Far more sophisticated clinical decision support systems will be needed to assist clinicians and patients in selecting the best treatment options and delivering safe and effective care. Certain types of clinical decision support applications, most notably preventive service reminder systems and drug dosing systems, have been demonstrated to improve clinical decisions and should be adopted on a widespread basis (Balas et al., 2000; Bates et al., 1999). More complex applications, such as computer-aided diagnosis, are in earlier stages of development (Kassirer, 1994), but the potential for these systems to contribute to evidence-based practice and consumer-oriented care is great.

The spread of the Internet has opened up many new opportunities to make medical evidence more accessible to clinicians and consumers. The efforts of the National Library of Medicine to facilitate access to the medical literature by both consumers and health care professionals and to design Web sites that organize large amounts of information on particular health needs are particularly promising (Lindberg and Humphreys, 1999).

The development of a more effective infrastructure to synthesize and organize evidence around priority conditions and to improve clinician and consumer access to the evidence base through the Internet offers new opportunities to enhance quality measurement and reporting. A stronger and more organized evidence base should facilitate the development of valid and reliable quality measures for priority conditions that can be used for both internal quality improvement and external accountability. Broad-based involvement of private- and public-sector groups and strong leadership from within the medical and other health professions are critical to ensuring the success of this effort.

Recommendation 8: The Secretary of the Department of Health and Human Services should be given the responsibility and necessary resources to establish and maintain a comprehensive program aimed at making scientific evidence more useful and accessible to clinicians and patients. In developing this program, the Secretary should work with federal agencies and in collaboration with professional and health care associations, the academic and research communities, and the National Quality Forum and other organizations involved in quality measurement and accountability.

The infrastructure developed through this public- and private-sector partnership should focus initially on priority conditions (see Chapter 4, Recommendation 5). Its activities should include the following:

  • Ongoing analysis and synthesis of the medical evidence

  • Delineation of specific practice guidelines

  • Enhanced dissemination efforts to communicate evidence and guidelines to the general public and professional communities



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