The document discusses current approaches to evidence-based healthcare which rely on extracting data from clinical systems and outcomes from randomized trials, and proposes an open architecture for an evidence macrosystem that incorporates diverse sources of evidence including industrial, personal, and social media data shared across modules for discovery, analytics, and evaluation at both the individual and population levels.

1. !"#$%&'%()*+,#&-./(0,12#'*3#4&5(64+
71%&(8+'9#3%'3:+%
0$*(;#,<(=><(?9>
>#+%'34+<(@%&3%+(64+(@2#&#'*2(*&$(A+*&52*3#4&*2(0&64+,*3#'5
B&#"%+5#3C(46(@*2#64+&#*(;*&()+*&'#5'4
=*C(D<(EF..
.G#39(39*&H5(34(I#'9(J+*"#3K(=><(B@(>*"#5(*&$(L*#9:*(>:*&<(@42:,M#*

2. I%19+*5#&-(N>4%5(#3(G4+HOP
(Complexes of)
Outcome
Exposures strength of association? Increased
Text4Baby individual breastfeeding
population

3. @:++%&3(811+4*'9%5/(I@A
Asthma App ER visits at 1 year
50 people
100 people
Usual Care ER visits at 1 year
50 people population
Q A%535(1+%51%'#R%$(#&3%+"%&3#4&5(*&$(4:3'4,%5
Q A4('4&R+,(*(9C1439%5#5(*3(39%(141:2*3#4&(2%"%2
Q ;3+4&-(#&3%+&*2("*2#$#3C
Q ?+4M2%,5/(524S(34(5%3T:1<(%U1%&5#"%<(594+3T3%+,<(2*'H
+%2%"*&'%(34(39%(+%*2(S4+2$

4. @:++%&3(811+4*'9%5/(>*3*(=#&#&-
EHR
Exposures Outcomes
?
Apps
population
Q !U145:+%5(*&$(4:3'4,%5(6+4,('*+%(1+4'%55(5C53%,5
Q A4(-%&%+*3%(9C1439%5%5(*3(39%(141:2*3#4&(2%"%2
Q ?+4M2%,5/(2#,#3%$(34($*3*('422%'3%$<(S%*H(#&3%+&*2
"*2#$#3C(V$*3*(&43('4,12%3%(4+(5C53%,*3#'W

5. @:++%&3(811+4*'9%5/
LT46T.(;3:$#%5
Asthma app Usual Care Asthma app
peak flow peak flow
Usual Care Asthma app Usual Care
individual
Q G#39#&T5:MX%'3(,:23#12%('+4554"%+
Q 7&2C(64+,*2(,%394$(64+($%3%+,#&#&-(#&$#"#$:*2
3+%*3,%&3(%Y%'3#"%&%55
Q ?+4M2%,5/('4,12#'*3%$(34(5%3(:1<(*&*2C5#5(#5
$#Z':23<(2#332%(H&4S&<(&43(S#$%2C(:5%$

6. !"#$%&'%(!U3+*'3#4&
Q !"#$%&'%(#5(54,%39#&-(34(M%(%U3+*'3%$
6+4,(39%('*+%(1+4'%55
[ ,#&#&-(#3(6+4,(39%($*3*
[ $#+%'32C(,*&#1:2*3#&-(39%('*+%(1+4'%55(S#39
+#-#$(*&$(1+%T$%R&%$(1+434'425

7. !"#$%&'%(;3+#1(=#&#&-

8. !"#$%&'%()*+,#&-
Hay, et al. J Eval Clin Prac 14(2008):707-713.

