From the August 2006 Issue
Building a Safety Net
A Final Farewell to Paper: What Works
What Is Application-Attached Storage Costing Your Facility?
Revving Up the Revenue Cycle: Case History
The Cure for the Fatally Flawed EMR Software Model
From The Editor
Weapon of Choice
By Robin Blair
One of the surest signs that a topic has gone mainstream is its
recurring appearance in the newsstand press, both consumer and business press.
Kudos to Business Week for its May 29 cover story, “Medical Guesswork:
From heart surgery to prostate care, the medical industry knows little about
which treatments really work,” by John Carey, and for giving the topic seven
insightful pages.
Carey wastes little time getting to the heart of the matter: evidence-based
medicine (EBM) and the pervasive lack thereof in modern medical treatment. Part
of Carey’s article focuses on Dr. David Eddy, a heart surgeon by trade, a
current mathematician and healthcare economist, and a proponent of amassing
clinical evidence upon which to base medical treatments. Eddy also is the
braintrust behind Archimedes, an elaborate computerized program of simulated
clinical trials in which myriad virtual doctors treat myriad virtual patients
and the computer analyzes the results.
What’s good about this article? The writing is masterful, the information is
eye-opening, and the path to a future of cost-effective medical treatments that
work is artfully constructed. But those are the minor goodies.
What works the best in Carey’s treatise is the exposure to the public of a
critical issue in healthcare. In many instances, doctors simply don’t know if
the treatments they prescribe are the ones most likely to produce the desired
results. They don’t know because they don’t have hard evidence; they lack
validated clinical reports resulting from years of trials and studies. Adding
fuel to the fire, says Carey, is “America’s infatuation with the latest
advances. … New radiation machines for cancer or operating rooms for heart
surgery are profit centers. … Once a hospital installs a shiny new catheter lab,
it has a powerful incentive to refer more patients for the procedure. It’s a
classic case of increased supply driving demand. …”
Carey is quick to admit that randomized clinical trials cost millions and take
years to conduct, and that even when time and money are available, sometimes
advances in medical knowledge render the results not so relevant. As enticing as
Archimedes sounds, even Eddy says it is technology in its infancy.
Perhaps Carey and Eddy need a stronger familiarity with the NHIN, nationwide
interoperability and the
an-EMR-in-every-pot initiative. After all, that endeavor is sweeping the nation
and being written about by national press as well as hamlet-based newspapers—as
if there were a master plan, a national budget for the master plan or a
prototype in existence, and as if anyone had any idea of where the gargantuan
amount of necessary funding is going to come from.
When it comes to carts and horses, evidence—from rigorous clinical trials or
simulated Archimedes-style trials—is the cart that should precede any variety of
horse. With the government teetering on the edge of another unfunded mandate
that threatens to extract investment from hospitals, physicians, payers,
employers and even patients, maybe evidence is the most deserving candidate for
a hearty helping of government investment.
It’s simplistic, of course, to suggest that no entity should be required to
invest in information systems, connectivity platforms, hardware or harmonization
until such time as doctors know, beyond a doubt, which treatments are most
likely to work for which patient populations. Isn’t it?
For now, anyway, I’ll keep my money on Colonel Mustard with a debit card in the
U.S Treasury.
© 2006 Nelson Publishing, Inc