues, over a period of approximately two hours, physicians were unable to start the KCI, and those who were in the process of testing were unable to proceed.
"KCI," a program that requires continuous payments to ABIM of $155 per year per US physician, was heavily promoted by ABIM as a "kinder, gentler MOC" that physicians could perform in the comfort of their own home, provided of course, that the physician's computer met ABIM's exacting standards. If not, the physician was required to pay an additional $130 to take their MOC examination at a PearsonVue testing center. Sadly on Saturday, hundreds, if not thousands, of US physicians (we really don't know) - all of whom had already funded millions upon millions of dollars for expensive executive salaries, benefits, and contractor expenses to the ABIM for years - lost another of their few precious free weekends staring at computer screens like guinea pigs for academic medicine's biggest income redistribution Ponzi scheme, MOC®.

Not surprisingly, after a lackluster apology, the ABIM tried to deflect blame to someone else: Pearson VUE.
“We at Pearson VUE take full responsibility for Saturday’s disruptive outage of service for ABIM’s Internal Medicine Knowledge Check-In. ABIM did everything they could to help us – and support you – during this time. It was our system that had these issues. As we have promised them, we promise you that we are taking additional steps in order to prevent this from happening again. We are extremely sorry for this unfortunate and rare occurrence and also apologize to the ABIM organization for the disruption and surrounding issues this may have caused. We are committed to continue working in partnership with ABIM in the care and handling of this incident.”
Calls made to ABIM assured physicians that only Pearson VUE was involved in the online proctoring. But there is an important disconnect in the announcement made by ABIM about this incident. Note that the press release issued to the public mentions that physicians at home AND at Pearson VUE testing centers were affected:
At approximately 9:45 AM (EST), on December 1, 2018, ABIM began receiving reports from Pearson VUE and individual test takers that they were unable to begin the exam or were unable to continue it if they had already started.
Their explanation is incomplete.

Might the problem have gone beyond Pearson VUE since individuals at home were similarly affected?

Recall that security of ABIM's examination is of utmost importance to them. They've even had a "Director of Test Security" and even sent their own director of test content to spy on physicians attending a board review course without their knowledge and later sanctioned or suspended over 130 physicians' board certification certificates accusing them of "cheating" in 2009. At that time, the same Director of Test Security for ABIM also worked for a litle known test security firm, Caveon Test Security. It was David Foster, PhD, CEO and President of Caveon Test Security, who was also a Chief Scientist at Kryterian Global Testing Services that touted the security and reliability of their patented keyboard and eyeball monitoring services to the American Board of Pediatrics Foundation on 15 May 2015. It was Kyterion's home testing platform that the ABIM's entire KCI initiative was based.

ABIM diplomates like myself want to know what role the link to Kryterian Global Testing Services had in the events of December 1, 2018 KCI meltdown. ABIM is obligated to come clean on this issue, since it appears more than just testing was occuring that Saturday in December. If the link to Kryterion's keyboard and eyeball tracking technology were involved, physicians' privacy rights may have been violated as well in the name of test security during this latest MOC® debacle.



Anonymous said...

Does this needed to be reported to the FCC? If there is a privacy issue then isn't this a Federal Issue concerning this mishap?

Failure to Warn said...

Unconscionable. Totally unprofessional and negligent of ABIM/ABMS executives to be pushing a faulty and improperly tested product on an unsuspecting public.

Physicians suffered immense harms as well as the patients they serve. Patients who continue to be undeserved and damaged themselves in this newest and latest edition of MOC distractions.

How about a "MOC may be bad for your health and well being" warning label on all MOC products and services from now on. Enough is enough.

I've had it with ABIMS BS science (they are not scientists but MOC salespeople). And now this quiet entry into the booming data and digital health technology markets. It's time to lawyer up and sue them. Blame is with everyone involved.

Anonymous said...

Strongly urge physicians who were harmed or those about to be harmed to have legal counsel.

Pearson Caveon Third Party Partnership? said...

Pearson Third Parties? ABIM Third Parties? ABIM says no.

Facts about Historic Partnerships

Standard Pearson Contract from 2016 included Caveon testing security (Director of Investigations Mannes was with ABIM at the time and had close ties/working relations with Caveon. A profound conflict of interest and inormation that should have been made available online with their employee director not listed anywhere in tax filings either. This obfuscation of a secret order of police with felony convictions should have been enough to cost everyone their jobs. It was hushed and sealed in court documents as well. Why? The ABIM lies and keeps its dark secrets from physicians. This is wrong. I have informed GuideStar about this. ABIM displays that star of platinum trasnparency on their site. They will be asked to take it down. Diplomates should demand that it be taken down. Call ABIM and GuideStar. I am tired of ABIM's lies. Another example of a lie. Dr. Barons said that he came to the ABIM in 2013 in a response to Newsweek's story. Wrong. Dr. Baron has been seated on the ABIM board since the time of the 9/11 attacks in New York in 2001. He has been manipulating the organization politically and financially long enough.)


Senior management at Caveon has deep involvement in testing security and AB Mannes, ABMS' former Director of Investigations had his offices close to Dr. Baron on Walnut Street from 2008-2017. (a.b.mannes status unknown as possible ABMS/Caveon/Pearson contractor) worked/works with Caveon as a director/mangager)

Caveon helped put teachers in prison for helping children pass tests in School programs under the heavy weight of Federal funding requirements in high stakes testing for children.


Caveon spied on children online stalking their blog and chat activity.
Management also advised lawyers on including in physicians ABMS contracts harsh civil and criminal charges in case of irregular behavior or copyright infringement. Not good news for physicians who are wary of the litigious practices of ABIM and Ballard Spahr.

Pearson bought ProctorCam in 2015. Worked with them since 2013. Now PVProctor. ProctorCam did not have security services, mostly platform for testing. Security would be third part or your own. ProctorCam was privately funded in 2011. The old ProctorCam link goes to PearsonVue's PVProctor. ABIM should enlighten us about the history of ProctorCam and give us the dope on this.

Let's see if Dr. Baron and Pearson with its media connections can keep this scandal out of the news.


Caveon's senior management worked for a company purchased by PearsonVue.


Anonymous said...

Who will pay for those refunds? Who will pay for the lawsuits? ABIM will pay court costs.

This is too blatant to ignore. Everyone at ABIM should resign. Go back to having a board of volunteer physicians elected by working physicians, not politicians and the medical industrial complex. The board can be tasked with finding volunteers to write their tests. That is all that is needed. A lifetime test. Make the certification voluntary. Do not offer MOC at all. It costs too much and is worthless. Stop this insanity that surrounds MOC and the money conflicts it causes. There is no other logical course of action.

Anonymous said...

From: ABIM
Date: Mon, Dec 3, 2018
Subject: Saturday's Knowledge Check-In: What Happened?

American Board of Internal Medicine

Saturday's Knowledge Check-In: What Happened?

Dear Dr.:

On Saturday, December 1, 2018, during the ABIM Internal Medicine Knowledge Check-In (KCI) administration, Pearson VUE – ABIM's exam delivery provider – experienced network instability issues that affected hundreds of physicians scheduled to take the Internal Medicine KCI exam.

If you were impacted by this issue, we want to formally apologize and let you know that we heard you. We heard the frustration and anger you expressed. You rightfully expected better. We know you spend a significant amount of time preparing for ABIM assessments – time away from friends, family and patients – and the last thing you should have to worry about is if the exam will work.

For a full recap of what happened, what will be done to prevent this from happening again, as well as an apology from Pearson VUE, please read ABIM's public blog post.

How ABIM is Addressing the Concerns of Affected Test Takers:

As a gesture of our apology and regret, ABIM will refund the exam fees for all physicians who experienced an exam-related issue – meaning anyone that was unable to take the exam, had an interruption, or experienced a delay in the length of time it took to complete the exam.

ABIM is currently conducting a thorough investigation of all incidents of record, and will fully refund impacted test takers by December 31, 2018. If you do not receive a refund by this date, please contact ABIM at 1-800-606-0259, or request@abim.org and we will work with you on a resolution.

Assuming all other MOC requirements are met, no physician will lose their certification if they were unable to complete the exam.

Again, we apologize to those physicians who had a poor testing experience on the most recent Knowledge Check-In, and sincerely appreciate your willingness to let us make it right.


American Board of Internal Medicine

Anonymous said...

"Poor testing experience?" They should have said catastrophic failure!

Anonymous said...

You are routed to PearsonVue when you take an examination, ABIM does not host your online testing experience so yes this would be a PeasonVue issue as well. You might want to have some sort of insight into the inner workings of technology before spouting conspiracy theories. Then again Doctors don't seem to know how to use computers, or write legibly, or even take patients in a timely manner on their appointments for that matter.

Kick_Ass Muscovite Mule said...

ProctorCam, the product beneath the PV brand, was so prone to freezing, so many security leaks, countless dense packets of esoteric code, that it was just a nano-mil above its competitors' hopeless online proctoring tools. It's a miracle that anybody finished a test.

Too many high-flying coders putting their fingerprints all over the cam's innards. The online testing security net-workers could not write anything compatible. That's part of the problem. AI heavy-breathers watching over you recording everything for playback w/ analytics of irregular behavior.

We're talking 2011 vintage brew; and then came them Britzkies spying on our children

Let's chat @ how_to_find__a_better_online_proctor.blog?

"Hey there, they're all bad!"

In the Discomfort of My Own Home said...

I took the exam on Saturday, and was only able to complete the first half of the exam. The timeline that ABIM cites is wrong, and their reports of "updating their website" are wrong as well. It was a "no-consequence" exam for me, but I don't get a chance to take it again, and the ABIM website still lists me as having my MOC exam completed by 12/31/19, even though they said I can take the Knowledge Check-In again in 2020, followed by 10 year exam if that doesn't work.

I don't mind the expense, nor do I mind the exam. I DO mind the total lack of humility or desire for customer service. Own your part, ABIM!!

Flagged for Audit said...

10 versus 2 versus lifetime certification

"The timeline that ABIM cites is wrong, and their reports of "updating their website" are wrong as well."

I'm interested in learning more about the actual timeline and how the ABIM's updates were misrepresented. Or any other information/experiences from folks' who took the Dec. test or any of ABIM's online proctored exams.

Anybody have anything to share? How many companies were used to perform the test for ABIM? What are those companies? Who is involved with the test security?

Anonymous said...

I just watched a Knowledge Check-in video below. Doctor's consumer report warnings/commentary, Wes Fisher.

We all have a lot of questions and almost no answers from the ABIM/ABMS.

What relationship does Kryterion and Caveon have with the ABIM/ABMS/Pearson Vue - current and past?

What relationship does Kryterion/Caveon/Foster/Fremer or anyone else at those companies (or their contractors) have with the ABIM/ABMS Pearson Vue? I see the patents for proctoring technology links Kryterion/Caveon (take your pick they have the same founder in Foster) to pushing for online testing with ABMS. This is documented. But is their company(ies) involved at all directly in the PearsonVue/ABIM/ABMS enterprise of delivering online proctored testing?

Caveon has been one of the companies linked with the ABIM's Office of Investigations and other member boards testing security or personnel. Are there or has there been in the past any shared assets/personnel? Any stock holdings/investments.

What about ProctorCam now called PVProctor. Do they did they ever have financial/personal relationships with Caveon or Kryterion.

Are there any residual contracts/royalties delivered to any founders at NEXTGEN Venture Partners/ProctorCam and PVProctor/PearsonVue or any of the above named companies?


coi @ abim.org said...

It is an incestuous and tightly knitted group. The head of client privacy at Caveon worked for the ABIM/Ballard Spahr. Mar Weinstein.

The former testing security director at the American Board of Radiology, Joe Kamel, now works for Caveon.

The conflicts of interest are immense.

While at the ABIM Christine Cassel served on the boards of Premier, Inc. The ABIM poured millions of dollars into the company they worked with CeCity with the knowledge that it was a buyout candidate for Premier, Inc. The press never reported on this. Why the quarantined approach to conflicts of interest in reporting/investigating?

The article below show Cassel was also on the Kaiser Hospitals and Insurance Plans board.
This an eggregious conflict of interest as it is insurance companies who require certification/MOC in collusion with their partner ABMS. Bylaws at Kaiser were taylor made as the model for many others to follow.

Dr. Baron worked for the CMS and had direct access to heads regarding policy recommendations that did not have to go to lengthy committee processes or public comment.
Baron has been with the ABIM for 17 years since 2001 consecutively. Conflicts of interest problems/concerns with Dr. Baron have not been made public. Term limits need to be followed at the ABIM. In this case Baron was promoted to be CEO in the revolving door shuffle between corporate and government roles.

