Gregory H. Dorn on Evidence Based Medicine

Please describe what you mean by evidence-based medicine.

GD: Evidence-based medicine ... or, more broadly, evidence-based healthcare ... is the practice of integrating individual clinical expertise with the best available external clinical evidence derived from systematic review of the literature. The key is to take the most rigorous evidence available and incorporate it into the clinical workflow, which creates an optimal union of the clinician's expertise and the most current proven methods.

What are the pros of it?

GD: First and foremost, evidence-based medicine is better for the patient. Studies show that better patient outcomes are achieved by bringing in the best medical evidence to bear on patient care decisions.

What are the cons?

GD: Some perceive evidence-based medicine as "routinized" care that compromises the art of care, or that doesn't weigh in on most clinical practices; however, the broad application and benefits of evidence-based medicine have now been widely documented in the literature, dispelling these concerns.

One of the cons is that not all evidence sources have proven results. Something to be cognizant of is that "evidence" is not a generic term to describe any type of medical information, so when selecting an evidence provider, healthcare organizations and practitioners should request proof of outcomes. To ensure that clinicians have the most rigorous, current clinical decision support, it important to seek evidence sources that have been proven to positively affect patient outcomes and healthcare efficiency.

Would there be a significant impact on the U.S. healthcare system if it were implemented much more widely?

GD: Absolutely. Studies have shown that large populations of patients receive sub-optimal care due to errors of underuse, misuse and overuse of interventions. A great advantage to patients is that they would be confident that they are receiving a national standard quality care regardless of the region in which they live or the healthcare provider that treats them.

Does the reform legislation now before Congress carry provisions for evidence-based medicine and if so, are they adequate? If not, what should be added?

GD: The version of the Affordable Health Care for America Act (H.R. 3962) that was submitted to Congress is emphatic about evidence-based practice, citing it in the standards for both treatment and prevention. It includes evidence-based care as a component of the definitions for qualified wellness programs, high-value care and patient-centered medical home services; and in their standards for dissemination of comparative effectiveness research and their strategy for national prevention and wellness. It's exciting to see these standards incorporated into legislation because ultimately it improves the care patients receive.

How does evidence-based medicine affect the legal malpractice problem that plagues healthcare providers?

GD: What I'm seeing is that clinicians are held accountable to the standard of care, regardless of whether they know the standard. In effect, the standard of care becomes the "law" that clinicians are to follow. Evidence-based medicine establishes this standard of care, and adds transparency by incorporating the standard into practice, enabling clinicians to be aligned with it.

With prescribed treatment plans for various diseases, it almost sounds that there could be no deviations. Is that true, and if so, how can U.S. healthcare improve if new and/or different treatments can't be used?

GD: The focus of evidence-based medicine is on integrating best medical evidence with clinical expertise; therefore, modifications are implicit. The clinician is the one who decides how treatment should be carried out, because they hold the expertise and judgment to assess the patient's situation with all its variables. The goal of evidence-based medicine is to supply the clinician with the most current, rigorous research so that they can use this information in their overall assessment. In fact, evidence-based medicine helps expedite the amount of time from when a treatment intervention is shown to be a more effective or efficient option to when it becomes the standard of practice, which helps clinical practice to keep current with emerging research.

Is there anything else you'd like to say about evidence-based medicine?

GD: When coupled with an effective workflow delivery format and a robust measurement approach for assessing results, evidence-based medicine can have immense impacts on the quality, safety and efficiency of patient care.

Zynx Health specializes in implementing evidence-based healthcare practices. In nine years at the company, Dr. Dorn has expanded its clientele from less than 50 hospitals to more than 1,700. He received a B.S. degree in engineering from Columbia, where he also obtained his MD degree. He also has a master's in health services from UCLA.

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