growing role as a disruptive agent of change in health care—by demanding better information and tools to support their health decisions.


Robert Hayward, Centre for Health Evidence

A health informatics agenda is emerging that is preoccupied with evidence. After years of underinvestment in information systems, large-scale health infostructure initiatives have emerged in Western economies. National health reform plans in the United States, Canada, and Britain place evidence-based information systems among the top deliverables for this decade. Indeed, current policy ties this to an electronic health record for all Americans. Evidence-based medicine (EBM)? Policy makers have proclaimed that it can be beamed to the bedside.

The proponents of health informatics are quick to enthuse. Harnessing IT will improve health services because, of course, “better information begets better health.” Yet how can better information yield better health? At least three things must happen. First, healthcare decision makers must discern better from worse information. Second, changes in knowledge must trigger changes in health practices. Finally, improved outcomes must result from altered practices. In short, better information begets better health through the medium of better choice.

If the starting point for better choices is better evidence, then the challenge of EBM boils down to at least three requirements. Evidence-based decision makers must be supported to do the following:

  1. Know what to do—because best evidence about best practices informs decision making.

  2. Do what is known—because they recognize problems, formulate questions, select resources, and apply knowledge appropriately.

  3. Understand what is done—because health choices and outcomes are iteratively validated.

If, on the other hand, the starting point is the messy informational milieu of front-line clinicians, then even the most meritorious evidence is useless unless practitioners are supported with

  • Convenience—because all the right information is available in the right place at the right time;

  • Discrimination—because relevant and important information is filtered by the unique needs of community, group, and individual; and

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