PR said...

Where is the public safety in the for-profit and so called not for profit corporations? Most of the boons they are receiving were lobbied for or a result of conspiratorial actions.

Where is public safety being served? This is a ruse to achieve tax exempt status. The public truly does not use the ABMS or MOC criteria to choose a doctor. Neither certification or MOC have any independent objective evidence or clinical support that they make the patient population safer.

However MOC does make their revenues double/soar and their highly unusual lock on and hold over physicians a very lucrative enterprise for all the ABMS/ACGME/NCQA/NQF partners. MOC makes the partners' domestic and offshore investments much safer.

Anonymous said...

Look for court documents involving Arora Board Review and the ABIM for that conflicted attorney. What attorney names appear as Ballard Spahr lawyers on the documents with Dr. Arora and the countless doctors being bullied by BS lawyers?

Was it not a Caveon client privacy attorney/ABIM partner Weinstein working with Caveon/Ballard and the Office of Investigations at ABIM on? the documents?

Anonymous said...

Dr. Baron,

Please post your salary.

Delfin said...

I became board certified because I think it is a necessary evil but don't participate in the rest of it as I feel it is a scam and undue burden on physicians. I am appalled at how company or easily manipulated physicians are.

Al Padilla said...

Now that MOC "activities" provide the bulk of the income for ABIM and ACP (and I'm sure other organizations), there's no chance that they will kill the golden goose merely because there is no evidence-based reason for doing this. Ostensibly, it's to keep up physician quality and competence, a laudable goal, but unsupported by results. And rest assured that ABIM, American Board of Medical Specialties, and their ilk will never sponsor meaningful research, since dropping MOC would bankrupt them (financially - there's no question about morally). And I'm sure most readers known how nonprofits remain nonprofit - they hire more overpaid VP's until the balance sheet balances. The only question in my mind is whether they should be considered ectoparasites (or maybe endoparasites because of physician members).
I think the only recourse is for us to unionize to fight the abuse that's coming from all sides.

Unknown said...

ABIM is big scam and steal money from the doctors
Who are those people and how this scam started and why we as a doctors has nothing to stop it ?
We should stop applying for that exam and report those people to FBI or other agencies
We shouhave the exam and the diploma from minsters of health not those stupid people and then life time certification and do CME every year for the state license

Anonymous said...

It is frightening to me that doctors allow themselves to be abused in this fashion. What about the countless hours we spend discussing cases with colleagues, or the fortune and time we spend at meetings-- getting both "hard" and "soft" CME? Why should not these things suffice? If all of the docs that are "required" to obtain MOC said no...it's over.
If it's so important to hospitals or state medical societies/licensing boards, THEY can compile a list of thousands of clinical cases/exam questions that docs can review online--all the while getting CME.
Time to tell these non-clinicians we are busy enough. If patients are concerned about quality of care, they can select any doc they wish.
Docs are far too compliant....and should try this word....NO.

Anonymous said...

I'm a physician. I graduated medical school in 1970. The expressed goal of the ABMS specialty boards is to assure the American public that a specialist in any one field is, to a reasonable level of probability, a competent clinician. It is clear that an every 10 year exam has its challenges in proving a specialist is competent. A 200-question exam is unlikely to prove competence -- most would agree. But an exam with more questions would improve the probability of proving the elusive goal -- competence. What about 500 questions? Statistically speaking it would be better but more of a hassle.

The fundamental premise that it is reasonable to test physicians periodically will be endorsed by every patient -- every one -- it just makes common sense. They want some assurance that their doctor is up-to-date. The idea that physicians can assert that they are competent by just stating that they are is embarrassingly ludicrous. But that's what seems to be the goal -- take an exam once after completing residency and that's it for life.

We all know physicians who are inept -- every one of us. We all know physicians who are not life long students, who do not read and who do not keep current. The one thing that an every 10-year exam does do is that it makes physicians hit the books. Is it fun? No. But guaranteed, everyone who does so, if they are going to be honest with themselves, will acknowledge that they learned a lot. And who benefits -- the patients.

