Improving healthcare outcomes through EBM

Oct. 2, 2010

Evidence-based medicine (EBM) can fundamentally transform healthcare, leading to a more personalized paradigm of care that preserves innovation while addressing waste in the healthcare system.

Brett Davis

Much of the dialogue around personalized healthcare, comparative effectiveness research and evidence-based medicine (EBM) has focused on the cost of the scientific and biotechnology breakthroughs we have witnessed in recent years, as well as the ethical, regulatory and reimbursement changes required in supporting this new model of care.

The past two years have seen significant advances toward adoption of EBM initiatives, fueled largely by public funding. From here, a steadfast commitment to consumer education and IT transformation are the keys to progressing on our nation's healthcare journey.

This time last year, the media, Washington and the healthcare community were focused on the importance of EBM and its role in transforming the delivery of U.S. healthcare. Today, it's easy to lose focus on the importance of EBM to the transformation of healthcare as topics such as sorting out meaningful-use requirements for electronic health-record (EHR) systems take center stage.

However, EBM is fundamental to national efforts to improve healthcare outcomes and reduce costs. While EHRs are a vital component of healthcare reform and are foundational to EBM, we cannot afford to divert our attention from the other requirements needed to make EBM a reality in the United States. This transformation is only possible through the synergy of healthcare information technology (HIT) with scientific breakthroughs in the molecular understanding of disease, novel therapeutics and diagnostics, as well as a fundamental redesign of our healthcare delivery models.

Important policy progress
We have taken several important steps on the EBM journey in the last two years. One of the most significant has been public policy and funding to support EBM initiatives. The American Recovery and Reinvestment Act (ARRA) of 2009 authorized approximately $1.1 billion in funding for comparative effectiveness research, a key enabler of EBM. In addition, the Patient Protection and Affordable Care Act, the health reform bill signed into law by President Obama this spring, establishes a private, non-profit entity called the Patient-Centered Outcomes Research Institute. Funding for the center could reach $500 million by 2013, according to an estimate from the Brookings Institution.

Perhaps more importantly, we have begun to lay the IT foundation required to support EBM. The ability to gather timely, accurate and comprehensive patient, clinical, claims and outcome data is fundamental to comparative effectiveness research (CER) and ultimately EBM. This initiative got a boost via $17 billion in ARRA funding to promote deployment of EHRs and other health information technologies that form the foundation for EBM initiatives.

Laying the right information infrastructure
Despite this national recognition of the importance of HIT and government commitment, it's absolutely critical that, in implementation, this national IT infrastructure take into account the needs of EBM if we hope to achieve the promise of healthcare system transformation.

For example, most of today's healthcare IT systems were designed to automate specific work flows or functions in a care setting. As such, most clinical, operational and financial data is locked in systems that cannot communicate, prohibiting the aggregation, analysis and secondary use of critical information that could help to improve care and drive down costs. To support CER and EBM initiatives, we require further progress around standardizing data and knowledge. In the interim, health systems should look to leverage solutions that enable the integration of disparate data to support enterprise analytics to understand what works in individuals and drive toward more personalized care.

How can we unlock the potential for secondary use of healthcare data? The ability to find meaning in volumes of aggregated data is at the very core of EBM. Advanced analytics capabilities, therefore, must be front and center, providing researchers, administrators and, importantly, clinicians with the tools they require to identify patterns and determine the relative effectiveness of treatments. These tools must be able to provide insight into the intricate differences in how individuals respond to various treatments.

Today, we are seeing the needs of specific end users or departments driving investment in one-off data marts and siloed analytics environments in an effort to glean some insight from transactional systems. However, to support EBM healthcare, organizations must move beyond siloed analytics, and instead invest in enterprise-class, interoperable analytics platforms. These integrated, enterprise analytics environments will hold the key to driving this transformation.

Healthcare providers must also be prepared to address IT infrastructure scalability and complexity issues along with requisite cost considerations. The disparate IT platforms and applications seen in many healthcare organizations today create complexity that raises costs and lengthens implementation times. This complexity, and the associated costs and implementation delays they spur, can undermine EBM initiative progress. As such, healthcare providers, in rethinking their IT environments, must look toward simplified architectures that reduce complexity and costs, and enable cleaner integration of critical information.

The ability to share real-time information and enable collaboration across institutions (as comparative effectiveness research teams may include members from multiple organizations) is also essential to realizing EBM. Security must be paramount in the creation and management of these data networks, as well as every layer of the technology and application stack. In the absence of an unwavering commitment to security, patient privacy and the reputation of EBM initiatives are at risk. Equal attention should be paid to physical and data access controls, including the need for effective identity management and provisioning as information is shared across organizations.

Communicating with patients
The final hurdle to EBM, viewed by many as the largest obstacle, is overcoming citizen apprehension. The public's uneasiness about EBM was evident last year when the United States Preventive Services Task Force announced updated mammography guidelines based on new research findings, recommending that women delay having routine screenings until the age of 50. Public reaction was understandably immediate and vocal.

“Evidence That Consumers Are Skeptical About Evidence-Based Health Care,” a 2010 study by the American Institutes of Research, further clarifies consumer sentiment and knowledge levels. The survey of more than 1,500 patients with employer-based insurance found “there is a fundamental disconnect between the central tenets of evidence-based healthcare and the knowledge, values and beliefs held by many consumers.” For instance, “only 34 percent of participants ever recalled having a physician discuss what scientific research had shown about the best way to manage their care, and 33 percent of survey respondents agreed or strongly agreed with the statement that 'medical treatments that work the best usually cost more than treatments that don't work as well.'”

Consumer education about EBM basics and the value that it stands to deliver will be essential to its ultimate adoption and impact. An education initiative of this scale requires time and significant public and private resources. As such, it must move forward in tandem with the infrastructure initiatives now underway.

This issue also underscores the importance of getting the proper IT systems in place to best inform EBM decisions. If decisions impacting patients are made using bad or misleading data, the public's trust will be further eroded.

The past two years have seen significant advances toward adoption of EBM initiatives, fueled largely by public funding. From here, a steadfast commitment to consumer education and IT transformation are the keys to progressing on our nation's healthcare journey. If we get this journey right, EBM holds the promise to deliver continued innovation to patients, address the cost/quality challenges our system faces and ultimately lead to personalized healthcare.

Brett J. Davis is senior director, personalized healthcare, Oracle Health Sciences.
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