Evidence-Based Medicine isn’t Going Anywhere

Technology and automation are sweeping through healthcare and they are changing medicine. Medical futurists can’t get enough of science fiction-turned-reality ideas such as IBM’s Watson, big data analytics, and knowledge gleaned from EHR data, more readily available in the U.S. since the HITECH Act helped physicians digitize their paper records.

For some doctors, all this technology might not seem like a march toward progress. Between guidelines, protocols, compliance and payer reimbursement rules, it can feel as if physicians’ capacity to make decisions on their own is being sliced off a little each day. 

In the end, however, all of these tools amount to clinical decision support and not clinical decisionmaking. These ideas have been and always will be the bedrock of evidence-based medicine. Digital tools are there to answer questions for physicians, access the most current bits of clinical data relevant at the point of care for the individual patient at hand, and confirm a physician’s instinct for diagnoses and care plans with reference data, images, and access to guidelines.

Evidence-based medicine and guidelines

In the 1990s, clinicians originally defined evidence-based medicine as the conscientious and judicious use of the best current evidence in making decisions about individual patients. “Conscientious and judicious” is an important concept, because it means integrating individual clinical expertise with that best available external clinical evidence from systematic research. Ten years later, the accepted definition evolved to take patient values into consideration along with evidence and expertise.

Combining clinical evidence with clinicians’ experience and education creates a healthcare paradox. As patients demand more personalized and precision medicine, they’re driving a need for more granular information and specific guidelines for different populations. After all, one size does not fit all patients. Yet guidelines are developed from data that has been purposefully abstracted so that they are one-size-fits-all.

That is why evidence can only take medicine so far: We are all individual patients.

In an awkward moment at the 2012 American Telemedicine Association annual meeting, Apple cofounder Steve Wozniak suggested to a hall full of several thousand physicians that artificial intelligence would eventually replace them. Patients would be diagnosed and treated by a computer, with only a technician at the bedside. While he was the convention’s honored guest and star speaker, the audience gasped with disdain, murmuring disapproval at the idea and even drawing a few scattered boos. Realizing his gaffe, “The Woz” quickly apologized and moved on to his next talking point.

He had hit a nerve, perhaps tapping into physicians’ fears: The forward march of technology, data systems and economic forces seem to all be conspiring against them. But this isn’t the case. Like evidence, technology can only take us so far. It takes a physician to choose a care path and adjust it as the patient responds.

Physicians will control the final answer

That being said, emerging technologies driving data science will help us hone our knowledge. Over the coming years, data will play a bigger role in clinical studies as researchers learn to use analytics tools to identify tighter cohorts and compare multiple trials to each other. We’re on the cusp of understanding how big data can be used as a research tool to find broader trends than would be possible with traditional methods. But we’re not quite there yet.

The tools for conducting clinical research - and communicating outcomes - are getting faster. Studies are building up on each other faster than ever before, and it’s getting harder for physicians to keep up with the best available evidence to assist them in making the best treatment decisions. Emerging technologies help publishers like us to stay current, as we examine data sets and constantly compare them against the established guidelines clinicians trust.

That’s where the physician comes in. Science can give us the best possible information, distilled into guidelines through careful examination of the evidence, which is constantly re-examined as new research is published. In the end, however, the most important data set for the patient isn’t contained in a cloud server farm. It’s in the exam room, wearing a white coat and stethoscope, making the best decisions on an individual basis.

Together, the evidence-based guideline - viewed through the lens of human intuition -creates medicine. And that is why medicine will remain an art, no matter how much assistance big data technology and analytics systems can offer.

Betsy Jones is Vice President of Medical Product Management and Chief Content Officer for DynaMed Plus. Prior to that, she served as Senior Vice President and Publisher for the American Medical Association and JAMA Network, and was Executive Vice President and General Manager at Wolters Kluwer Health/LWW.