Evidence-Based Electronic Health Records Can Help Tackle the ‘Crisis of Variation,' According to New Elsevier Issue Brief

EBM experts identify challenges, solutions in using EHRs to orchestrate population health management, patient engagement, meaningful use and value-based accountable care

Philadelphia, PA, May 1, 2014

Elsevier, a world-leading provider of scientific, technical and medical information products and services, recently announced the availability of the second in a series of issue briefs on evidence-based medicine (EBM). The issue brief, "Closing the Gaps in EHR Evidence and Guidelines: An Agenda for Change," reveals challenges with using electronic health records (EHRs) and how developing smarter EHRs that incorporate EBM will deliver myriad benefits to both patients and healthcare providers.

The issue brief, which highlights the insights of six of the EBM experts who presented at the Health Care Leadership Forum, "Evidence at the Center of Care," in Chicago, notes that EHRs are stymied by incomplete evidence and impractical, imprecise guidelines. It identifies a "widespread crisis of variation" as a result of EHR overuse, underuse and misuse. But John D. Halamka, MD, MS, CIO at Beth Israel Deaconess Medical Center, predicts that, "EHRs have a rosy future, and leaders will continue to bridge the gap between data expectations and EHR capabilities. Clinical guidelines and rules will grow in sophistication, with the result being an increasingly directive form of EBM that more closely adheres to the thought processes of clinicians."

The issue brief also highlights suggestions from the EBM experts on building a smarter EHR and furthering the mission of evidence-based practice, including:

  • Preparing for a new paradigm: Mark Roberts, MD, MPP, Professor and Chair, Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, is convinced that an emerging EBM paradigm will blend clinical, historical, genetic and randomized control trials (RCT) data, national and local guidelines, clinical research results, risk prediction models and tools, and patient preference data. He also predicts that population-based modifiable risk tools will generate integrated and individualized guidelines within EHRs, improving both individual and population health.
  • Focus, focus, focus: Providers should focus on 10 highly prevalent inpatient and outpatient conditions with documented variation in terms of misuse, overuse or underuse, advises Howard C. Bauchner, MD, Editor-in-Chief, Journal of the American Medical Association (JAMA) and Professor, Boston University School of Medicine. Once providers review guidelines generated by reputable entities, they should "…zero in on Level 1, Grade A evidence that offers little opportunity for patient or physician discretion."
  • Revamp evidence and guideline research: Carolyn M. Clancy, MD, Assistant Deputy Secretary for Health for Quality, Safety and Value, Department of Veterans Affairs, believes that EBM research leads to systematic evidence reviews that lead decision makers to adopt and use evidence. That in turn, encourages providers to pinpoint future research needs, she says.
  • Adhere to guideline development standards: Dr. Clancy champions guidelines that include actionable statements, embrace the how and why of medicine, and link with quality measures and data sources.
  • Personalize guidelines:Providers will increasingly rely on the Archimedes Model, which "creates virtual humans with virtual physiologies that mimic the behaviors of real physiologies and patients "to estimate each individual's actual risk, along with a reduction in risk based on varied interventions," predicts Dr. Roberts.
  • Re-examine alerts within the EHR: Dr. David Bates, MD, MSc, Senior Vice President for Quality and Safety, Brigham and Women's Hospital, advises providers to only interrupt clinicians with the most essential alerts, tracking how clinicians respond and turning alert review and sharing into a regular routine.
  • Take a second look at EHR design: Vendors and providers should expand their scope beyond evidence and guidelines to focus on the nuances of EHR design, recommends Edward Shortliffe, MD, PhD, Professor of Biomedical Information, Arizona State University, Scholar in Residence, New York Academy of Medicine and Adjunct Professor, Columbia University.


About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

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