HCLF: 'EHRs must become smarter'

CHICAGO—Personalized medicine may bring clinicians at odds with evidence-based medicine, said Howard C. Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, speaking at the Healthcare Leadership Forum. Healthcare is working on “reconciling patient preference with evidence-based medicine,” he said.

Meanwhile, $25 billion is spent on IT in U.S. hospitals and “there has been a tremendous surge in the use of EMRs. Up to 70 percent of providers engage patients with EHRs. How rich and integrated those EHRs are is uncertain.” Interoperability remains a challenge, he said, but there is a great deal of interest in improving connectivity. The cognitive capacity of EHRs remain limited and Bauchner said he has "a sense they will stay siloed for many years to come.”

JAMA has a long association with evidence-based medicine, Bauchner said, publishing a 1992 seminal paper defining evidence-based medicine. The publication gets about 5,000 reports a year and the editorial team discusses 1,800 of those. “We read so many papers which provides an enormous landscape and special look at American medicine.” Evidence-based medicine has experienced substantial improvements, he said, such as incorporating systematic reviews into guidelines. “We’re just beginning to see the next evolution of guidelines and grading of evidence but “we still struggle in how to take that summary variable and understand how to articulate what that would mean from a clinical standpoint.”

Bauchner said he thinks health IT can help incorporate level A evidence into EHRs. The question, he said, when considering safety, quality, variation, etc., is “how can we create a horizontal view of these issues so there can be progress in health outcomes? The key will be health IT.”

Health IT plus guidelines equals value, he said. “EHRs must become smarter. We have to go beyond counting and linking databases.” He said big data makes him nervous. “I’m not sure anyone knows where we’re going.” A focus on “little data” might be better than “extravagant themes of the future.” He suggested not focusing on conditions for which there are no guidelines because that will result in uncomfortable debates between doctors, patients and the IT world. “It’s going to be much more difficult to change physician or patient behavior if the decisions are always discretionary.”

The Healthcare Leadership Forum was sponsored by Clinical Key and presented by Clinical Innovation + Technology.