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From 'Cookbook' to Evidence-Based Medicine

 |  By Philip Betbeze  
   March 04, 2011

Once upon a time, physicians, as a group, resisted attempts by private payers and others, to force them to practice safer, more efficient medicine by standardizing patient interventions and the timing of those interventions based on disease states.

Why? Something was lacking. Make that a lot of somethings. The ability to crunch outcomes data from many sites of care was a critical unmet need in previous efforts to standardize care and eliminate duplicative and inefficient medical decisions that cost the health system billions. It was simply impossible to collect this data and draw conclusions from it to recommend changes in care pathways.

At the time, physicians were on solid ground in refusing to follow so-called evidence-based guidelines. They were able to successfully argue that the practice of medicine is largely an art, with wide variations in outcomes more dependent on patients' differences than on their common disease states.

Sometimes, these rules and regulations limited the physician's ability--based on his or her medical education--to treat the patient as he or she saw fit. But most importantly, the evidence for some of the rules was incomplete, flawed, and, they argued, it was being forced upon them by health plans. Some argued that such rules were based more on saving costs than on the improving the welfare of the patient. It was impossible to standardize treatments for patients with certain maladies because each patient reacted differently to the types of care prescribed, they said.

That critical contention was wrong, and now that reams of data from thousands of patients with similar disease states can be sliced and diced, it's becoming evident (no pun intended) that best practices, should they be followed, are better not only for patient outcomes, but for costs as well.

You won't find too many physicians who will debate that point anymore. According to results of the HealthLeaders Media Industry Survey 2011, senior healthcare executives ranked quality and patient safety among their top three priorities. But it's still difficult to gather the large amounts of information necessary for best practices to be developed. At least it has been.

Paul Grundy, MD, is hoping that will change quickly. He leads a massive effort by his employer, IBM, and the Premier Healthcare Alliance, to integrate healthcare data from hospital and non-hospital care sites to measure performance and improve population health.

Grundy, who is IBM's director of health care transformation, says the effort will involve more than 2,400 hospitals and thousands of other sites of care (physician practices, outpatient clinics, etc.) Those participants will share their data about outcomes to gain insight, measure performance and improve population health. The project, they say, will support hospitals, doctors and other health providers in working together to enhance patient safety while reducing the overuse of procedures, readmissions, unnecessary ER visits and hospital-acquired conditions.

"We're moving to a place where we'll have data—and actionable information--for the first time," he says. "This is beginning to help build the tools and solutions to make use of that data."

The key, though, outside of the data, is physician direction and accountability, he says. In addition to the data component, the effort is meant to provide this information to physicians so that they set standards for themselves by which they will be held accountable. Contrast that with the old-time utilization reviews that HMOs used to employ and it's a quantum leap forward.

Regarding the purchase or use of clinical technology, healthcare leaders rated high quality care and physician alignment as their top priorities, according to the 2011 HealthLeaders Media Industry Survey.

By using cloud computing, the system is aimed at providing physicians clinical decision support, analytics, data, and a quickly accessible dashboard, so that they have much more information about the patient.

"They'll know whether their patients have had that last blood test, whether they're taking their prescriptions," says Grundy. "The system knows whether or not you're actually doing the right thing and can see which docs are managing disease and which ones aren't."

By putting these powerful tools in the hands of physicians, who have developed the standards by which they'll be judged, and you have a very powerful set of tools for better outcomes and lower costs.

"You have the docs tell you what they want to monitor," he says. "They decide how they want to judge themselves. And when they do that they are very competitive."

Of course, this isn't the only pilot or demonstration project going on with the objective of providing better patient care at a lower cost. But it might be the biggest. Challenges remain, and Grundy expects to learn much more that will change the system as it matures.

"If docs are determining the stuff they want to monitor, how do you keep from reinventing the wheel every time you add a new facility or physician practice?" he says.

Or, how do you deal with natural language ability, massive amounts of information, and structuring it so the human mind will understand.

"It comes down to playing a game of Jeopardy!," he says.

Interesting interjection, because speaking of Jeopardy!, which is involved in another IBM project that's getting a lot more media attention than this one, I hear that a human, (a Congressman, no less) has finally beaten Watson.

Something tells me IBM didn't develop this computer with an idea that it would confine its talents to wining at a game show many more times than it loses. Maybe Watson is seeking a new challenge.

Healthcare will certainly provide it.


Philip Betbeze is the senior leadership editor at HealthLeaders.

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