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CMOs: Evidence-Based Medicine's Best Advocates

Philip Betbeze, for HealthLeaders Media, May 4, 2012

Many physicians have resisted evidence-based medicine guidelines over the years—sometimes for good reason. Some still refer to evidence-based medicine by the epithet "cookbook medicine," saying that because each patient is different, there's no way to prospectively determine what particular interventions will work best for a particular patient with a particular malady or group of maladies.

Hospital administration, in the past, has not been much help. Halfhearted attempts to force physicians to adopt evidence-based medicine practices have been hampered by the fact that reimbursement has rarely been at stake.

Furthermore, attempts to push through such changes have often come from administrators. Doctors don't tell them how to do their jobs (don't they?) so an administrator shouldn't tell him how to do his.

So it wasn't necessarily the message but the messenger.  I'm finding that physician resistance to implementing such guidelines is fading in the face of

  • Better and more thorough clinical research
  • Electronic medical records that incorporate that research in the form of reminders and accessible research
  • A younger cadre of physicians who are no longer resistant to computer or other technological assistance in diagnosis
  • A reordering of the responsibilities and accountabilities of the chief medical officer
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1 comments on "CMOs: Evidence-Based Medicine's Best Advocates"


David A. Burton, MD (5/4/2012 at 5:37 PM)
In order to catalyze change behavior change in physicians (and other clinicians), there are a few prerequisites, including, for example: 1. The evidence for the clinical effectiveness guideline being advocated must be credible and available. Few physicians practicing on the front lines (in ambulatory or hospital settings)have time to do a literature search, identify and consult national experts and digest the information into a usable knowledge base. Even many CMOs do not have the infrastructure to provide this resource. Bottom-line: We need better systems to transform credible, commercial grade Clinical Content into clinical effectiveness guidelines (e.g., diagnostic algorithms). 2. Clinical effectiveness guidelines need to be available at the point of care. Once the guidelines are available, they need to be loaded into an EMR, so they are readily available "just-in-time" when they are needed. We need to "make it easy for physicians to "do the right thing" 3. The outcomes of implementing clinical effectiveness guidelines need to be measured and reported. Analytic feedback engages physicians. Outcomes should be measured not only in the research study, but also in the everyday implementation of the findings of the study. 4. The reports of the outcomes need to be provided to physicians in a format (visualization) that is easily understand. Tables of numbers are not very easy to comprehend. Graphical display is essential. 5. Analytic feedback should be used to create a learning environment not for punishment. The idea of using data regarding outcomes to "rank and spank" the outliers will destroy any hope of physician engagement. 6. Financial incentives need to be aligned. Financial incentives should not be expected to drive clinical behavior, but they can reinforce behavior, provided behavior can be tied causally to better outcomes. Thanks for the study. David A. Burton, MD Chief Executive Officer