blog post

Role of Evidence-Based Medicine in improving the quality of healthcare

Improvement of health care quality is an important deliverable in all healthcare organizations in the country today as they face pressures of keeping up with an increasingly digital ecosystem, amongst other key pressing concerns of the financial health of the organization, defining cost-efficient workflows and enhancing the patient experience.

According to a study published in the BMJ, it has been observed that if the medical error was a disease, it would be the third largest killer in the US. There hasn't been an equivalent study for India, but a study conducted in 2013 by Harvard University estimates that 5.2 million injuries occur across India each year (out of the 43 million globally) due to medical errors and adverse events.

In this light, it becomes pertinent to avoid preventable deaths – to the extent that is possible using available clinical tools. One of the ways of refining healthcare quality and reducing medical errors within healthcare organizations is adapting an Evidence-Based Medicine (EBM) centric approach.

Evidence-based medicine (EBM) is the conscientious, prudent and reasonable utilization of the best evidence in reaching an assessment of the best care to be provided to patients. EBM integrates clinical experience and patient values with the best available research data. It advocates the use of high-quality clinical research in clinical decision making.

Experienced healthcare practitioners use individual clinical expertise, patient dialogue, and the best available external evidence, and none of these elements alone are enough. Without current best evidence, practice risks becoming rapidly out of date, denying patients access to new treatments and management techniques.

In India, shared decision making isn’t the norm – integrating research evidence and incorporating patient inputs holistically is still not widely prevalent. Supplementing physician experience with evidence from high quality randomized controlled trials and observational studies, clinical expertise and the needs and requirements of patients would take time to implement in India – otherwise, it would risk being a concept restricted to the academic discussions instead of its point-of-care execution.

The usage of a clinical decision support tool (CDSS) to practice EBM is widely documented. CDSS tools have been recognized for their potential to reduce medical errors and increase health care quality and efficiency. CDSS is a tool/aid to supplement clinical decision making - in which the characteristics of an individual patient are matched to a computerized clinical knowledge base and patient-specific assessments or recommendations are then presented to the clinician or the patient for a decision.

A clinical decision support tool can help a clinician to have access to the latest relevant information when making diagnostic and treatment decisions. CDSS tools such as BMJ Best Practice are structured around the clinical workflow and updated daily, using the latest evidence-based research, guidelines and expert opinion to offer step-by-step guidance on diagnosis, prognosis, treatment and prevention. Incorporation of a CDSS tool within the hospital workflow can help healthcare organizations in India to deliver better quality healthcare by reducing clinical errors, enhancing clinical productivity, and building treatment standardization.

In a country like India, the adoption of CDSSs is likely to run into implementation barriers such as discrepancy between real and ideal clinical workflows, continuous demands for an easy to use point of care tool developed in meaningful healthcare technology but is likely to see widespread adoption with the current batch of new physicians, with their familiarity with advanced technology.

Though CDSS implementation is not a panacea for all the ills that plague the Indian healthcare system, but a meaningful and thoughtful implementation will go a long way in reducing the variations in care exist.