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 sys- tems were designed to automate specifi c work fl ows or functions in a care setting. As such, most clinical, operational and fi nancial 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 personal- ized care.
How can we unlock the potential for secondary use of healthcare data? The ability to fi nd meaning in volumes of aggregated data is at the very core of EBM. Advanced analytics capabilities, therefore, must be front and center, providing researchers, administra- tors 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 specifi c end us- ers 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 ad- dress 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 en- vironments, must look toward simplifi ed architectures that reduce complexity and costs, and enable cleaner integration of critical information.
The ability to share real-time information and en- able 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, pa- tient 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 fi nal 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 fi ndings, 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 clarifi es con- sumer sentiment and knowledge levels. The survey of more than 1,500 patients with employer-based insur- ance found “there is a fundamental disconnect between the central tenets of evidence-based healthcare and the knowledge, values and beliefs held by many consum- ers.” For instance, “only 34 percent of participants ever recalled having a physician discuss what scientifi c 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 signifi cant 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 signifi cant 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.
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