Kaiser's decision to remove Vioxx from
its regional formularies occurred before the implementation of the organization's
EMR. I should add that EMR's are still in their infancy, and usually
built as clinical management systems, rather than systems for robust data
extraction and analysis. People sometimes have the notion that extracting
data from an EMR is an easy process. Far from it, though, especially
if you want a clean and accurate dataset. There are also issues with
data that is only available from EMRs in text format.
Marguerite
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Jim, this is very interesting statement "...such
information was almost certainly adequate to motivate Kaiser to remove
a me-to drug with no safety or effectiveness advantage (Vioxx) from its
formulary".
Did Kaiser remove Vioxx from its formulary it BEFORE or AFTER randomized
trials were published (related to Vioxx safety and efficacy)? If they did
it before the trials became available, then it would constitute a fascinating
example of the use of EMR that may provide some important lessons for all
of us (including skeptics like me).
Thanks
ben
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]]
On Behalf Of Jim Walker
Sent: Friday, November 04, 2011 12:45 PM
To: [log in to unmask]
Subject: Re: Evidence-Based Medicine in the EMR Era
I agree that we should be extremely cautious about identifying appropriate
methodologies for determining when such information can appropriately inform
clinical action.
But it is the case that so much more information is so much more accessible
than on paper that it does represent a quantum leap (qualitative difference)
in the information-gathering phase of observational research (while doing
nothing to address the methodological limitations of observational research).
So, for example, such information was almost certainly adequate to motivate
Kaiser to remove a me-to drug with no safety or effectiveness advantage
(Vioxx) from its formulary.
On the other hand, it is hard to imagine how such information could justify
"preventitive" hormone-replacement therapy.
So for me, the interesting questions here are: What is the patient's prognosis
without the therapy being considered? What is the pathophysiological credibility
of the observed difference? How large are the (apparent) OR and CI? What
are the potential adverse effects of the therapy? Is some form of effective
near-real-time monitoring available?
Best regards.
Jim
James M. Walker, MD, FACP
Chief Health Information Officer
Geisinger Health System
>>> "Dahm,Philipp" <[log in to unmask]>
11/4/2011 12:21 PM
>>>
It is unclear to me how the reported EMR quest for evidence provides any
qualitative advancement.
Isn't it in essence the same as sending your medical student into the dungeons
of the medical records department (as it has been commonplace for decades)
to research some question based on your institutional experience? The only
difference is the speed with which it can occur.
I'm concerned that articles such as these will "knight" those
specializing in retrospective data-mining....
Ph*
On Nov 3, 2011, at 10:40 AM, Dr. Carlos Cuello wrote:
Quite interesting on how electronic medical records can become a part of
observational evidence and apply when there is no other evidence at hand.
--
Carlos A. Cuello-García, MD
Centre for Evidence-Based Practice & Knowledge Translation Tec de Monterrey
School of Medicine Cochrane Collaboration Iberoamerican branch CITES piso
3. Morones Prieto 3000 pte. Col. Doctores 64710 Monterrey, NL. Mexico.
☎ +52.81.8888.2223 & 2154. Fax: +52.81.8888.2052 Skype:
dr.carlos.cuello www.cmbe.net<http://www.cmbe.net/>
⚫
Twitter<http://twitter.com/CharlieNeck>
⚫ Linkedin<http://mx.linkedin.com/in/drcuello>
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