Comparative Effectiveness Research: the Horizon

The bill does specify that the governors must be diverse, so there will be academic experts, government leaders, clinicians, representatives of healthcare industries including pharmaceutical and device manufacturers. Dr. Clancy from AHRQ [Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality] will be on it, and the Director of NIH will be on it, Dr. Collins [Francis S. Collins, M.D., Ph.D., director of the National Institutes of Health]. Those two, from government, will be on it; otherwise, it will be a group of non-governmental people. And PCORI will have a budget, and will commission research.

HCI: Will your organization do research for them?

Hubbard: Probably not, actually. We’re set up as a nonprofit health policy organization, so our focus will be more on the policy aspects of this.

HCI: Tell us about your study and its overall goals.

Hubbard: It’s an overview of the hurdles that have to be overcome in order to get to an effective dissemination of CER findings. We’ve mostly been talking to various experts and to people from key stakeholder groups with some role in the dissemination of information.

HCI: So what do you see as the greatest hurdles in the dissemination of comparative effectiveness researching findings?

Hubbard: Just for starters, and this is a set of findings that probably a lot of hospital CIOs are familiar with already, but in general, what has been demonstrated over and over from the IOM and other organizations, is that all kinds of evidence coming from solid peer-review research, virtually all kinds of evidence have a difficult time getting fully disseminated and picked up and used in the healthcare system. In general, evidence in all fields of medicine faces a very protracted and uneven and erratic path, to get to the point where it actually gets seen by doctors and patients and gets utilized, and influences decision-making. That is something that is surprising to many of us who are laypeople or patients, that good research findings don’t get instantaneously absorbed by doctors across the country. So in comes this new investment in comparative effectiveness research. And one of the reasons to push new comparative findings out there is that comparative findings should be more useful to physicians and patients from the beginning.

What is it that doctors and patients are most interested in at the point of care? It’s what will work; and comparative findings naturally lend themselves to that, more so than do non-comparative findings. But comparative findings will face the same challenge as all other clinical information in getting into use. So there will have to be a very thoughtful, national, dissemination strategy for CER findings. And that’s where our strategy comes in. And one of the insights is that the health IT investment is critical. And the health IT investment, fundamentally, is the means of communication of literally piping findings to clinicians. But the capabilities that we’re now seeing in healthcare IT are such that it can significantly improve the odds of turning this research into something more immediate at the point of care for clinicians and patients to use.

HCI: So what should be on the radar screens of CIOs and healthcare IT professionals, as PCORI gets set up and developed?

Hubbard: First, I think that there are at least two pretty straightforward things that CIOs would probably want to look at and bear in mind as far as CER. One is, to the extent that clinical decision support is further built out, will be a means of disseminating CER findings. And it may be a comment on the obvious, but to the extent that CPOE and CDS get expedited into use, that clearly becomes an important path of dissemination for CER findings, as for all forms of medical evidence. And all the pieces of healthcare reform have to interlock in order for the big objectives to be realized, including covering more people, getting them treated, and treating them optimally. So it’s not just that HIT all by itself will have the total effect, it involves payment reform, chronic care management, CER, and everything. The other big thing, though, for CIOs to keep watch on, and as I was saying, a number around the country are already involved, is in the use of their existing data to look at that in conjunction with CER findings that they might be getting through medical journals, to do real-time search on what works in their systems.