Harvard offers digital repository of medical evidence to providers

Ivy League school’s Library of Evidence will first offer imaging guidance with plans to expand its online resource as evidence-based medicine grows nationally.

Harvard Medical School has launched a free, publicly accessible digital repository of medical evidence to help clinicians practice evidence-based medicine in accordance with legislation that goes into effect in 2018.

The Protecting Access to Medicare Act, signed into law in 2014, was slated to go into effect on Jan. 1, 2017, requiring healthcare providers to use approved clinical decision support systems to consult “appropriate use criteria”—developed or endorsed by national professional medical specialty societies or other provider-led entities—when ordering certain advanced medical imaging procedures. However, the Centers for Medicare and Medicaid Services has since decided to extend the deadline to Jan. 1, 2018.

Harvard’s Library of Evidence, which is being touted as the future of clinical decision support content, will initially focus on medical imaging to help doctors choose the most appropriate imaging test for their patients to comply with the law.

However, the long-term goal for the online resource is to expand to other areas that require evidence-based clinical decision support tools such as laboratory testing and other medical procedures.

“Harvard basically put up the money and came up with this resource that is publicly available,” says Ali Raja, MD, co-executive director of the Library of Evidence and associate professor of emergency medicine at Harvard Medical School. “This gives everybody a free way to meet the federal regulations.”

Raja believes that improving patient care and health outcomes is the ultimate goal. “It’s about quality of care and not ordering inappropriate tests and exposing patients to unnecessary imaging or costs,” he contends.

All that is required to use the Library of Evidence is to register online and create an account, according to Raja. The digital repository provides a database of clinical knowledge that can be accessed by individual physicians to look up the evidence for certain imaging tests, he says. However, it can also be embedded into clinical decision support systems used enterprise-wide by practices and hospitals.

“Library of Evidence provides clinicians, EMR vendors, and IT professionals with curated, interoperable content to embed into your pre-existing EMR so that you can deliver real-time, evidence-based clinical recommendations at the point of care,” states the Harvard Medical School website.

“There are a number of vendors that make great clinical decision support systems, but the clinical decision support content that they get they sometimes have to pay for from professional societies and others,” observes Raja. “Those vendors now have a free option and, for those hospitals that decide not to use those vendors—there are some homegrown systems, we give them a free library of evidence-based clinical decision support.”

According to Raja, CDS vendors MedCurrent and Medicalis are currently incorporating Harvard’s Library of Evidence into their respective products and are planning to offer it as an option to customers as the evidence source. “We should have hospitals going live with this very soon,” he adds.

Raja makes the case that the effective use of a clinical decision support system results in patients getting the right tests, the right medications and the right treatment. He notes that medical imaging is just the first step in implementing the practice of evidence-based medicine nationally. “So much of the CMS budget goes toward imaging that they wanted to start with that,” says Raja. “They fully plan to over the next few years roll this out for other testing and medical procedures.”

As he points out, the focus of Harvard’s online library is the “accumulation, curation, organization and functionalization of medical evidence rather than on the creation of new evidence.” Raja adds that a team of five librarians are working on the digital repository full time.

“Recommendations chosen from professional society guidelines, local best practices and peer-reviewed literature are converted into health IT-consumable clinical logic and then graded by two independent parties—a curator and a validating clinician,” states the Library of Evidence website. “Once agreement on a final grade is reached, the full record will be made freely available to the public.”

“We can get evidence graded, incorporated, and evaluated very quickly,” he concludes.

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