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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. Good read http://www.nejm.org/doi/full/10.1056/NEJMp1108726 -- 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> The content of this data transmission must not be considered an offer, proposal, understanding or agreement unless it is confirmed in a document signed by a legal representative of ITESM. The content of this data transmission is confidential and is intended to be delivered only to the addressees. Therefore, it shall not be distributed and/or disclosed through any means without the authorization of the original sender. If you are not the addressee, you are forbidden from using it, either totally or partially, for any purpose IMPORTANT WARNING: The information in this message (and the documents attached to it, if any) is confidential and may be legally privileged. It is intended solely for the addressee. Access to this message by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken, or omitted to be taken, in reliance on it is prohibited and may be unlawful. If you have received this message in error, please delete all electronic copies of this message (and the documents attached to it, if any), destroy any hard copies you may have created and notify me immediately by replying to this email. Thank you. Geisinger Health System utilizes an encryption process to safeguard Protected Health Information and other confidential data contained in external e-mail messages. If email is encrypted, the recipient will receive an e-mail instructing them to sign on to the Geisinger Health System Secure E-mail Message Center to retrieve the encrypted e-mail.