Last month I had the pleasure of attending my favorite conference, the American Medical Informatics Association’s (AMIA) Joint Summits on Translational Science in San Francisco, with several of my colleagues from Prometheus. In this article, I’d like to highlight a theme I observed while at the meeting: evidence-generating medicine (EGM).
Evidence-based medicine (EBM)—the idea that medical care should be based on evidence— has received considerable attention over the past couple of decades. However, clinical research informaticians Peter Embi and Philip Payne argue that unidirectional application of evidence from research to practice is not sufficient to achieve the Institute of Medicine’s (IOM) goal of a “Learning Health System.” According to Embi and Payne, we need to be generating evidence from practice as well—what they call the evidence-generating medicine (EGM) paradigm: “The systematic consideration and incorporation of research and improvement activities into the organization and practice of healthcare to accelerate biomedical discovery and improve the health of individuals and populations.”
I’m already starting to see signs of EGM in the clinical quality improvement (CQI) area where I spend much of my professional time. Quality improvement registries, such as the national Measures and Outcomes Registry for Eyecare (MORE) that we’re creating for the American Optometric Association (AOA), fully embrace the EGM paradigm. MORE will systematically collect structured, coded data from multiple EHR vendors and organize it for reuse for performance and outcomes measurement. These data will be shared in aggregate with participating clinicians, allowing them to benchmark their own performance and patients’ outcomes against those of their peers nationwide. Discrepancies among clinicians’ perceived and actual performance and clinical practice guidelines can catalyze change at the level of individual clinician behavior as well as help healthcare organizations and societies adjust and tailor their educational programs.
While the term EGM may be just starting to gain adoption, it certainly isn’t the first time we’ve considered incorporating research activities into practice. In fact, much of our focus at Prometheus over the past several years has been on how to efficiently and effectively repurpose health data in order to facilitate research and quality improvement activities. If you’re interested in following our work, check out our recent presentations and roundtable discussions (Friday, March 27th) from the last AMIA Annual Meeting and AMIA Joint Summits conference.
Where else have you seen signs of the EGM paradigm?
By: Frank Farach, Staff Scientist