Printer-friendly format

Technology is revolutionizing nearly every aspect of our daily lives, from how we communicate with our families and friends to how we deliver healthcare. Technological breakthroughs in medicine have significantly enhanced our capacity to combat disease and improve quality of life in ways that were not imagined even 25 years ago. In addition, research has accelerated at a dizzying pace, increasing our understanding of the body and promoting the development of new drugs and other therapies to prevent and cure illness. And yet, imagine what it would be like if your healthcare provider told you that the best treatments available to you were developed in 1991. Unfortunately, this is generally the case for most of healthcare. Despite breathtaking advances in technology and research, knowledge gained from research takes, on average, 17 years to be incorporated into widespread practice, according to a report from the Institute of Medicine. Just imagine the advances that could be achieved by closing the gap that currently exists between what we know and what we do. Why does such a gap exist? Given the volume of research results published and the day-to-day demands of healthcare delivery, it is impossible for even the most diligent healthcare providers to stay current on state-of-the-art care. The traditional methods of continuing education, conferences, and journals are simply inadequate. With thousands of new articles published in medicine and related fields every year, only academic researchers with narrow interests have any hope to stay current. To make matters worse, most of the research that is published comes with very little guidance regarding how to translate those findings to real-life settings. While we are learning a great deal about the biology underlying various illnesses and appropriate therapies, we know very little about what it takes to translate those findings into real world treatments. This has led to a proliferation of research-based guidelines, clinical pathways, and “toolkits” designed to summarize the research and encourage its adoption in direct clinical care. While these methods have helped somewhat, practitioners still find it difficult to stay current with advances. Unfortunately, guidelines frequently end up sitting on an office shelf, unread and unused. So what’s to be done to bridge this science-to-service gap? Technology may hold the answer in the form of the newest generation of web-based electronic health records (EHRs). The first generation of EHRs focused primarily on duplicating existing office workflows and translating paper forms onto an electronic screen. While helpful, this was a necessary but insufficient step that offered substantial benefits to record accessibility (with corresponding risks to data security), interoperability, and, last but not least, legibility. Recent history has unfortunately demonstrated one of the most salient benefits of electronic health records – disaster recovery. The natural disasters with Hurricane Katrina and the flooding in the Midwest showed the resilience of EHRs in protecting important medical history. In recent weeks, Columbus Regional Hospital in Columbus, Indiana was evacuated due to flooding. The water submerged the basement room where medical records were stored... on a computer server. Paper records would have been lost forever, but the hospital’s digital records were still available via offsite backup. The newest wave of EHR development is now focused on using EHRs to improve quality of care by helping clinicians make better decisions. Electronic records can now inform healthcare providers of the latest guidelines from research and deliver them electronically at the exact moment a clinician needs that information. This kind of context-sensitive learning is called Clinical Decision Support (CDS), and it is one of the most powerful tools available to change clinical practice. CDS still leaves care decisions in the hands of healthcare professionals, but it enables them to receive the latest information on treatment advances when they need it and where they need it. One simple example of this technology exists in most prescribing software today. When a physician writes an electronic prescription, the software will check that prescription against all other medicines taken by the patient and warn the doctor if there is a possible contraindication or other problem. The doctor can then change the medication or stay with their decision if medically justified. While Clinical Decision Support systems offer great promise to help bridge the gap between research and practice, they are only one piece of a complex puzzle. Better technology alone will not change clinical practice, as evidenced by the relatively slow adoption of EHRs. Perhaps the greatest challenge to overcoming this science-to-service gap is influencing systemic, organizational, and individual inertia. Governments and other payers need to review administrative and bureaucratic barriers that unintentionally impede the delivery of research-based treatments. Organizations need to align their internal management practices to promote adoption of research-based care by measuring and rewarding superior clinical outcomes. Finally, healthcare professionals must be willing to continually re-examine their assumptions regarding effective care. Only in such environments can technology fulfill its potential as a critical tool in successfully bridging the gap between science and service. Tom Doub, PhD, is vice president for research at the Centerstone Research Institute. www.centerstone.org July 2008

Tags:

None

Login and voice your opinion!