The lessons of March Madness and evidence-based medicine

The lessons of March Madness and evidence-based medicine

May 23, 2017
Steve Arendt, MD
From the May 2017 issue of HealthCare Business News magazine

By Dr. Steve Arendt

It happens every year during March. Even people who don’t follow college basketball suddenly get caught up in filling out their brackets, trying desperately to figure out who will come out on top so they can claim bragging rights (and often a nifty cash prize).

While there are those who just sort of randomly choose teams so they can be part of the action — not a bad strategy if there are a lot of upsets — many others spend an inordinate amount of time poring through the latest statistics and analyses trying to gain an edge. But what if, instead of using up-to-the-minute stats, they decided to use last year’s information, figuring it would be close enough? It’s a pretty good bet that the information would be of little value to them.

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Yet, that is the situation in which hospitals and health systems often find themselves when it comes to evidence-based content. When it was first implemented, all of that content was likely spot-on. But just like college basketball rosters, the evidence in medicine is constantly evolving. Hospitals and health systems are typically a year or more behind in reviewing their content, which means at least some of the information being delivered to the point of care through the electronic health records (EHR) is going to be outdated. This is bad, because, as Anne Bobb has said, “When order sets are … inadequately maintained, they become templates for efficiently practicing outdated medicine on a widespread basis.” The hard part is determining which pieces of content need to change.

The usual process for updating content is either for physicians to attempt to manually review the content against current evidence-based sources, or to completely replace the current content with new. Neither approach is ideal. Manual review of all the current content is a virtually impossible task due to the time and resources required. So it tends to occur on more of a rolling cycle that can make the first-reviewed content even more outdated by the time it comes up again. That approach also tends to lead to spending time reviewing content that really doesn’t need updating.

Conversely, replacing all the content with new in a “full-court press” is a very tough sell, especially given the investment of time, money and resources that were required to bring the content to its current state. A better approach is to define the conditions where the evidence changes the most rapidly — those that are generally high-volume, high-risk or high-cost — across all disciplines and venues. Technology can then be leveraged to automatically compare the interventions for those conditions to the latest evidence-based recommendations, enabling you to focus your organization’s attention where the needs are most immediate.

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