Empowering Physicians Through Evidence

For physicians to practice evidence-based medicine, decision-making must be based on the best available data that are frequently, consistently and systematically identified and displayed. Traditionally, providing that type of information to physicians at the point of care has been challenging; however, new tools, which allow for interoperability and flexibility, provide a practical solution.

The need: EBM and Order Sets

Memorial Hermann Healthcare System, a 12-hospital system in Houston, had a challenge to solve. CMIO Robert Murphy, MD, needed evidence-based clinical content that could be integrated with Zynx Order Sets. Their choice was the DynaMed clinical point-of-care resource.
Interoperability was a priority for Murphy who explains that DynaMed and Zynx work well together which supports the organization’s efforts to build and update order sets. DynaMed provides access to the most current evidence-based clinical content from Zynx, as well as other EMRs and mobile devices.

“It is both easy and convenient for physicians to access the data in DynaMed,” Murphy says. “If a technology requires multiple log-ins, has restrictions on remote access, or can’t be accessed via tablets and mobile devices, physicians won’t use it.” He has been reassured by the rapid adoption of DynaMed at Memorial Hermann, which he sees as indicative of the fact that DynaMed’s content and technology is highly valued by clinicians.

The Memorial Hermann team sees clear clinical benefits from DynaMed as well. Recently, Murphy conducted a deep dive into venous thromboembolism in pregnant women because it is the leading cause of maternal mortality in the U.S. “To obtain the empirical, comprehensive evidence that physicians required to understand complications associated with such conditions, the physicians went directly to DynaMed to access the most current evidence on the topic,” he says.

Also, the pressure to provide this evidence to physicians isn’t simply an internal Memorial Hermann initiative. Meaningful Use Stage 2 requirements put a far greater emphasis on the availability of evidence-based clinical information at the point of care. “In fact, one of the requirements is to have reference information available with an info button,” Murphy says, “and we believe our architecture will easily meet those standards going forward.”

Changing care through new evidence

Having the most current clinical evidenced-based information available at the point of care can inform or change care, especially when physicians are faced with rare or difficult cases. In November 2012, an adult patient presented to Brannon E. George, MD, an internal medicine physician at Memorial Hermann, with whooping cough, a rare, highly contagious bacterial disease that causes uncontrollable, violent coughing. “Due to the uncommon nature of the illness, I used DynaMed to research recommended medications and treatments for adults, and also discovered what medications are contraindicated,” George says.

George, who uses the tool two to three times per week, says he can make certain he is properly treating a particular patient or population, especially when faced with uncommon cases. “This allows for consistent, standardized care across all patients, which is the basis for the push for evidence-based medicine,” says George, who adds that the technology is particularly helpful because it’s also accessible on a smartphone.

In addition to informing physicians, Murphy sees the tool as a means to change care on a system level through the widespread dissemination of constantly updated clinical knowledge and content. “Having information updated on an ongoing basis allows our medical staff and informatics team to be kept abreast of the changing evidence, which can move our entire enterprise forward,” he says. “We are just starting to see the rapid cycle of information being published, resulting in our ability to incorporate those data into order sets and rules, which can instantly be made available in all of our hospitals. The cycle time is greatly reduced.”

Health IT can no longer exist as a static platform, says Murphy, who recognizes the value in DynaMed’s ongoing alerts and notices to keep his organization continuously current of the ever-evolving medical evidence.