Bringing evidence-based best practices into practice.

The Vanderbilt Center for Evidence-based Medicine (EBM) defines the term as " the judicious application of scientific knowledge by clinicians in tandem with patient preferences and values … an ongoing process of integrating evidence with the clinician's training and expertise for the care of patients and patient populations. " But, according to a 2003 study of 89 health plans sponsored by the Center, only 55 percent of physicians adhere to evidence-based best practices. Physicians want to deliver the best possible care to patients and EBM supports them in this effort. So why is there such a lag in the adoption of evidence-based medicine? Knowledge management is a challenge. The explosion of information from clinical trials and other studies makes it difficult for physicians to keep abreast of new evidence-based standards. Some physicians are wary of EBM as " cookbook medicine " that may restrict their autonomy and curtail their discretion in treating unique patients. Resource constraints are another issue. Some physician organizations argue that they do not have adequate resources to adopt and implement evidence-based best practices, especially when they face conflicting payer policies on reimbursement for various treatment alternatives. Lack of understanding and clarity about best practices and concerns about resources are real problems. But, the most fundamental difficulties in adopting EBM are rooted in the care process. According to George J. Isham, M.D., chief health officer at HealthPartners, disjointed care systems and ineffective processes impede physicians by erecting barriers to putting best-science standards of care into practice. The real challenge is to deploy available resources more effectively in care systems designed to manage knowledge with reliable, efficient tools that bring EBM into routine clinical practice. Information technology must support clinical workflows that make it realistic for physicians to use best practice guidelines in real time.