Harvard Medical School is launching Library of Evidence, a publicly accessible digital repository of medical evidence to help practicing clinicians choose the most appropriate imaging test for each patient. Founded in collaboration with the Center for Evidence-Based Medicine at Brigham and Women’s Hospital, the library is a project of the HMS Countway Library of Medicine and representatives of other HMS hospitals and Harvard institutions.
How it Works
The Harvard Library of Evidence provides clinicians, EMR vendors, and IT professionals with curated, interoperable content to embed into your pre-existing EMR so that you can deliver real-time, evidence-based clinical recommendations at the point of care. For example, if a physician is ordering a CT scan for a patient with back pain, the system might prompt him to reconsider and suggest an ultrasound instead, citing evidence-based recommendations that explain why the latter may be a better option.
The Harvard Library of Evidence’s team of librarians, clinicians, and engineers features a library of annotated, graded recommendations regarding appropriate use of testing, using IT-industry interoperability standards. The HMS Library of Evidence will initially focus on two primary functions specific to the requirements of AUC Final Rule published by CMS under PAMA
1. A literature review process targeting a clinical decision (e.g., use of imaging in patients with right lower quadrant abdominal pain), done systematically and in a reproducible manner and
2. An evidence grading process using widely recognized methodologies.
Grading Methodology
The Library’s evidence grading methodology is based on the 2009 version of the Oxford Centre for Evidence-based Medicine (CEBM) – Levels of Evidence and the U.S. Preventive Services Task Force (USPSTF) I-Scores. Recommendations chosen from professional society guidelines, local best practices and peer-reviewed literature are converted into Health-IT consumable clinical logic and then graded by two independent parties – a curator and a validating clinician. Once agreement on a final grade is reached, the full record will be made freely available to the public.
Each recommendation is represented as a unit of evidence and users can select content based on the following pre-defined categories:
Diagnosis/Symptom
Source Type (e.g. local best practice, professional society guideline, peer-reviewed article)
Publisher (e.g. ACR)
Choosing Wisely
Professional Society
Imaging Modality
Body Region
Strength of Evidence
“The use of objective reliable and high-quality medical evidence in clinical decision-making is the foundation of good patient care but incorporating it into daily practice is challenging,” said Ramin Khorasani, HMS professor of radiology and vice chair of the Department of Radiology at Brigham and Women’s Hospital in a statement. “The Library of Evidence is an important step toward organizing what is known to help advance the goal of evidence-based practice in a concrete way.”
