Evidence-based medicine is an important model of care because it offers health systems a way to achieve the goals of the Triple Aim. It also offers health systems an opportunity to thrive in this era of value-based care. In specific, there are five reasons the industry is interested in the practice of evidence-based medicine: (1) With the explosion of scientific knowledge being published, it’s difficult for clinicians to stay current on the latest best practices. (2) Improved technology enables healthcare workers to have better access to data and knowledge. (3) Payers, employers, and patients are driving the need for the industry to show transparency, accountability, and value. (4) There is broad evidence that Americans often do not get the care they need. (5) Evidence-based medicine works. While the practice of evidence-based medicine is growing in popularity, moving an entire organization to a new model of care presents challenges. First, clinicians need to change how they were taught to practice. Second, providers are already busy with increasingly larger and larger workloads. Using a five-step framework, though, enables clinicians to begin to incorporate evidence-based medicine into their practices. The five steps include (1) Asking a clinical question to identify a key problem. (2) Acquiring the best evidence possible. (3) Appraising the evidence and making sure it’s applicable to the population and the question being asked. (4) Applying the evidence to daily clinical practice. (5) Assessing performance.

1. 5 Reasons the Practice of Evidence-
Based Medicine Is a Hot Topic

2. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
What Is Evidence-Based Medicine?
Imagine you’re a provider caring for
a stage II prostate cancer patient.
Naturally, you want to choose the
treatment to provide the best
outcome possible.
He is 84 with no visible symptoms.
What course of action is best?
Evidence-based medicine can
guide you and your patient to the
most appropriate treatment.

3. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
What Is Evidence-Based Medicine?
Evidence-based medicine includes three key components:
Research-based evidence
Clinical expertise
Patient’s values and preferences

4. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
What Is Evidence-Based Medicine?
Practicing evidence-based
medicine offers clinicians a way to
achieve the Triple Aim’s objectives:
Improved quality
Improved patient satisfaction
Reduced costs

5. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
What Is Evidence-Based Medicine?
Using evidence-based medicine, a
provider can assess the evidence
as well as the risks and benefits of
ordering diagnostic tests and
treatments for patients.
Providers can then better predict
whether a treatment will do more
harm than good.

6. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
What Is Evidence-Based Medicine?
As reported in this article:
Using evidence-based
medicine “help[s] physicians
provide more rational care
with better outcomes.”

7. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
What Is Evidence-Based Medicine?
Evidence-based medicine
encourages a dialogue between
patients and their provider, so
patients can share in decision-
making and make their values
and preferences known.
Patients feel their doctors are
listening to their concerns and
taking those concerns into
consideration when determining
the treatment plan.

8. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Components of Evidence-Based Medicine

9. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Reasons the Practice of Evidence-Based
Medicine Adds Value to Health Systems
With so much scientific knowledge
being published, it’s difficult for
clinicians to stay current with
latest medical practices.
A primary care physician would
need to read 17 articles a day,
365 days a year to stay current.
Using standard evidence-based
protocols, providers can achieve
this impossibility.
1 Staying Current

10. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Reasons the Practice of Evidence-Based
Medicine Adds Value to Health Systems
Healthcare workers now have
much better access to data and
knowledge because of improved
technology like electronic medical
records (EMRs), data warehouses,
and sophisticated analytics.
Evidence-Based Decision Making:
Global Evidence, Local Decisions
2 Improved access to data

11. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Reasons the Practice of Evidence-Based
Medicine Adds Value to Health Systems
Payers, employers, and patients are
driving the need for the healthcare
industry to show transparency,
accountability, and value.
Practicing evidence-based
healthcare can help the industry
achieve these goals.
3 Improve transparency

12. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Reasons the Practice of Evidence-Based
Medicine Adds Value to Health Systems
Although the U.S. spends more
money per person on healthcare
than any other nation in the world,
there is broad evidence Americans
often do not get the care needed.
With evidence-based medicine,
care improves because clinicians
have access to data previously
untapped and best practices
vetted and agreed upon by peers.
4 Data use improves care

13. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Reasons the Practice of Evidence-Based
Medicine Adds Value to Health Systems
The most important reason for the
interest in evidence-based medicine
is that it works.
As demonstrated with 15 case
studies in the publication Evidence
Based Medicine Matters, the use of
evidence-based medicine resulted in
improvements ranging from quicker
recovery times after surgical
procedures to safer ways to deliver
breech babies.
5 It works!

14. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The Future of Evidence-Based Medicine
The acceleration of the value-
based payment movement will
continue in the years ahead.
Opportunities for improvement
using evidence-based medicine
are driving excitement in today’s
healthcare systems.
Patients gain confidence that
they are getting the best care
possible because treatments are
based on the most current
medical knowledge.

15. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
The five steps of evidence-based medicine include the 5 As: ask, acquire, appraise, apply, and assess.

16. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
The first step in moving to evidence-
based care is to form teams of
clinicians whose role is to ask
questions to identify the critical few
problems that need to be addressed.
When choosing a problem to focus
on, it’s important to identify a high-
priority problem that offers a
significant return on investment.
1 Ask a clinical question

17. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
Some questions clinicians can ask to
help identify problems include
Why are we practicing this way?
Are we adhering to best practices?
Can we produce better outcomes?
1 Ask a clinical question

18. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
To help clinicians rank quality between evidence sources
David Sackett, MD, popularized the evidence-based
medicine pyramid.
Four levels of evidence:
Most desirable at top
2 Acquire the best evidence

19. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
Level I: Evidence in Level I is considered the gold
standard of medical knowledge because it comes from
randomized controlled clinical trials (RCTs).
Level I
RCTs enable the results from a
clinical trial to be “free from any bias
that might otherwise be introduced
by the people involved.”
2 Acquire the best evidence

20. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Level II evidence comes from three different sources:
• Controlled trials without randomization
• Cohort or case-control analytic studies
• Multiple time series studies
5 Steps to Move to an Evidence-Based
Model of Care
Level II: Evidence in Level II is not considered quite as
reliable as evidence from Level I, but better then III and IV.
2 Acquire the best evidence
Level II-1
Level II-2
Level II-3

21. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
Level III: Evidence in Level III is based on expert opinion,
in particular, from experts who’ve narrowed their focus as
much as possible about a complex area.
2 Acquire the best evidence
Level III
The downside is that sample sizes are
usually too small and there aren’t any
control groups. This leaves a large
margin for error unless group
statistical techniques are used
to compile the opinions of a
large number of experts.

22. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
Level IV: “Evidence” in Level IV is based on personal
experience. This is the least desirable source of
evidence and lacks any statistical validity.
2 Acquire the best evidence
Level IV

23. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
There’s good evidence (RCTs) and there’s bad evidence
(e.g., from personal experience).
Then there’s evidence that
falls in the gray area—neither
clearly defined as good nor bad.
It can be difficult for clinicians
to know whether or not to use
evidence in the gray area.
3 Appraise the evidence

24. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
Questions clinicians can ask when appraising evidence:
3 Appraise the evidence
Does the evidence improve decision-making or outcomes?
Does the evidence improve clinical quality or patient safety?
Does the evidence improve efficiency and lower costs?
Does the evidence improve the care experience?
Does the evidence improve access to healthcare services?

25. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
If the evidence passes the appraisal
step and adds value to the practice
of medicine, then clinicians can
incorporate the new knowledge into
their daily clinical practice.
Since not all clinicians will
understand the value of adopting a
new standard of care, it’s essential
to communicate the change and the
benefit it adds to patient care.
4 Apply the evidence

26. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5 Steps to Move to an Evidence-Based
Model of Care
Lastly, assess any improvements to
performance or outcomes the new
evidence provides.
This can be accomplished by
establishing a baseline and then
measuring improvements.
Ongoing reassessment, measuring
any gains or losses, should be part
of an ongoing cycle to ensure the
best outcomes.
5 Assess your performance

27. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Key Takeaways
Evidence-based medicine includes
three key components:
1. Research-based evidence
2. Clinical expertise
3. Patients’ values and preferences

28. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Key Takeaways
Interest in the practice of evidence-
based medicine is high for five
reasons:
1. Staying current on knowledge
2. Improved access to data
3. Improved transparency
4. Americans not getting needed care
5. Evidence-based medicine works

29. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Key Takeaways
The five steps of evidence-based
medicine:
1. Ask a clinical question
2. Acquire the best evidence possible
3. Appraise the evidence and make
sure it’s applicable
4. Apply the evidence
5. Assess your performance

30. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
More about this topic
Introducing the Accelerated Practices (AP) Program:
Dr. John Haughom, Dr. Bryan Oshiro, and Sherry Martin
Health Catalyst Academy: An Innovative Approach for Accelerating Outcomes Improvement
Dr. John Haughom – Senior advisor
The Rising Healthcare Revolution: The Future Is Already Here
Dr. John Haughom – Senior advisor
Planning for Healthcare Improvement: A Goal Without a Plan Is Just a Wish
Dr. John Haughom – Senior advisor
Preventable Medical Errors: The Future is Calling Us
Dr. John Haughom – Senior advisor
Link to original article for a more in-depth discussion.
Five Reasons the Practice of Evidence-Based Medicine Is a Hot Topic

31. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
For more information:

32. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
John Haughom, MD is an experienced healthcare executive with proven expertise in
technology-enabled innovation, developing results-oriented strategic plans, leading
multifaceted organization-wide change, and directing complex operations. He has a
strong record of turning vision into effective strategies and successfully implementing
initiatives resulting in value including higher quality, safer care at the lowest possible
cost. His broad knowledge of healthcare and emerging healthcare technologies is
coupled with his recognized leadership abilities, strong communication skills, and
demonstrated ability to contribute to organizational goals such as improved clinical outcomes, lower
costs, improved access to care, and increased profitability.
After practicing for 15 years as an internist and gastroenterologist, Dr. Haughom assumed a senior
executive role with responsibilities for system-wide automation, budgeting, customer support,
database administration, healthcare delivery, information technology, quality control, research, safety,
and strategic planning. Dr. Haughom became President and CEO of a firm focused on health care
transformation through consulting, strategic planning, mentoring inexperienced physician leaders,
involvement in regional and national reform movements, membership on boards of leading edge
organizations committed to improving the value of healthcare, and partnership with other like-minded
organizations with similar aspirations and goals. As Senior Vice President of Clinical Quality and
Patient Safety for the premiere health care system in the Northwest spanning three states (Oregon,
Washington and Alaska), Dr. Haughom developed and implemented a system-wide quality
improvement strategy, comprehensive patient safety plan, and comprehensive system-wide
information technology strategy.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com