The Internet and evidence-based decision-making: a needed synergy for efficient knowledge management in health care

• Published in: Canadian Medical Association journal (CMAJ) Vol. 162; no. 3; pp. 362 - 365
• Main Authors: Jadad, A R, Haynes, R B, Hunt, D, Browman, G P
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact, Inc 08-02-2000
• Subjects: Decision Making; Decision Support Techniques; Evidence-Based Medicine; Health care; Humans; Internet; Knowledge management; Review
• ISSN: 0820-3946; 1488-2329

The Internet fosters the use of evidence by providers and consumers at the point of care. Some tools, called Internet Web site "calculators," are designed to match unique patient information with an underlying evidence-based knowledge repository and sources of potential feedback. Examples include tools for assessing the risk of cardiovascular morbidity for individual patients, information about potential drug interactions and drug dosing, and recommendations about appropriate screening interventions for a given patient. Systems that would allow a patient to complete disease-specific Internet-based surveys are also being developed and evaluated. Special programs would then provide up-to-date evidence-based care recommendations to the patient, according to his or her unique circumstances. These care recommendations could also be sent, by means of the Internet, to the patient's health care practitioners for follow-up of important aspects of care.(f.10) To increase compliance with the recommendations, the Internet could also be used to deliver reminder messages to health care providers and consumers. An increasing number of Internet sites, such as those for the Centre for Evidence-Based Mental Health(f.11) and the School of Health & Related Research (ScHARR) at the University of Sheffield, UK,(f.12) offer simpler decision aids such as calculators for interpreting studies of treatments and diagnostic tests. However, for these tools the user must dig the basic figures out of original and secondary sources, such as journal articles and reviews. From these examples it would be easy to conclude that the Internet has already created a wide array of opportunities for the development and practice of evidence-based decision-making. But this is just the dawn of the Internet age. So far, most (if not all) of the Internet- based applications to promote evidence-based decision-making represent merely a transition from paper-based to electronic-based media; the information is still processed and distributed in text form. Furthermore, most of the efforts to date have been developed for and by health care providers. The true "revolution" (in the sense of going full circle) is likely to come from current and future increases in bandwidth, which will allow anyone to communicate through the Internet more effectively. With these developments we will be able to go beyond text to more "natural" or primal ways of representing and exchanging knowledge. Soon we will be able to deliver research evidence integrated with other types of information (e.g., clinical data, anecdotes, rules of thumb or intuitive statements), using more engaging ways to package the messages and multisensory modes of communication.(f.15) These changes, coupled with developments in wireless, portable (especially palmtop), "wearable" and "ubiquitous" computing,(f.16) will give us, perhaps for the first time, a clear opportunity to develop true partnership, effective communication and efficient use of research information by different groups of decision-makers in all settings within the health care system, regardless of who and where they are.(f.16) Reaching "information nirvana" will not be easy(f.17) and will require unprecedented levels of collaboration among all groups participating in health care decisions.(f.16) The application of the principles and tools of evidence- based decision-making could help us to meet some of these challenges. Dr. Jadad holds a National Health Research Scholar Award from Health Canada and was supported, in part, by the Program in Evidence-Based Care, Cancer Care Ontario. Dr. Browman was supported by the Hamilton Regional Cancer Centre and the Program in Evidence-Based Care, Cancer Care Ontario, as well as by HEALNet, a National Centres of Excellence program funded by partnerships between federal granting agencies and Industry Canada. The Program in Evidence-Based Care is supported by grants from Cancer Care Ontario and the Ontario Ministry of Health. The authors thank Ann Murray for her editorial assistance.