Technology Support for Evidence-based Medicine

May 3, 2006

I recently attended our local Health TechNet meeting, run by David Main in Virginia, where Dr. Joseph Bormel of QuadraMed presented his thoughts on Evidence-based Medicine. I found the talk englighting but the conversation in the meeting (where there were nurses, physicians, and other practitioners present) even more enlightening. My pet peeve about evidence-based medicine is that most of us concentrate on the reasons why it’s hard and how we can’t get consensus on many important decisions (which is true). However, because we spend so much time thinking about why it’s hard and how it’s difficult to get agreement we forget to actually start our projects and try to gain experience with it. Dr. Bormel was kind enough to give me permission to post his presentation online so here it is.

  • There are some good content on this site and some intelligent individuals.
    Thank you for the ideas and the intellect I will keep coming back for more.
  • Joe Bormel
    The meta-story around EBM is further elaborated here:

    http://healthcare-informatics.com/ME2/dirmod.as... Topic&mid=67D6564029914AD3B204AD35D8F5F780&tier=7&id=2B2F56DC92CD41AA98DFB62FD8E8741D

    For those in a hurry, just follow the JAMA link in the initial text, and take a look at the figure on the bottom of page two. Then, forget that it's talking about just doctors and just healthcare ;-)
  • Joe Bormel
    Shahid and community,
    I just attended an AMDIS (amdis.org) meeting where dozens of prominent CMIOs discussed the realities of EBM in 2008.

    To paraphrase what I heard: "EBM is important. Perhaps even more important and more often, there is a need for 'what do I do where is is no EBM for my current context.' One specific commercial source seemed to take that explicit orientation, and was recognized for achieving that goal."

    I think want people really want is CBM.

    C here stands for 'certainty'. Perhaps the thrust of EBM was to favor evidence over eminence. Eminence is a source of power (role, relationship, and expertise being the three). In healthcare, we'd rather have maximal certainty of the right or best decision. That means evidence where it exists; where it doesn't, maximizing certainty that best available evidence has been factored in.
  • Steve Beller, PhD
    Nice EBM presentation! Relevant is a page on our WellnessWiki discussing issues concerning ways to improve care quality with evidence-based practice guidelines and problems with current practice guidelines and how to solve them.

    I’d like to say something about the slide about the aspirin therapy dispute, which relates to all evidence-based guidelines. Maybe there is one, but I don’t know of a single guideline that is the best practice (i.e., safe and most cost-effective treatment) for everyone with a particular diagnosis under all conditions. That means guidelines, no matter how good the evidence upon which they’re based, should continually evolve (as well as the diagnostic systems used to select them) in such a way that they have fine-grained specificity enabling clinicians to use them only with patients for whom they have justifiable benefit. That means there’s the need to collect and analyze clinical outcomes data from the field continuously, executing knowledge feedback loop processes with deployment of sophisticated decision support tools.

    I’d be interested in anyone’s thoughts about this.

    Steve
  • Great comment and ideas, Joe. I'll get in touch with David and see what he thinks about another Health TechNet event covering this topic.
  • jbormel
    Shahid shares several important observations. One, Evidence-based Medicine (EBM) is important. And, two, it's critically important to move forward by engaging in improvement-oriented learning initiatives.

    Most of the external materials in my presentation came from the IHI, the Institute for Healthcare Improvement, and one of their leaders, Dr Don Berwick. This organization, through many, many vehicles has been helping provider organizations do exactly what Shahid is prescribing. Well over 2,000 healthcare organizations have joined the 100k lives campaign which specifies both the goals of specific projects, as well as tools (content, see ihi.org) to avoid the distractions and perils of re-inventing the wheel.

    Shahid, you might want to propose to David Main that a separate meeting is held to focus on Organizational Dynamics; I think that's at the heart of your pet peeve. You should be the organizer to ensure we get it right. Invite Ken, Jim, myself and perhaps others to prepare 10-15 minute presentations. That's a provider, a consultant, and a vendor. Generally, that's the required chemistry for technology-enabled change. You're correct that EBM and adoption of EBM are very important opportunities for social networking and learning through Health TechNet.

    For those who haven't yet read it, my slide 22 points here: http://www.newyorker.com/printables/fact/041206...
    a phenomenally articulate and noble summary of the promise, limits and opportunities of EBM, driven by aggressive, focused and inventive people (e.g. the readers of this blog).
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