HIT: Comparative effectiveness research may be beneficial, but not straightforward

BURLINGTON, MASS.--While comparative effectiveness research (CER) is widespread, the information may not be all that straightforward for physicians to understand and obtain, and the research is often seen as a burden rather than a service, Michael A. Fischer, MD, assistant professor of medicine at Harvard Medical School in Boston, said during a presentation at the 2011 HealthIT conference sponsored by the Massachusetts Health Data Consortium Feb. 4.

"Can comparative effectiveness research improve care?" asked Fischer. While he said that there has been a recent increase in the volume of CER, many barriers still exist within the system.

These challenges include: gaps between actual and best practices, the underuse of beneficial treatments (statin treatment for hypertension), use of harmful new therapies and treatment patterns with excessive costs.

In addition to these obstacles, Fischer offered that there are still multiple aspects to improving care with CER that need to be addressed including: the perception of CER, educational limitations and practical interventions to promote quality.

“If we don’t do something to address the educational limitations and our limited ability to intervene with quality right now then we won't have a foundation to build CER no matter how good we can make the perception of it," he said.

He offered that some in the industry don’t trust CER results and have resistance to evidence-based medicine, which is something that CER must combat.

In addition, Fischer said that arguments against evidence-based medicine stem from the thought that this will create “cookie-cutter” medicine--a loss of physician autonomy and the de-personalization of medicine.

But the core issue is: "that cost effectiveness research is seen as a burden, not a service," according to Fischer.

“Trying to keep up with the new [CER] data is like trying to get a drink from a fire hose,” said Fischer. “There is not an easy way to keep up with this.”

He said that there has been ineffective dissemination of the new results and while evidence reviews and guidelines exist, they are lengthy and difficult for physicians to read.

Other challenges to the CER system also exist and these include:

• Educational challenges: “We must bring the CER information overload into a framework where doctors are already overloaded”;
• Practical challenges including the volume of recommendations to implement, limited quality controls for practice and difficult-to-structure interventions;
• Proliferation of the guidelines: With the increasing volume of evidence-based recommendations in primary care it would take physicians 18 hours per day to deliver all of the indicated care and most see CER as a system that will only increase expectations.

Possible solutions to reaching a meaningful CER system include: better educational models, proactive planning for dissemination and the balance in the messages that are delivered and more robust models of continuing medical education.

In addition, Fischer said that building better IT interventions and understanding physician workflow can help with these problems and in identifying high-yield areas for intervention.

What's the take home message? Within the realm of CER there will be a lot more information coming but the biggest barriers already exist, he said. However, we have an opportunity to address systemic problems, he offered. " If we are not ready to make the most for the new CER data it will be a missed opportunity instead of a chance to make things better."