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Parsing the Evidence

December 21, 2010
by Mark Hagland
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A physician informaticist offers insights on the forward progress of evidence-based care practices

Last year, Bill Fera, M.D. transitioned from being a physician informaticist at the University of Pittsburgh Medical Center (UPMC) health system to becoming executive director in the Health Care Advisory Services practice at the New York-based Ernst & Young consulting firm. Fera, who remains Pittsburgh-based, has years of experience working with the concepts and practices around evidence-based patient care. That topic is the subject of the cover story in the January issue of Healthcare Informatics . Fera spoke recently with HCI Editor-in-Chief Mark Hagland regarding where the evidence-based care phenomenon is at the moment and where it’s going.

Healthcare Informatics: What’s your perception of the needs around evidence-based order sets and where things are going?

Bill Fera, M.D.: I think people start with the notion that they can do this all themselves. There’s some ego involved, and everybody believes that they have a better mousetrap. But the evidence could be changing on a monthly basis, and when it comes to maintaining and updating those order sets, it doesn’t really make sense to do it all in-house. I’m also intrigued with what Isabel [the Ann Arbor, Mich.-based Isabel Healthcare, which offers evidence-based clinical decision support for medical diagnosis] does, and I think they’re exactly on the right track. And the ability to pull out symptoms and history from what’s going into the medical record, and receive diagnostic suggestions, is very neat. I think the government is trying to push everyone in that direction—if you look at comparative effectiveness, at meaningful use, at ICD-10, the government wants us to move forward in various ways in this area. In Canada, they have something called the Cochrane Database that supplements their use of ICD-10.

You can make all these kinds of information available to everyone, if you have the right data infrastructure. And so if you look at the long-term view of meaningful use, ICD-10, and comparative effectiveness, I think you see a view of data-driven medicine. And I think that what you also see with ICD-10 and comparative effectiveness and this availability of data, is this ability of payers and providers to partner in areas of mutual interest.

HCI: There has historically been a lack of trust between the two groups.

Fera: Yes, and part of that is because of the past lack of transparency and availability of data. Payers have their data, and providers have theirs. But through ICD-10 and comparative effectiveness, everybody now begins to have access to the same data, and can make that new paradigm real. And then with the next step, from the Isabel standpoint, you see some real opportunities.

HCI: What kinds of challenges and opportunities do you see ahead?

Fera: The next step that people are looking for, and what electronic medical records should enable, is this virtual collaboration—the ability to share information in real-time, and to have that information be available to whoever is using the electronic record system—establishing a common portal, so that everyone can look at the same types of information and evidence.

HCI: So, for example, that the referring physician and specialist can look at the same information?

Fera: Yes, exactly. Historically, if a primary care physician doesn’t send a referral letter to a specialist, they don’t know what they’re looking at; they’re seeing patients blind, if you will. And certainly that’s true in the ED. But the more that you can look at the patient’s history, and at the evidence you can apply to the situation, in a collaborative framework, the more you can improve care. I think that’s the next step forward for the electronic medical record from the operational standpoint; we still haven’t realized the ability to do full clinical data analysis, but the ability to collaborate in real time on care is the next area of development.

HCI: How quickly are physicians moving to understand the potential benefit of these types of tools?