The chest beating about spending too much time and the exams are too "high stakes" and stressful is just another way of saying I don't want to be tested and I don't want to do the work. The vast majority of those who take the every 10-year exam pass. Is it a little stressful -- you bet. But what other stimulus will get the job done -- to get physicians to hit the books.

The whining by physicians has become a roar -- but it is all self-serving and not what our patients want. But we know best -- even if a physician has been out 10, 20, 30 or, like me, 43 years since residency we bristle at the idea that every 10 years we are basically told we have to hit the books and the exam is the stimulus that causes it.

I certain will acknowledge the cost of the exams is high -- in my specialty the exam costs about $8 a question -- seems pretty ridiculous for a computer-generated test. And nobody is twisting your arm to take a review course, although it is a pretty efficient way to help refresh your knowledge.

Finally, some specialties have proposed open book tests where participants are specifically advised not to study -- they can take the exam again if they flunk and the exam is a "learning experience." Bull. Who looks up information when a patient is in front of us? What if you have no idea what to look up? Most of the challenge of medicine is getting the diagnosis correct. If the diagnosis is correct then, perhaps we can look up the treatment. But making a correct diagnosis requires clinicians to have a very large fund of knowledge in their heads.

And, please, stop attacking the members of the specialty boards -- every one is made up of physician volunteers who are elected to their Boards by other physicians and who make a sincere effort to do the right thing. There is no vast right wing conspiracy here. Just honest doctors trying to work on behalf of our patients.

Rob said...

@anonymous - It certainly sounds like you were born in the fifties and have little grasp of the use of information technology in patient care. Your standard arguments for MOC seem to identify you as an ABIM/ABMS shill.

My first board certification was in 2001, when the use of information tech was in its infancy and I needed to memorize every bit of information. Much like landline telephones, however, that time is over. As a physician in clinical practice today, I use resources like UpToDate throughout my day for a number of purposes - yes, including making sure I do not miss a potential differential, but also to make sure my treatment meets the most current recommendations. I call this good patient care, and it has very little resemblance to the archaic model of medicine we were taught in medical school and the archaic model that MOC continues to foist upon physicians. The days of memorizing facts that have nothing to do with any of your patient population are over.

Interestingly I can track the amount of time I spend on clinically relevant research while using UpToDate and it averages well over 100 hours a year. Significantly more than the already ridiculous amounts of time required to memorize the useless factoids that do not apply to my practice but are deemed "essential" by my specialty board.

If UpToDate and others can automatically track this time spent on clinically relevant learning, perhaps ABIM and others can figure it out, as well. Probably not until they (and you) realize we are not practicing in 1970 any longer.

Unknown said...

Although I was fortunate enough to successfully complete the KCI on Saturday, December 1st, It took an additional 1 hour to have the responses to my last 3 questions be "accepted" by the online module. There was no proctor to help and when I attempted to call Pearson from my phone, only a "live chat" was available. After 45 minutes, there was still no one to help me troubleshoot what was going on. Fortunately, I was able to complete the exam, however, it took an hour longer than it should have and an undue amount of stress that none of my work was going to be saved should the system crash. We all need to band together and stop participating in MOC. If everyone in the country refuses to do it, they will have to change!

Anonymous said...

It was Russian hackers who wanted to smear ABIM that did it. Let's appoint a special counsel to investigate the matter thoroughly so as to get the bottom of foreign interference in our country's Certification process. This is totally unacceptable!!!

Bungus said...

What, you all are really surprised? The ABIM knows it can get away with this type of abusive behavior because they KNOW that physicians are used to being told what to do and not to complain. Can you blame them? Doctors are experts at bending over and not fighting back. They get what they deserve. Can you please pass the Vaseline?

Unknown said...

I agree

Anonymous said...

@anonymous, like you, I am also a Physician with approx 40 years of practice of medicine. In todays times, really, knowing every tid bit of medicine is outdated. Use of technology available to all of us on our finger tips with it brings in a host of information sources/resources.
I will agree a one time test of knowledge and thereafter CMEs that one believes are pertinent and most suited to his (or her needs) should be left to the individual physician based on the questions that his (or her) patients ask of him (or her).
In any case, repeated exams have not been shown to improve patient care. Then why gun for an unproven medicine?

Data DrivenFP said...

It's the MONEY, honey.