Policy and Practice Information systems: the key to evidence- based health practice

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems.

[1]  T. Lancaster,et al.  The Cochrane Collaboration in Primary Care: an international resource for evidence-based practice of family medicine. , 1995, Family medicine.

[2]  J. Marshall,et al.  The impact of the hospital library on clinical decision making: the Rochester study. , 1992, Bulletin of the Medical Library Association.

[3]  David B. Kendall,et al.  Perspective: Pursuing The Promise Of An Information-Age Health Care System , 1998 .

[4]  D W Moran.  Health information policy: on preparing for the next war. , 1998, Health affairs.

[5]  J Zvárová.  On the medical informatics structure. , 1997, International journal of medical informatics.

[6]  E. Dickinson,et al.  Clinical effectiveness for health care quality improvement. , 1998, Journal of quality in clinical practice.

[7]  L Becker.  The Cochrane Collaboration. Valuable resource for family physicians. , 1997, Canadian family physician Medecin de famille canadien.

[8]  A R Jadad,et al.  Systematic reviews and meta-analyses on treatment of asthma: critical evaluation , 2000, BMJ : British Medical Journal.

[9]  B. Kaya,et al.  The introduction of evidence-based medicine as a component of daily practice. , 1996, Bulletin of the Medical Library Association.

[10]  P. Tugwell,et al.  Are therapeutic decisions supported by evidence from health care research? , 1998, Archives of internal medicine.

[11]  R. Haynes,et al.  Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research , 1994, Annals of Internal Medicine.

[12]  K. A. McKibbon,et al.  Online access to MEDLINE in clinical settings. A study of use and usefulness. , 1990, Annals of internal medicine.

[13]  D. Sackett,et al.  Evidence-based medicine. , 1998, Lancet.

[14]  Alex Jadad,et al.  The Internet and evidence-based decision-making: a needed synergy for efficient knowledge management in health care , 2000, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[15]  R B Haynes,et al.  Effect of problem-based, self-directed undergraduate education on life-long learning. , 1993, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[16]  Roberto J. Rodrigues,et al.  Telemedicine and the Transformation of Healthcare Practice in the Information Age , 2000 .

[17]  K. A. McKibbon,et al.  Evidence-based practice. , 1998, Bulletin of the Medical Library Association.

[18]  R. Grol,et al.  Dissemination of guidelines: which sources do physicians use in order to be informed? , 1998, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[19]  M W Enkin,et al.  Using anecdotal information in evidence-based health care: heresy or necessity? , 1998, Annals of oncology : official journal of the European Society for Medical Oncology.

[20]  J R Moehr,et al.  Informatics in the Service of Health, a Look to the Future , 1998, Methods of Information in Medicine.

[21]  W. Rosenberg,et al.  Evidence based medicine: an approach to clinical problem-solving , 1995, BMJ.

[22]  K. Odunsi,et al.  Evidence-based medicine: how do we find the evidence? , 1998, The Journal of the American Association of Gynecologic Laparoscopists.

[23]  Fiona Godlee,et al.  Getting evidence into practice , 1998 .

[24]  L J Donaldson,et al.  Clinical governance and the drive for quality improvement in the new NHS in England , 1998, BMJ.

[25]  Roberto J Rodrigues,et al.  Ethical and Legal Issues in Interactive Health Communications: A Call for International Cooperation , 2000, Journal of medical Internet research.

[26]  A. Detsky,et al.  Evidence-based medicine. A new approach to teaching the practice of medicine. , 1992, JAMA.

[27]  B. Silverman,et al.  The role of Web agents in medical knowledge management. , 1998, M.D. computing : computers in medical practice.

[28]  J. McMurray.  Failure to practice evidence-based medicine: why do physicians not treat patients with heart failure with angiotensin-converting enzyme inhibitors? , 1998, European heart journal.

[29]  M. Berkwits.  From practice to research: the case for criticism in an age of evidence. , 1998, Social science & medicine.

[30]  R S Hayward,et al.  GAP: a computer-assisted design tool for the development and analysis of evidence-based automated questionnaires. , 1995, Medinfo. MEDINFO.

[31]  David H. Gustafson,et al.  Wired for health and well-being : the emergence of interactive health communication , 1999 .

[32]  A Clinical Informatics Network (CLINT) to support the practice of evidence-based health care. , 1996, Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium.

[33]  Jochen R. Moehr,et al.  Towards improved information retrieval from medical sources , 1998, Int. J. Medical Informatics.

[34]  A R Jadad,et al.  Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals. , 1998, JAMA.

[35]  D. Gustafson,et al.  An Evidence-Based Approach to Interactive Health Communication: A Challenge to Medicine in the Information Age , 1998 .

[36]  L Kaegi.  Health services researchers zero in on quality, policy, and practice in a changing health care system: report of the 15th annual meeting of the Association for Health Services Research. , 1998, The Joint Commission journal on quality improvement.

[37]  R B Haynes,et al.  A critical appraisal of the literature on the effects of computer-based clinical decision support systems on clinician performance and patient outcomes. , 1992, Proceedings. Symposium on Computer Applications in Medical Care.

[38]  Silverman Bg.  The role of Web agents in medical knowledge management. , 1998 .