Using EHRs to keep current with evidence-based medicine

Practicing evidence-based medicine can be an overwhelming challenge to a rank-and-file physician. Certainly, physicians try to keep up – reading journals, interacting with colleagues, attending conferences, engaging in Continuing Medical Education (CME) activities, and (increasingly) using the internet for medical data lookup – but the pace of information becoming available will outstrip any given physician’s ability to remain current.

A recent report highlighted the difficulty physicians face when trying to remain current with the latest medical recommendations. A variety of services have evolved to help physicians access data – UpToDate and Epocrates are examples of popular services used by physicians to quickly find information. Much medical education, in fact, focuses on the notion that “you will never know it all; what you need to develop is a systematic way to look up and find the information you need on-the-spot.”

The pace of publication of clinical evidence, in fact, is accelerating. At any given time, tens of thousands of studies are taking place around the world, and access to their findings is a problem for everyone. In fact, among clinical informatics specialists, the term “studyome” has emerged (akin to the human genome) – the totality of human studies worldwide. The challenge for accessing this vast mine of data is even more daunting than for the genome – raw results have very different meanings stemming from different study designs (e.g. interventional vs. observational studies). The challenge has been to try to standardize study design descriptions to make sense of it all, so that study results can be available for data mining, synthesis, re-analysis and reuse.

Efforts by informatics organizations to “computerize the human studyome” will help systematize the evolution of clinical recommendations based on medical evidence. From this, various clinical and scientific bodies can create an increasingly-robust set of clinical guidelines, recognizing that not all clinical questions have a single answer. But how can that be presented to rank-and-file physicians?

Clinical Decision Support is a feature of Electronic Health Records (EHRs), where information embedded in the patient’s EHR can alert physicians to optimal medications, current recommendations, or the need for certain tests. While superior to the ad-hoc way physicians must access such decision support if not using an EHR, these features of current EHRs are still in their infancy. To date, Clinical Decision Support has been focused on medication management (alerts to drug-drug interactions, drug-allergy flags, and drug-disease issues), on clinical performance metrics (like PQRI, or HEDIS measures), and on searching for web links to external references.

Linking the efforts by informaticians to better extract results and meaning from the human studyome to clinical-guideline development that is evidence-backed, and then linking all of this to decision support features in EHRs – this is the holy grail of health IT.

As the distillation of meaningful understanding from the vast data store of human studies becomes more accessible, and as this drives clinical decision recommendations, and as these things can be captured in evolving EHR systems that rank-and-file clinicians can use in their daily work, then the enormous potential for this technology will become evident. No longer can physicians sit on the sidelines about EHR adoption – in order to practice quality medicine and make use of the full body of clinical evidence, using modern EHRs with robust Clinical Decision Support will be “a must.”


Robert Rowley, MD – Chief Medical Officer, Practice Fusion, Inc.