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J Am Med Inform Assoc. 2001 May-Jun; 8(3): 199–201.
PMCID: PMC131027

An Informatics Infrastructure Is Essential for Evidence-based Practice

Suzanne Bakken, RN, DNSc

Abstract

The contention of the author is that an informatics infrastructure is essential for evidenced-based practice. Five building blocks of an informatics infrastructure for evidence-based practice are proposed: 1) standardized terminologies and structures, 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Selected examples illustrate how each of these building blocks supports the application of evidence to practice and the building of evidence from practice. Although a number of major challenges remain, medical informatics can provide solutions that have the potential to decrease unintended variation in practice and health care errors.

A number of authors have highlighted the ubiquity of variation in practice and have urged that clinicians move toward evidence-based practice.14 However, a number of barriers have been identified. These include the rapid rate of medical knowledge development, inadequate access to clinically relevant information at the point of need, increased workload and patient complexity, and difficulty translating the evidence for use with a particular patient.58

While recognizing that medical informatics is not the panacea for reducing all barriers to evidence-based practice, the contention of the author is that an informatics infrastructure is essential for such practice. This contention is based on two underlying premises. First, in contrast to traditional conceptualizations of evidence-based practice, which typically refer to randomized clinical trials, systematic reviews, and practice guidelines as the sources of evidence that are integrated with clinical expertise for practice decisions,9 evidence is more broadly conceptualized as a continuum of synthesized information. This continuum ranges from the “gold standard” of randomized clinical trial findings to aggregated data from the encounters of an individual clinician or experiences of an individual client. This is consistent with the vision of informatics pioneer Marsden Scott Blois, who stated that clinicians at the point of care should be able to query a database to answer questions such as “What did I do the last time I saw a similar patient?”10 Second, most definitions of evidence-based practice (e.g., those given by Sackett et al.9 and Friedland11) focus on accessing, critically analyzing, and applying evidence to practice. In contrast, the second underlying premise of the author is that an informatics infrastructure for evidence-based practice must also facilitate the building of evidence from clinical practice.

Five components are proposed as the building blocks of an informatics infrastructure for evidence-based practice: 1) standardized terminologies and structures (i.e., terminology models), 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Table 1[triangle] displays selected examples of how the building blocks support the application of evidence to practice and the generation of evidence from practice.

Table 1
Examples of How Proposed Building Blocks of an Informatics Infrastructure for Evidence-based Practice Support Applying Evidence to Practice and Building Evidence from Practice

Tremendous progress in the development of the individual building blocks of an informatics infrastructure for evidence-based practice has occurred. In particular, sources of digital knowledge have rapidly increased. Representative sources are shown in Table 2[triangle] .

Table 2
Examples of Types and Sources of Digital Evidence

However, major challenges remain. These include:

  • Development of business models that support cost-effective and efficient development and dissemination of high-quality digital sources of evidence12
  • Achievement of consensus standards for describing, organizing, obtaining access to, and archiving electronic information sources12
  • Optimization of information retrieval strategies for clinical relevance8,13
  • Integration of the evidence-based practice infrastructure building blocks to support the context-specific retrieval and application of evidence in practice and to facilitate the development of evidence from practice
  • Incorporation of principles of evidence-based practice and the supporting informatics tools into clinical processes and organizational structures
  • Development of informatics competencies related to evidence-based practice in the health care professional work force

Although these challenges are not small, they suggest areas in which medical informatics can contribute solutions that have the potential to decrease unintended variation in practice and health care errors.

Acknowledgments

The author thanks participants in the IMIA Nursing Informatics Postconference, May 2000, in Rotorua, New Zealand, for their thoughtful discussion and comments on the presentation of an earlier draft.

Notes

This paper is based on a presentation given at the IMIA Nursing Informatics Postconference, May 2000, in Rotorua, New Zealand. Its preparation was supported by grant NR04423 from the National Institutes of Health.

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