The Real Enemy: My Response to InformationWeek

This past weekend, InformationWeek published an intriguing article indicating that some of my statements regarding evidence-based medicine are a source of "animosity" between CIOs and their physician stakeholders – physicians whom the article proposes consider information technology "the enemy" of good medicine.  Yesterday, they graciously published my response to their article.  So what do you think -- is IT the enemy of good medicine?  Check it out!

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One Comment

  1. Lydell Anderson, MD
    Posted June 6, 2011 at 3:24 pm | Permalink

    As a physician and part time self-study computer science student and part time Utilization Review physician who has dreamed of producing a superior Personal Health Record (PHR) application, I read with interest your rebuttal to the criticism of EBM.
    In my UR physician role nearly every day I am confronted with the argument that "My Patients are different" and "Medicine is not cookie cutter recipes" and "In my experience, this works well."
    While it is true, that no one has done a true, prospective, randomized, peer-reviewed, nationally recognized, Evidence Based Medicine (EBM) study of the effectiveness of wearing a parachute when jumping out of a plane from 10,000 vs. NOT wearing the parachute, I would argue that the only thing that separates Western Medicine from Witch Doctors is EBM of some degree.
    The holy grail will be (I still have hope!) a world wide database of anonymized but unique patient data that correlates interventions with outcomes. To do this, however, many other pieces must fall into line. For one: Clear, concise data entry. Otherwise GIGO (garbage in, garbage out).
    I cannot tell you how many medical reports I have read (some by leading software companies such as one major health care provider's customized version of a leading Electronic Medical Record software application) which obscure the clinical data rather than highlight it or allow processing. In the reports I read, there are large chunks of narrative mindlessly copied and pasted from visit to visit ("We plan to taper off Vicodin next visit..." repeated month after month with no obvious correlation with reality of what is actually going on with the patient).
    The key outcome measures are inadequately measured. To continue with the aforementioned example of Vicodin, there if often little no mention of whether it has relieved pain, increased the patient's ability to function in the real world, or had any significant side effects. Sometimes there is not so much as a blood pressure documented. Furthermore, there is often no mention of the actual dose, frequency, and quantity of the medication that IW is prescribed vs. actually taking.
    Use of diagnoses are often vague or inaccurate ("syndromes" are a classic garbage dump for diagnosis when we don't know what is really going on) and there is often no way to distinguish between "working diagnoses" and confirmed diagnoses or refine the diagnosis automatically as more is learned about a particular disease, for example, how to separate out cohorts of patients previously lumped in together with the same "fibromyalgia" diagnosis and reexamine them in light of new research to determine which ones may benefit by further testing or alternative treatments, or were mis-diagnosed (for example Lyme disease, autoimmune disease, sleep apnea, etc).
    The more I think about the problem, the more difficult it seems. If we cannot even document basic clinical measures in a concise, well-defined, way, I see little hope for the kind of population based EBM which could really make a huge difference in both quality and quantity of health care delivered for an given amount of money ($$$).
    If there was a nationwide, open-source, consensus based way to describe medical data in the way physicians actually need to think and act to become more like scientists and less like witch doctors, I believe eventually the acceptance of EMR/EHR's will be not only welcomed, but sought after.
    Meanwhile, I think most of this will have to be driven from the bottom up by private patient implementations of their own PHR', which hopefully will have some basic standards by which to communicate with big name EMR/EHR's.
    My $0.02
    Lydell Anderson, MD

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