Continuing medical education: the paradigm is changing.

With the realization that lifelong learning is more than attending conferences, the potential for greatly expanding effective continuing medical education (CME) has never been more encouraging. Databases from groups and individual managed care practices and advances in information technology are providing major opportunities toward this goal by identifying specific information deficits and promoting practice-linked education. The National Committee for Quality Assurance (NCQA) standards, requiring audited Health Plan Employer Data and Information Set (HEDIS) reports, are a step forward in the development of CME linked closely to practice. The optimal educational use of practice data to improve clinical outcomes will require research to determine the best methods. HEDIS standards will probably continue to deal with common problems of omission rather than with those caused by physicians' lack of knowledge, which will require other approaches. Development of these methods will provide rich opportunities for demonstration studies. The spectacular advances in information technology, especially the almost limitless capabilities of the Internet and electronic mail, offer boundless possibilities of information sources and enhanced communication among physicians about puzzling patients. The further implementation of the electronic medical record with computerized reminders and other clinical information delivered at the point of need will trigger major advances. An appealing user-friendly, practice-linked, and self-directed CME is on the horizon, promising to help the practicing physician optimize patient care.