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. http://www.hifa.org/about-hifa/hifa-vision-and-strategy (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: https://doi.org/10.1016/j.jclinepi.2019.01.008 [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 IS NEW?
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
Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org
HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG firstname.lastname@example.org