A ‘Green Button’ For Using Aggregate Patient Data At The Point Of Care
- 1 July 2014
- journal article
- Published by Health Affairs (Project Hope) in Health Affairs
- Vol. 33 (7), 1229-1235
- https://doi.org/10.1377/hlthaff.2014.0099
Abstract
Randomized controlled trials have traditionally been the gold standard against which all other sources of clinical evidence are measured. However, the cost of conducting these trials can be prohibitive. In addition, evidence from the trials frequently rests on narrow patient-inclusion criteria and thus may not generalize well to real clinical situations. Given the increasing availability of comprehensive clinical data in electronic health records (EHRs), some health system leaders are now advocating for a shift away from traditional trials and toward large-scale retrospective studies, which can use practice-based evidence that is generated as a by-product of clinical processes. Other thought leaders in clinical research suggest that EHRs should be used to lower the cost of trials by integrating point-of-care randomization and data capture into clinical processes. We believe that a successful learning health care system will require both approaches, and we suggest a model that resolves this escalating tension: a "green button" function within EHRs to help clinicians leverage aggregate patient data for decision making at the point of care. Giving clinicians such a tool would support patient care decisions in the absence of gold-standard evidence and would help prioritize clinical questions for which EHR-enabled randomization should be carried out. The privacy rule in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may require revision to support this novel use of patient data.Keywords
This publication has 41 references indexed in Scilit:
- Mining the ultimate phenome repositoryNature Biotechnology, 2013
- The Randomized Registry Trial — The Next Disruptive Technology in Clinical Research?The New England Journal of Medicine, 2013
- Rescuing clinical trials in the United States and beyond: A call for actionAmerican Heart Journal, 2013
- The Inevitable Application of Big Data to Health CareJAMA, 2013
- Scientific Evidence Underlying the ACC/AHA Clinical Practice GuidelinesJAMA, 2009
- Bridging The Inferential Gap: The Electronic Health Record And Clinical EvidenceHealth Affairs, 2007
- Information Technology And The Inferential GapHealth Affairs, 2007
- The Promises And Pitfalls Of Evidence-Based MedicineHealth Affairs, 2005
- Why we need observational studies to evaluate the effectiveness of health careBMJ, 1996
- Evidence based medicine: what it is and what it isn'tBMJ, 1996