Being able to instantly provide physicians with the latest scientific evidence they need to help clinical decisionmaking is one of the top selling points for healthcare information technology. This is a function many private-sector companies offer, and now the federal government is looking to offer it as well.
The U.S. Agency for Healthcare Research and Quality is requesting proposals from interested parties capable of developing a national Clinical Decisions and Communications Science Center. Submissions are due by noon EDT Aug. 11 and a contract will be awarded no later than Sept. 30.
"It may not be a (private) company, it could be an academic institution or an association -- we don't know who the applicants will be," said Jean Slutsky, director of the AHRQ's Center for Outcomes of Evidence. "The overarching goal is to put the best available evidence in the most useable form for whoever needs it -- whether you're a policymaker, a physician or a patient."
The request for proposals was posted June 30 and included a $4.6 million estimate for a two-year contract. Slutsky said she wasn't at liberty to say how much the AHRQ was willing to eventually spend on the center, but she did disclose how much it will cost the public to use its services: nothing.
"These products will be publicly available, free of charge," she said.
Stephen Hau, vice president of marketing and business development for the mobile computing software provider PatientKeeper, said he sees the center as something that will complement rather than compete with private enterprise.
"We're been supporting this initiative," Hau said. "We have a solution called the PatientKeeper Reference Library for which we don't develop the content, but it links physicians to different decision-support knowledge bases. We see this as an additional option for the provider."
One of those knowledge bases is the "mobile reference suite" developed by San Mateo, Calif.-based Epocrates, which provides drug, disease and diagnostic information physicians need to make clinical decisions. Kirk Loevner, Epocrates' chief executive officer, said the AHRQ initiative fits well with what his company is doing.
"Epocrates commends the government for continuing to support technology in healthcare and recognizing the benefits it can provide in easing the information burden for physicians and improving patient care," Loevner said. "Healthcare professionals can only benefit from an additional resource such as the dedicated center proposed by the AHRQ."
Paul Keckley, director of the Vanderbilt Center for Evidence-Based Medicine, Nashville, called the AHRQ's proposal "a great piece of the puzzle," but was less enthusiastic than Loevner.
"Every vendor and every organization is developing something similar that varies subtly," he said. "It's not a bad thing, but the notion that having it available will dramatically increase adherence (to evidence-based guidelines) is false hope."
The cost of implementing computer systems and the disruption in workflow needed to install and learn how to use them remain big obstacles to wider adoption of technology-guided, evidence-based practices, Keckley said.
"It's not a question of whether the content or evidence is out there, because a physician can sit down and Google and get the information in 15 minutes," he said. Wider adoption will come when physicians see more proof that integrating evidence-based guidelines into their practice really does improve patient care and when the guidelines become more helpful in managing co-morbidities, Keckley said.
"The doctor could know certain things about the co-morbidities that a patient has that are not in the guidelines," he said. "The more complicated the conditions and co-morbidities, the weaker the evidence."
Keckley did say, however, that he thought medical specialty societies charged with defining and maintaining professional standards with limited personnel and resources would probably find the Clinical Decisions and Communications Science Center particularly useful.
In addition to providing Web-based clinical decision support, the center would also develop a "healthcare interpretation guide" to convert scientific terms found in medical literature into language the general public can easily understand; arrange two healthcare-decision symposiums a year; and disseminate the information products developed under the contract and provide technological support to facilitate their use.
View the request for proposals.