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New Column—On Call: Regular Advice from UC San Diego Health Experts

By Lawrence Friedman

UC San Diego Health is delighted to offer this column to provide timely updates on the latest evidence-based developments in disease prevention, medical diagnosis, and treatment. Topics will be chosen based on common medical conditions relevant to San Miguel de Allende residents and from your suggestions. We have world-class experts in every specialty, so nothing is off-limits. We anticipate writing about the latest in evidence-based approaches to treating certain types of cancer, heart and lung disease, stroke, and osteoporosis as well as sharing preventive and health maintenance advice.

Today’s column will address an important set of issues creating the foundation for 21st-century health care. It starts with evidence-based care and why it’s important. David Sackett, a renowned Canadian physician, was one of the earliest champions of evidence-based care. He defined it as the conscientious, explicit, and judicious use of the current best evidence in making decisions about an individual patient’s care. He describes the term “best evidence” as coming from external systematic research dependent upon the strongest types of research such as mega-analysis, systematic reviews, and the gold standard—randomized controlled trials. In other words, good medicine is medicine backed by scientific evidence.

Evidence-based and best-evidence go hand in hand; it’s important to pay attention to this concept because health care recommendations come from many sources, and the Internet has ballooned with a wealth of often unfiltered information that influences patients and providers alike. Some of the information is legitimate; some is tainted by companies trying to sell drugs or devices.

Dovetailing with evidence-based healthcare have been three major jolts to contemporary health care. The first is the digitalization of health records, otherwise known as electronic health records (EHR). Medical information is proliferating at such a rapid and exponential pace that no physician can possibly keep up with the latest research, even within their area of expertise, without the help of electronic decision support.

The data being compiled in EHRs provides the foundation for the second trend, big data. Big data is millions of small data elements extracted from EHRs in a searchable manner that allows predictive analytics to help make individual patient decisions—it is the backbone of precision medicine. According to the NIH, which quotes the Precision Medicine Institute on the NIH website, precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.”

The third major trend is value-based care, defined as the interplay between quality, patient experience, and cost. It is about taking care of patient populations, using analytics to make sure the right patient gets the right care at the right time by a provider with the right information at their fingertips. Without EHRs and their data, value-based care wouldn’t be possible.

To incentivize this trend, insurance companies are now making payments to many US doctors and hospitals based on how well they demonstrate patient outcomes rather than by the volume of services provided. Understanding evidence-based decision-making and its application to individual health care is a great foundation for all of these health columns to come.

Lawrence Friedman, M.D., Associate Dean for Clinical Affairs, UC San Diego Health. For questions, comments or topic suggestions, please contact: 1-619-471-0234 or


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