9. I443#&-(64+(!"#$%&'%

10. 0&$:53+#*2(!"#$%&'%()*+,#&-
Asthma App ER visits at 1 year
50 people
100 people
Usual Care ER visits at 1 year
50 people population

11. ?%+54&*2(!"#$%&'%(*+$%&5
Asthma app Usual Care Asthma app
peak flow peak flow
Usual Care Asthma app Usual Care
individual

12. ?%+54&*2(!"#$%&'%(*+$%&5
Flovent Flovent PRN Flovent
dancing dancing
Flovent PRN Flovent Flovent PRN
individual

13. @+4S$54:+'#&-(G9*3(=*33%+5
Q V@4,12%U%5(46W(!U145:+%5
[ $4%5('94'42*3%(3+#--%+(V,CW(*539,*O
[ 3%53#&-('4,,4&(+%-#,%&5(V8@!0<(53*3#&<(MTM24'H%+W<
'4,12%,%&3*+C(,%$#'#&%5
Q V@4,12%U%5(46W(7:3'4,%5
[ S9*3(4:3'4,%5($4(1*3#%&35('*+%(*M4:3O

14. !"#$%&'%(=*'+45C53%,
Rooting for Industrial Evidence Personal Evidence
Evidence Farming Gardens

15. ]4S('*&(S%(5'*2%(%"*2:*3#4&O

16. ;34"%1#1%$
,]%*239
Q ]%*239(*115(M:#23
#&$%1%&$%&32C
[ 2#332%($*3*(59*+#&-(*&$
#&3%+41%+*M#2#3C
Q ^#,#35(%Z'#%&'C(*&$
#,1*'3(46(_:*2#3C
,]%*239

17. 0&3%+&%3(]4:+-2*55(=4$%2
Q ;3*&$*+$#K%(*&$
,*H%(41%&(39%
N&*++4S(S*#53P
Q I%$:'%5($:12#'*3#4&<
51:+5('4,,:&#3C
#&&4"*3#4&<(5:114+35
'4,,%+'#*2(*&$(&4&T
1+4R3(:5%5

18. 71%&,]%*239`4+-
Estrin DE, Sim I. Science; 330: 759-60. 2010.

19. 71%&,]%*239`4+-
Q A9%(S*#53(594:2$(5:114+3
39%(%"#$%&'%(,*'+45C53%,

20. 71%&(8+'9#3%'3:+%(64+(*&
!"#$%&'%(=*'+45C53%,
Q =4$:2%5(64+(:5*-%(*&*2C3#'5
[ a(46(3%U3(,%55*-%5<(a(46(5%55#4&5<(%3'`
Q I443#&-(64+(V-24'*2W(%"#$%&'%
[ $*3*(59*+#&-(S#39(59*+%$(5C&3*U(*&$(5%,*&3#'5
Q 0&$:53+#*2(6*+,#&-<(%`-`<(S#39(I@A5
[ ,4$:2%5(64+(#&64+,%$('4&5%&3<(+*&$4,#K*3#4&<(*$*13#"%
3+%*3,%&3(53+*3%-C<(,#U%$(,%394$5<(%3'`
Q ?%+54&*2(%"#$%&'%(-*+$%&#&-<(%`-`<(LT46T.
[ ,4$:2%5(64+(5'+#13#&-(*&$(*&*2CK#&-(#&$#"#$:*2#K%$(LT46T
.(1+434'425<(%3'`

21. 71%&(8+'9#3%'3:+%(64+(*&
!"#$%&'%(=*'+45C53%,
Q ;4'#*2(,%$#*(64+($#5'4"%+C(46(%U145:+%5(*&$
4:3'4,%5(39*3(,*33%+
Q ;9*+%$(2#M+*+#%5(46("*2#$*3%$(,%*5:+%5(*&$
#&53+:,%&35(V%`-`<(?I7=0;W
[ ,%*5:+%5(39*3(-%3(*3(R&%+T-+*#&%$(,%'9*&#5,5(M*5%$
4&(39%4+%3#'*2(,4$%25(46('9*&-%<(%3'`

23. 4*2(64+(,]%*239(!"#$%&'%
Q 8(2%*+&#&-('4,,:&#3C('4:12%$(S#39(*&
41%&(*+'9#3%'3:+%(64+(M+4*$<(+*1#$<(*&$
#3%+*3#"%($#55%,#&*3#4&(46(%"*2:*3#4&
,%394$5(*&$(R&$#&-5(39*3(,*33%+

24. Q 0$*(;#,(#$*`5#,b:'56`%$:
Q >%M4+*9(!53+#&($%53+#&b'5`:'2*`%$:
Q 9331/cc41%&,9%*239`4+-c