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Evidence-based medicine

Health care moves toward perfect vision

By Michael J. Moody, MBA, ARM

Hardly a day goes by that we don't read yet another article or hear another news story regarding the escalating cost of health care in the United States. In fact, over the past 30-plus years, it has become one of the greatest challenges facing our economy. No other segment of our economy has created as many problems for employers and employees alike.

The Consumer Price Index (CPI) is a common indicator of the extent of inflationary costs, and it measures inflation at the retail level. It reflects the average price change over time for a constant quality, constant quantity market basket of goods and services. The basket of goods and services typically includes such staples as food, transportation, energy, shelter and medical expenses. As currently being used by the Department of Labor in developing its CPI, there are two medical care classifications—medical care commodities (MCC) and medical care services (MCS)--each containing several item-specific categories that make up the medical segment.

For many years, price increases in the medical sector have outpaced overall inflation by a significant amount. Granted, as any good economist will tell you, there are a number of reasons for this imbalance; however, the fact remains that price increases in the medical sector have outpaced overall inflation by a significant amount, year after year.

Over the years, many potential solutions have been advanced to curtail the medical sector's runaway costs. Various initiatives have been introduced by the federal government, and a number of programs have been enacted by the individual states. In recent years, discussions have centered on "bending the cost curve," and possible methods of reducing the overall medical CPI. Unfortunately, many of the ideas advanced to date have turned out to be long on theory, short on results. It is no wonder that the results to date have produced only marginal savings. Most of the ideas deal with reducing some aspect of the transactional cost of medical goods and services. Certainly as many managed care programs have shown, there are savings to be obtained by "managing" the transactional aspects of the medical process. But little or nothing is being done to address the "elephant in the room," improving medical outcomes.

Recent studies show that the United States is ranked first in health care spending out of 12 other industrial countries, spending nearly $8,000 per person annually for health care service or, put another way, about 16% of our GDP. According to the study's author, the Commonwealth Fund, "Health care spending in the U.S. dwarfs that found in any other industrial nation." However, that is not the real issue; the problem is "the high rate of spending doesn't necessarily make for a higher standard of care." In fact, despite higher costs, "quality in the U.S health care system is not notably superior to the far less expensive systems."

What is needed is a whole new way of looking at this issue. It is time that we begin to look at the actual results we are receiving for the dollars spent. It is time to actually "bend the cost curve."

A new way of thinking

One of the major disparities in the medical profession has been the difference between the amount of information that is available regarding a specific medical condition and the knowledge that the individual clinician has of that information. And this disparity continues to grow. Hardly a day goes by that the national evening news is not reporting about some new developments in the fight against this disease or that disease. Obviously, this must be very difficult for any doctor to keep up with, particularly when it is estimated that there are more than 12,000 diseases worldwide.

According to experts in the health care profession, current medical information is doubling every five years. Couple this with the fact that 81% of physicians reported that they spent five hours or less a month reading medical journals. It is little wonder that many doctors feel overwhelmed by the array of new information that is being added to the existing database. Frequently, doctors complain that they know that the answer to a specific issue is out there but they just cannot find it.

Because the medical profession had long been aware of this growing information issue, in the early 1990s they developed a concept known as "evidence-based medicine" (EBM). While EBM is still struggling to develop a common definition, it is frequently referred to as the process of systematically reviewing and using clinical research findings to aid in delivering the optimum clinical care to a patient. Efforts to formalize the EBM concept were established in the early 1990s; however, the model that emerged contained a fatal flaw.

Conceptually, the early efforts to utilize EBM made a lot of sense and did improve upon the existing lack of access to recent and relevant information. The problem was that the concept was deterministic and, as a result, centered on a concept that "comes up with an answer." Proponents of EBM quickly found significant resistance within the medical community. Most doctors believed that this approach took too much of their analytical skill out of the equation. As a result, the initial efforts at EBM failed to gain significant traction among doctors.

However, the approach to EBM was about to take a serious turn for the better. Few people watching Jeopardy during the first week of February 2011 realized just what a transformative event they were about to witness. As it turned out, it was more than just man vs. machine as Ken Jennings (holder of Jeopardy's record for the longest winning streak) and Brad Rutter (Jeopardy's biggest all-time money winner) took on an IBM computer creation known as Watson. This was one of the public's first glimpses at Watson's remarkable computing capabilities. However, like chess master Garry Kasparov before them, Jennings and Rutter soon found out just how formidable an IBM computer (Deep Blue) could be.

In short order, Watson made believers of most of the observers. He had rapid responses to a wide array of questions and left little doubt about his (its?) ultimate capabilities. Shortly thereafter, IBM began looking for a more constructive way to utilize the unique talents of Watson. One of the first business sectors they chose was the medical profession, which for the most part was drowning in information overload.

First and foremost, IBM's connectional approach to EBM was much more palatable to the medical profession. This is due primarily to an approach that provides a clinician with a list of possible options. This allows the doctor to make the final judgment call based on the facts of the case and the patient's actual condition. Since doctors can now have access to the most relevant information, outcomes should improve.

Overall, the entire health care system will benefit, since doctors can spend more time effectively dealing with their patients and have recent, relevant information with which to work. For example, "Watson can sift through an equivalent of about one million books or roughly 200 million pages of data, and analyze this information and provide precise responses." However, what is really remarkable is that it does all this in less than three seconds, thus helping to identify the most likely diagnosis and treatment options for even the most complex cases.

Recently, IBM announced an agreement with WellPoint that has created the first commercial application of the Watson technology. WellPoint has begun working with select physician groups in clinical pilots. Currently, they are beta testing Watson within several oncology practices and will expand the pilot programs throughout 2012. In addition to a review of the current literature, Watson can also access individual patient health records to personalize specific recommendations. Bottom line, the purpose of this exercise would be to "help steer physicians toward tests that are worth doing, and toward treatment options that are likely to succeed," notes an IBM spokesperson.


It's time for a bold move with regard to health care. Tinkering at the edges has not proven effective. Instead of having "bend the cost curve," be little more than a bumper sticker slogan in a political campaign, the health care profession needs to take control. No business segment should be satisfied for distinguishing itself by having a CPI increase that is always higher than the overall CPI.

By strongly endorsing the use of evidence-based medicine, health care professionals can not only reduce the cost of health care but, more important, improve the outcomes of health-related conditions. The profession has been making rapid advancements in many areas; however, to some extent they are the victims of their own success. As it currently stands, no one person could possibly "keep up" with all of these changes. By utilizing the unique advantages of Watson, every clinician can have instant access to the latest advances. In today's world economy, we can accept nothing less than the very best that is represented by Watson's capabilities.


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