Evidence-based medicine the future of health care, experts say




WASHINGTON – The widespread use of evidence-based pathways will be a good thing for health care, according to Ascension Health senior vice president Dr. Michael Schatzlein.

Speaking at the Hospital of Tomorrow meeting, Dr. Schatzlein said that the more “medicine can be protocolized, the safer we’ll be and the healthier we’ll be.”

Some providers have feared that a by-product of evidence-based medicine would be so-called “cookbook medicine,” but Dr. Schatzlein noted that, “in truth, about 85% of the patients manged by every doctor with a relatively narrowly defined condition can be managed the same way and should be on a pathway.”

©Alexander Raths/

As more evidence is gathered, the role of the doctor will transform, Dr. Schatzlein said, to a health care provider focused more on the medical outliers, leaving “very little room for physician style.”

“The brilliance of the doctor comes from identifying … who is sliding off the pathway and to whom the pathway doesn’t apply, and applying all your expertise in those circumstances and letting the rest come through on protocol,” he added.

Speaking on a panel discussing value-based care, Dr. Schatzlein also suggested that it might take some time for the public to truly embrace value-based care.

“We are pushing something the public doesn’t want,” he said. “They want access. They want to pick their provider.… Americans have been trained [to] overconsume care and demand more care than they need.” He said that if there was a move to pure value-based medicine, with the appropriate incentives, “the populace would revolt.”

But the quality and quantity of data still remain an issue, and a change in mindset must occur in order to share more than the bare minimum HIPAA-compliant data, Dr. Schatzlein said at the meeting, which was sponsored by U.S News and World Report.

Dr. Jim Frankfort, chief medical officer and vice president of clinical informatics at IMS Health, suggested that most of the low-hanging fruit in the quality improvement and cost reduction space has already been picked, and at this point “no matter how big you are, you don’t have enough data for the subtle improvements in quality and cost that we’re left with. Even if you had the data, how many of your institutions have the clinicians with the expertise to know how to do continuous process improvement? And then there’s the matter of who’s going to pay for it.”

He predicted that an unprecedented level of collaboration between competitive hospitals and health systems will be necessary to achieve the full gains of value-based care.

“I think hospitals are going to contribute their data so collectively we can amass the scale necessary to address the subtle issues that impact cost and quality,” Dr. Frankfort said, noting that the contributions must go beyond HIPAA-compliant data. “Simple changes in data can render it completely useless for a whole swath of problems you want to address. The changes we need to make in data sets for HIPAA compliance really render it useless for a lot of the stuff we are going to need.”

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