Practicing Evidence Based Medicine (EBM) in Healthcare Delivery

Health care managers are under constant pressure to improve care delivery, render quality services at reduced costs at par with international standards. In order to do so, there is a need to consolidate patient data from disparate sources and make it accessible from a centralized source. Health care entities can no more survive with clinicians maintaining their own clinical data unshared, non- aligned and non-integrated with others.  There is a need to discourage information silos and encourage integration and collaborative sharing of information amongst caregivers.  Need has been realized to move towards not just basic automation of administrative, clinical and financial processes in a health care setting but towards evidence-based and data-driven approach to health care delivery.  Evidence based medicine lays the foundation stone for clinical decision support systems which are an integral part of health management information systems today.

The term “evidence based” was first used in 1990 by David Eddy and then the term    “evidence-based medicine” first appeared in the medical literature in 1992 in a paper by  Guyatt et al. David Sackett in his book ‘Evidence-Based Medicine: How to Practice and Teach EBM’ has defined evidence-based practice as, “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of an individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

This definition emphasizes the need for clinicians to stay up-to-date and well informed of all researches and advances in their respective and related fields of medicine by reading published literature, publishing their own research, clinical findings and outcomes. Emphasis should be on a systematic approach to data acquisition as evidence and utilization of this data along with research based findings from published literature for making clinical decisions based on evidence and not intuition. This book by David Sackett also explains clinicians on how to ask clinical questions they can answer (answerable clinical questions), searching for the best evidence, appraising the evidence, determining if they can apply valid and important evidence in the care of their patient; and evaluating their progress.

Practicing evidence based medicine is not easy. Health care leaders have to join hands to make this a success by providing hospital infrastructure and management supportive of use of evidence based data for decision making in terms of leadership, resources, emphasis and accountability. Collaboration with other care givers can be strengthened so as to make evidence from all possible sources as a driver for care related decisions rather than personal preferences and other subjective factors.

Potential benefits of evidence based medicine for patients and the public are:

  • Better quality of care
  • Improve health outcomes
  • Improve consistency of care

Potential benefits for health care professionals are:

  • Better quality of management decisions
  • Better decisions in clinical medicine
  • Therapeutic evaluations
  • Preventive strategies and screening
  • Formulating healthcare policies
  • Predicting health economies
  • Reassure health care professionals that practice / intervention is appropriate
  • Reduce outdated, ineffective or wasteful practices

Potential benefits for health care systems are:

  • Improves efficiency and quality of health care delivery

Clinicians can refer to the following knowledge sources regularly to look up published medical information for their evidence based practice:

  • Medical journals
  • Literature databases
  • Medical text books
  • Practice guidelines
  • EBM resources like cochrane database of systematic reviews and clinical evidence (www. cochrane.org)
  • PubMed for published medical information and journals
  • Online books
  • Medical databases
  • Evidence based search tool like curbside.MD (http://www.curbside.md)

The following internet sources can be referred to for further reading and references on this topic:

–       Centre for evidence based medicine (CEBM)- http://www.cebm.net/

–       The Cochrane Collaboration – http://cochrane.org

–       Citizendium – http://en.citizendium.org/wiki/EBM

–       Curbside.MD-http://www.curbside.md

–       American Medical Informatics Association- https://www.amia.org/

–       Evidence-Based medicine for primary care and internal medicine- http://ebm.bmj.com/

Written by- Ms. Ranjeeta Basra K. – Assistant Professor- International Institute of Health Management Research- India