Evidence Based Medicine – An Idea Whose Time Must Soon Come!

The following appeared a little while ago.

The Benefits of Evidence-based Medicine in EHR Systems

June 10, 2008

Evidence-based medicine is often admired but seldom practiced. It is rarely practiced because few physicians have the time to critically appraise the medical literature; an unfortunate reality considering the impact on quality of care, and the fact it could be changed.

When integrated into an electronic health record (EHR) system, evidence driven decision support is presented to the physician at the point of thought, providing crucial evidence-based literature that promotes timely and informed medical decision making. Further integration with a single platform solution that includes an electronic prescribing module provides the physician with objective, medication therapy decision support at the point of prescribing.

Integrated seamlessly into a practice’s EHR, e-prescribing provides additional information, including the cost, efficacy and adverse effects of various medication-based therapeutic alternatives to help the physician make the best prescribing decisions.

Three published estimates suggest that physicians are directing 80% of the spending in our $2 trillion health care market. Yet if you consider the information that we physicians bring to these spending decisions, frankly, it is primitive and pathetic. Imagine physicians as purchasing agents with $2 million annual budgetary authority. Studies show that we physicians don’t know how much the drugs and diagnostic tests that we order cost, and we lack comparative information about their effectiveness and adverse effects. Furthermore, our compensation is largely disconnected from the quality and cost-effectiveness of our performance. Is it any wonder that the U.S. has the most expensive health care in the world, while perennially ranking near the bottom of industrialized countries in metrics like healthy life expectancy?

Health information technologies, especially EHR systems, are often promoted as the solution to much of what ails our health care system. The implementation of technology has become a powerful political issue, but in such a fractured healthcare system, adoption remains a constant struggle for small and medium-sized practices.

Evidence-based medicine (EBM) promises to displace Authority Based Medicine, wherein practicing clinicians simply followed the recommendations of expert thought leaders in the healthcare community. These thought leaders were usually identified by their affiliation with distinguished academic medical centers with successful college football programs.

Much more here:

http://ehrscope.com/blog/the-benefits-of-evidence-based-medicine-in-ehr-systems/

This article makes a series of useful points.

First among them is the level of control that physicians have over health expenditure. Linked to this it would seem that there is a real obligation to use that control wisely. As the article goes on to make clear there are a number of barriers to that happening. Among these is just the scale of the knowledge management task modern medicine poses to practitioners as well the difficulty there can be in accessing reliable, trustworthy evidence on what the appropriate thing to do is in real time with the patient sitting in front of you.

Second, as is laid out later in the article, there is compelling evidence that EBM saves both lives and money.

Third there is now increasing evidence that provision of paid incentives for quality of care can not only change behaviour but also still save substantial sums of money.

What is needed is to have available clinical systems which make the search for evidence and then its application to care seamless and as effortless as possible. Also we need systems – such as those being developed by Pen Computing in Australia – that make quality audit and clinician feedback as seamless as possible.

There is an opportunity to make a huge difference with such systems. We have started down the path but there is much more to do both in system and incentive design as well as information provision and decision support.

David.