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Monday, June 1, 2015

Precision Research vs. Precision Care

One of the topics that shows up repeatedly in discussions of Comparative Effectiveness Research is the mismatch between data quality requirements in research, and that presently used in EHRs for patient care, for example, as noted in this article.

What then, are the impacts of research on care, if data gathered for care is not as precise as that used for research?

Because of these differences:

  1. Patients who qualify for an intervention according to EHR data may include patients that wouldn't qualify according to the guideline produced based on the research.
  2. Patients who should have qualified but didn't according to EHR data might be missed because the EHR does not capture data according to the guideline.
  3. Interventions provided according to the EHR may not be the same interventions specified according to the guideline.
  4. Interventions captured by the EHR that should have been appropriate according to the guideline might not be captured in a way that they are recognized as being appropriate.
  5. We very likely aren't capturing the outcomes in either case, and if we are, we likely have similar challenges with regard to that data capture.
So we have noise that would introduce variability in who gets treated, and in capturing accurately who was treated and what their outcomes were.

My question is, that if research indicates the number needed to treat is say 50, what is it really given the differences between theory and practice?  Is the promise of all of this precision in medicine real? If not, what needs to happen to make it so?