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Evidence-based Medicine, and Less!

July 26, 2008
by Joe Bormel
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Last week, I participated in the 17th annual AMDIS Physician Computer Connection symposium in Ojia, CA. As Larry Stofko suggested in his blog post on reporting relationships (), many of the other participants at the meeting were CMIOs, with a healthy balance of CIOs and other executives. Not surprisingly, the topic of Evidence-based Medicine (EbM) came up, again and again, as our industry moves from “how do we bring these systems live” to “how do we best use these systems to improve care and its delivery.”

There’s a useful earlier dialogue and presentation on EbM that I assembled two years ago (). The dialogue, then and at the AMDIS meeting last week, clarified that in medicine there is often the lack of scientific certainty (as well as social agreement) around what to do in many real situations. The consensus was, EbM is great when it exists. Something one notch less than EbM is even more valuable and practical in our real and imperfect world. This same point came up in Kate Huvane’s recent post (), described as “And when science fails, maybe art needs to step in.

Almost ten years ago there was a fabulous related JAMA article “Why Don’t Physicians Follow Clinical Practice Guidelines?” by Michael D. Cabana, MD, MPH, et al.

I have a friend, Vi Shaffer, who currently serves as a research VP with Gartner. At the time Cabana’s article was published, Vi commented that his approach to a serious subject was really quite profound. The reason, she said, was that he used a bit of humor to effectively describe why all of us, not just doctors, resist changing our behaviors even when the “evidence” indicates change would be a good thing for us personally. I strongly encourage everyone to read the article and to review the Figure at the bottom of page two, “Barriers to Physician Adherence to Practice Guidelines in Relation to Behavior Change.”

How do you discuss Evidence-based Medicine with your community? Where do you see the role of executives starting and stopping in regard to bringing EbM to our institutions?

[Flesch 47, Flesch-Kincaid 12 ... elaboration in an upcoming post! ]

/Media/BlogTopics/2005 Bormel - From Crisis to Confidence, Creating High Reliability in Healthcare.pdf

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