Evidence-Based Practice. In this presentation, we'll consider the
essential key points related to use of evidence-based healthcare information in
practice in the context of the EHR. The reference for this presentation,
unless otherwise noted, is Chapter 15 of the optional Hoyt text.
These key points that we'll cover are: Evidence and EBP can be
interprofessional, EBP Resources, EHRs are EBP platforms, and Semantic tools are
essential for the healthcare quality agenda.
Let's pause for a moment to reflect. What does the word evidence mean to you?
How does it relate to data and information and knowledge?
For some background for this exciting topic, Google defines evidence as the
available body of facts or information indicating whether a belief or a
proposition is true or valid. This definition aligns with the
transformation of data to information and knowledge that is core to information
science and informatics. And, for that matter, the research
enterprise in general. Applying knowledge to practice was
considered wisdom, as per our previous discussion on informatics theory and fits
with the notion of applying evidence to practice.
Since the 1990s, scientists across the healthcare professions have emphasized
the need for evidence based practice, referencing gaps in knowledge and quality
and the financial consequences of those gaps.
The knowledge gap refers to evidence that exists but has not been translated into
practice. The Institute of Medicine estimated a
delay of 17 years from publication to widespread adoption of evidence in
practice settings. And some scholars have suggested that the
results of many studies may never impact practice.
The quality gap refers to many issues in healthcare quality.
Health system researchers have uncovered serious quality gaps including
unnecessary healthcare services. Services inefficiency delivered and
missed prevention opportunities. The financial burden of these
unnecessary, inefficient and missed services was conservatively estimated at
$750 billion for 2009. Evidence-based practice is key to
addressing these gaps. However, the notion of evidence-based
practice is complex. We know evidence comes from research but
how do we apply that evidence collaboratively in the real world.
This is especially challenging because health care professions differ in their
perceptions of what constitutes evidence. Satterfield and colleagues found common
challenges across disciplines. They include how evidence should be
defined and comparatively weighted. How and when patients and other
contextual factors should enter the clinical decision making process.
The definition and role of the expert, and what other variables should be
considered when selecting evidence based practice, such as age, social class,
community resources, and local expertise. Key point one: Evidence and
evidence-based practice can be interprofessional.
Evidence-based practice models for medicine, nursing, psychology, social
work and public health re-evaluated and synthesized to create a new model of
collaborative health care practice in which health decisions are not solely the
practitioner's but are shared among the practitioner's clients and other effected
stakeholders. The model is grounded in an ecological
framework and emphasizes shared decision making.
Key point two: Evidence-based practice resources.
Evidence-based practice resources come from the scientific literature, reviews
of the scientific literature, and guidelines synthesized from the
literature. Here are a few of the resources that are
available. And here are the websites.
Mobile applications can be handy. They can make your evidence appear at
your fingertips. Hundreds of clinical practice guidelines
are available in free iPhone and Android apps.
Visit this website and find at least one app that would be useful to your
profession. Key point three: EHRs are EBP platforms.
The EHR has potential to improve decision making by incorporating evidence-based
practice. This is a form of decision support.
It can be linked to diagnoses or order entry, or provided as a look up, such as
an info button. Key point four: Semantic tools are
essential for the health care quality agenda.
Just as it is challenging to apply semantic tools to any knowledge, due to
semantic equivalence and semantic gaps, it is similarly challenging to apply
semantic tools to evidence-based practice.
Early efforts to do so have been under way for the past decade among Omaha
System users. Several proprietary EHRs are
incorporating evidence-based Omaha System guidelines for clinical decision support
and documentation. Informaticists and health IT
professionals are needed to address the challenge of combining evidence based
practice, electronic health records functions, and standardized
terminologies. Doing so supports practice and generates
new data, data about clinical use of evidence, and data about clinical
outcomes related to evidence-based practice.
This is consistent with our interprofessional health care informatics
worldview, that we can combine EBP, EHRs, and semantic tools in a dynamic research
practice context to improve healthcare quality.
After a brief review of the concepts of evidence and knowledge we considered four
key points. Evidence and EBP can be
interprofessional, EBP resources, EHRs are EBP platforms, and semantic tools are
essential for the health care quality agenda.
These key points are fundamental to understanding opportunities that arise
from representation of evidence-based practice within the EHR.
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