Have you ever wondered why, when there are so many algorithms, treatment guidelines or comparative effectiveness reports, there are so few physicians following them? Prominent national organizations, like the Agency for Healthcare Research and Quality, and medical societies invest vast amounts of money and human resources to develop these tools through private and public funding. So why are physicians casting these valuable evidence-based resources aside? Why are these reports that are meant to improve the quality of medical practice going unread by the vast majority of providers in the United States? The answer is simple — these tools are not smart enough.
For starters, consider how healthcare providers are trained in the U.S., where their clinical education is more of an apprenticeship than didactic. Physicians and pharmacists learn and gain experience by working through their preceptors in real-world settings of hospitals, clinics and pharmacies. Thus, the hands-on experience they gain in actual practice taking care of individual patients oftentimes supersedes whatever guidance may come in a report from a national or international organization, which is typically based on the treatment effect of an average patient and often has a retrospective view of medical evidence. Hence, such information lags behind the actual practice of medicine, which evolves in real time just as science does and is void of real-world data.
Subsequently, we in the U.S. healthcare system need to re-think the type of information that will help providers become better practitioners while safeguarding the principle of personalized medicine. Providers need to be connected to clinical guidance through assimilation and dissemination of the data gathered at their own practice and the practices of their peers in real time. This doesn’t eliminate the need for academicians and medical societies to develop their own guidelines and pathways. Rather, that information should be part of the larger set of evidence that is fed back to the physician while he or she is choosing the best course of care for the patient sitting in front of them.
Ideally, the information will be a combination of guidelines, expert opinion, providers’ own data based on past patients for whom they have provided care and data from peers. Patient-experience data and clinical trial information are also important parts of the information platform. As physicians are diagnosing patients, they are provided supportive guidance based on information gathered in real time, utilizing multiple data points. In addition, every time a physician diagnoses and provides treatment to the patient and inputs that information, the database becomes even more robust, and data provided back to the clinician will have greater statistical confidence. The guidelines and clinical trial data are also updated as these resources become available.
Such a system will also allow us to develop metrics that track and reward providers for making the care decisions that matter to patients, while also considering cost efficiency. Just like no individual’s health is average, no individual’s life choices are average. Patients often have different priorities regarding health outcomes they prefer. Thus, they are more likely to follow the treatment prescribed if it is consistent with what they see as a good outcome.
This new system will also facilitate innovation, as it will provide biopharmaceutical companies an opportunity to make smarter decisions for future research and development and clinical trial design and recruitment. Companies will be able to evaluate and demonstrate the value of their innovations and, most importantly, promote pharmacovigilance in real time.
So how can we begin to change the current arcane system of evidence-based practice? We need to examine the interoperability and standardization of relevant electronic health record data fields and identify solutions to trace an individual product to a medical outcome. We also need to have policies that standardize methods that improve data quality and establish standards on how to extract data from various sources in addition to EHRs.
Instead of trying to fix a broken system of promoting outdated and irrelevant voluminous guidelines and algorithms, let’s build a system that allows physicians to practice medicine based on their own practice information, while incorporating guidelines and other types of data into their decision making. Let’s allow better-informed physicians to care for the individual patient by providing them the right drug, at the right time, for the right purpose, after reviewing the right information. It’s about time that our healthcare system became as smart as our phones.
Robert Popovian is the Senior Director of U.S. Government Relations at Pfizer Pharmaceuticals.