The ecosystem of evidence cannot thrive without efficiency of knowledge generation, synthesis, and translation

11 April, 2019

Dear HIFA colleagues,

In 2004 we described in The Lancet how the availability and use of reliable information is dependent on the integrity of a complex 'Global Healthcare Information System', and how this integrity is broken in many places, paricularly in relation to low-and middle-income countries. (see tab: The Global Healthcare Information System). This paper led to the launch of HIFA, which aims to address three key inherent weaknesses of the system: communication (among stakeholders in the system: the HIFA Forums), understanding (of the system and how to improve it: HIFA Voices), and advocacy (promoting political and financial investment to improve the system: HIFA campaign activities). I am always very interested to read the perspective of others who have a 'systems-thinking' lens on the issue. This new paper in the Journal of Clinical Epidemiolgy provides further insights.

CITATION: The ecosystem of evidence cannot thrive without efficiency of knowledge generation, synthesis, and translation

Antonino Cartabellotta, Julie K. Tilson

DOI: [restricted access]


Evidence-based medicine (EBM) has experienced numerous advances since its inception over 2 decades ago. Yet a persistent gulf remains between how medicine is actually practiced and the goal of providing care based on best available research evidence integrated with patient perspective and clinical expertise. A primary source of challenge for EBM is induced by inefficiencies in the generation, synthesis, and translation of evidence. During the 8th International Conference for Evidence-based Healthcare Teachers and Developers, GIMBE Foundation presented an innovative approach by defining an ecosystem of evidence. Based on the features of a natural ecosystem, the ecosystem of evidence is influenced by living organisms: stakeholders replete with competition and collaboration among and between them, as well as their conflicts of interest; the environment: social, cultural, economic, and/or political contexts; and nonliving components: scientific evidence, influenced by the rules, standards, and frameworks associated with evidence generation, synthesis, and translation. This article provides an analysis of the strengths and weaknesses of this ecosystem with a focus on nonliving components, specifically evidence generation, synthesis, and translation. Specific suggestions are outlined for building a stable and resilient ecosystem of evidence.



What this adds to what was known?

- Evidence-based medicine is assessed through the lens of an ecosystem made up of living organisms, the environment, and non-living components.

- Strengths and weaknesses of the non-living components of this ecosystem (scientific evidence generation, synthesis, and translation) are identified.

What is the implication and what should change now?

- Evidence Generation: Enhance efforts to increase value and reduce waste in medical research.

- Evidence Synthesis: International cooperation is needed to improve quality and reduce duplication of systematic reviews and clinical practice guidelines.

- Evidence Translation: Strategies are needed to implement and monitor advances in knowledge translation, shared decision-making, and patient adherence.

- In the ecosystem of evidence, the evidence synthesis must always inform generation of new evidence, and evidence translation must inform both generation and synthesis of evidence.


Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: