Dr. Mark B. McClellan, Brookings Institution Senior Fellow, talks about the importance in creating a learning healthcare system where we can routinely get evidence out of medical practice.
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Moving More Towards Evidence-Based Medicine. Dr. Mark B. McClellan: In many cases the way that we develop evidence today hasn't change much in the last 30 or 40 years. Paper records have to be abstracted, studies are done on a one-off basis, it requires a lot of time and a lot of investment and effort to get the results out. What I have to talked about today is the importance of creating a learning healthcare system, where we can routinely get evidence out of medical practice, that's increasingly feasible with more electronically-based data sets and with capturing this unlimited amount of additional information from physician input, by having a healthcare system where we can routinely do the kinds of studies that up until now have taken special protocols and taken a lot of time to set up, we can transform our ability to get evidence on what works. A lot of the work that can be done now involves what are called distributed data systems, where as long as each medical office or each medical practice is following the same kinds of interoperability rules, they are collecting their data in the same way, they are contributing to an overall analysis, you don't have to share information that's patient identifiable. You don't have to set up a single big database, we can learn from medical practice without compromising confidentiality or without setting up a big new database, and we can do it routinely. Physicians Role in Evidence-Based Medicine Dr. Mark B. McClellan: Physicians are a large part of leading the effort, learning more from their actual practices, in many cases, it's physicians own experience with using treatments in new ways or modifying devices that provides the important insights they can get to better care faster. The challenge that we have had is capturing that information, capturing that evidence, is physician driven to improve practice. So, I think as we move forward on addressing the problems of cost and quality on healthcare system, physician leadership is going to be very important and that includes helping to develop better evidence on what works. Electronic Health Records: What Needs to Happen to Make Them the Standard? Dr. Mark B. McClellan: I think there are several important obstacles still. One, a very important obstacle is that many people don't trust how their electronic information is being handled. We need to take more aggressive steps, but the Federal government is going to have to lead to assure privacy and security of electronic records. Second, we need to keep making progress on the interoperability of those records, so that information gathered in different systems can be put together effectively without compromising confidentiality and there is a lot of work going on in that area right now. And third there are many business opportunities to make the economics of electronic health information pay-off, e-prescribing incentives, new steps to use electronic information, to identify and promote high quality care, all of that helps create a new business case for electronic records. So, I think collectively it's going to enable us to use much more electronic information to improve care in the near future. I think over the next several years, we are going to continue to see progress, there are already a number of studies being done to evaluate drug's safety, to learn more quality of care. Right now we are using electronic information and that's going to get better soon. So, you will keep seeing incremental progress that's going to add up to some fundamental changes in healthcare.
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