Question

For this discussion, consider the ways in which technology and informatics are used to support evidence-based practice. Please address each of the following questions in your discussion response for this week:

1. Choose a specific evidence-based practice (examples: CAUTI reduction, sepsis protocol, SCIP protocol, bedside shift report, etc.).
   • Describe how technology and informatics are used to support the interventions used in practice?
   • Describe how employing evidence-based practice guidelines improve patient outcomes?
2. What benefits and challenges have you experienced with (the integration of) information technology in your practice?
3. What strategies did you, or could you, use to overcome these challenges?

Answer

1. Introduction

Informatics is any practice that involves the use of information. It involves using information and applying cognitive and practical skills for manipulating the information (knowing), and comparing this with the various health sciences aiming at a better understanding of health problems and evidence leading to decisions or actions (doing). Informatics has a broad application across health care including management data on service utilization, assessing population health needs, disease management, and consumers making informed decisions about their health. For EBP, informatics can provide enhanced access to and dissemination of information. It provides means to the management of vast volumes of information and presenting this at the right time in the right place to enable high-quality decisions. Today with the internet, the amount of information is huge, informatics can help break this down and provide the correct research for the right area in the instance of say a clinical encounter. For evidence-based clinical decisions, there are methods of decision analysis and modeling using probability to predict the best course of action and assess potential outcomes. Finally, informatics can provide monitoring and audit against best evidence through various means of information, to determine if practice is effective and to make improvements in areas of sub-optimal care. All of these methods are a vast improvement for integrating evidence into practice in contrast to the traditional methods of medical education which focus on retraining the facts to be recalled at a later time.

Evidence-based practice (EBP) involves making clinical decisions based on the best available evidence, using it alongside clinical expertise and patient values. Evidence-based practice is not new, but it is now receiving increasing attention in health care as medicine becomes more complex with more decisions and therapy options. There is some resistance to EBP which arises from the ‘art’ of medicine with its individualistic craft approach and its tradition of passing down information from mentor to protégé. We must stress, EBP is not about cookbook medicine. EBP is about integrating individual clinical expertise with the best available external clinical evidence from systematic research. In ideological terms, it aims to keep the ‘art’ of medicine while emphasizing some of the science-based aspects in the ‘art’. For medical practitioners, it is applying a conscientious, explicit, and judicious process in making decisions. This will help to improve the quality of their clinical judgments and keep up to date with the new and relevant research. Evidence-based practice is patient-centered. It’s about providing care that is of the best quality with the understanding of the potential risks and benefits for treatment and non-treatment for the patient, with the use of informed consent. For the patient, it means receiving high-quality care which is up to date with minimal error in diagnosis and treatment with the view that will increase the length and quality of life. With the explosion of research, medicine has a struggle to change practice. Major barriers include problems with the volume and lack of awareness of new research, and the lack of resources and time, so changing practice can be quite slow. Measures need to be taken and doctors must come to understand the research and change their practice, and patients must understand that the quality of care is directly linked to the care that’s been proved to be effective through research.

1.1 Importance of Evidence-Based Practice

The practice of evidence-based medicine can be regarded as a systematic and disciplined way of evaluating clinical problems and practice. EBM is a lean, mean patient care providing machine. It allows the clinician to quickly, efficiently, and effectively weigh the pros and cons of a particular treatment. If there are no current RCTs suggesting the use of a particular medication, the clinician is able to use clinical experience, hierarchy of evidence, and patient values to make a very informed decision. Evidence-based medicine involves conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM is very important, and in fact, it’s the backbone of our internal medicine residency program. Because many different treatments lead to similar outcomes, we want to ensure that we’re providing the most efficient and effective care for our patients. This residency program is going to teach us how we can acquire the best evidence, how to assess its validity and usefulness, and how to apply it when making medical decisions. The concept of EBM and steps involved are summarized in the article: “Evidence-Based Medicine: What It Is and What It Isn’t” (Sackett, 1996). The practice of EBM has proven successful in many surgical and medical specialties. It’s been shown to reduce costs, improve the quality of intervention, and lead to better patient outcomes. In a study conducted by David L. Berger, M.D., MS (2003) and colleagues, it was found that EBM is most successful when it involves the cooperation of clinical scientists, biostatisticians, and personnel in biomedical informatics. To be EBM practitioners, we must become efficient in avoiding outdated practice habits and to stay informed on recent developments and evidence across all areas of patient care. This is no easy task, but with practice and familiarity, it becomes second nature.

1.2 Role of Technology and Informatics

Technology has come a long way and has become more affordable and easier to use. In a recent survey of US adults, 72% of internet users said they looked online for health information within the past year. One of the many reasons why they are seeking health information online is that it has become easily available and convenient. The use of computers and mobile devices can now allow practitioners and patients to access health information from any location with internet wifi or cellular access. This is an important determinant as with EBP, it is not only important to access evidence, but it is also important to be able to apply and integrate it into clinical practice. This improved access to technology can dispel the restrictive view that evidence-based practice can be limited to only using research when it is available. In a clinical scenario, it is not uncommon to encounter situations where there is no clear evidence or evidence-based guideline to best manage a patient. Often without easy access to research materials, decisions are often defaulted to previous practice habits or even mere intuition. With improved access to information technology, such a situation can prompt the practitioner to search for evidence at the point of care, and thus, will close the gap between practice and research. As a matter of fact, it is suggested that the best method to promote evidence-based practice is to teach clinicians how to form questions about clinical practice and search for the answers. With the improved availability of research materials and evidence, technology can ultimately teach us how to think critically.

The concept of evidence-based practice (EBP) has created a substantial impact in the medical industry. Though its formulation has been a long and rough process, it has proven itself to be a critical player in improving the existing healthcare system, which is filled with outdated practices that are either flawed or have been rendered obsolete by newer and more effective interventions. According to the definition provided by Sackett and colleagues, EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” The expected outcome of EBP is to improve the quality of clinical practice and ultimately improve patient outcomes. It is clear that the goals of EBP correspond with the needs of the healthcare system, and it’s important to recognize that technology and informatics is a key driver behind the success of EBP and the execution of its objectives.

2. Specific Evidence-Based Practice

2.1 Selection of a Practice

2.2 Overview of the Chosen Practice

3. Technology and Informatics in Practice Interventions

3.1 Integration of Technology in Practice

3.2 Informatics Support for Practice Interventions

3.3 Benefits of Technology in Practice Interventions

4. Improving Patient Outcomes through Evidence-Based Practice

4.1 Understanding the Impact of Evidence-Based Practice

4.2 Patient Outcomes and Evidence-Based Guidelines

5. Benefits and Challenges of Information Technology in Practice

5.1 Benefits of Information Technology

5.2 Challenges Faced in Integrating Information Technology

6. Strategies to Overcome Challenges

6.1 Identifying and Addressing Barriers

6.2 Training and Education for Information Technology

6.3 Collaboration and Support

7. Conclusion

Technology and Informatics in Evidence-Based Practice

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