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Commentary
May 11, 2011

Delivering Clinical Evidence Where It's NeededBuilding an Information System Worthy of the Profession

Author Affiliations

Author Affiliations: Institute for Healthcare Improvement, Cambridge, Massachusetts (Dr Davidoff); Annals of Internal Medicine (editor emeritus), Philadelphia, Pennsylvania (Dr Davidoff); Hartford Medical Society, Farmington, Connecticut (Ms Miglus); and University of Connecticut Health Center, Farmington (Ms Miglus).

JAMA. 2011;305(18):1906-1907. doi:10.1001/jama.2011.619

The output of published clinical evidence, once a gentle trickle, has increased into a torrent.1 How ironic it is that the volume, richness, and complexity of the clinical literature (undeniably its greatest assets) have now reached the point where they are making it all but unmanageable.1 But that literature is more important than ever, because questions continue to be raised at a rapid rate in clinical practice—about 5 questions per physician per half-day primary care session, about half of which go unanswered.2 Streamlining input to the literature,1 although in some ways an attractive option, carries its own risks and would not address serious problems on the output side, particularly the limited amount of time available to clinicians for consulting the literature. Those problems will remain unresolved unless and until there is a remedy for the gross inadequacy of current mechanisms for finding, extracting, and delivering the best possible information to where clinical decisions are made—the weakest link in the chain of research evidence.

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