Indian Chamber of Commerce

Indian Chamber of Commerce (ICC) recently organised a virtual event #ICCHealthcareInitiatives on evidence-based medicine. The objective of the event was to initiate a peer-to-peer discussion around the importance of Evidence based Medicine (EBM), the benefits and challenges of the implementation of Clinician Decision Support System (CDSS) in the treatment regime. The event was attended by several leaders from Government, medical fraternity, and health technology industry.

Dr Richa Debgupta, SVP at Fortis Hospitals, and Co-chair, ICC National Healthcare Committee highlighted the importance of holding discourse around evidence-based medicine to enable clinicians for improved healthcare delivery. The entire session was moderated by Dr Subhrojyoti Bhowmick, Clinical Director at Peerless hospital, Kolkata, who re-iterated that the Covid-19 has changed the way healthcare delivery is looked at, with clinical decision-making systems (CDSS) becoming the new normal.

The chief guest of the event, Prof (Dr) Debasish Bhattacharya, Director, Medical Education, Ex- Officio Secretary, Department of Health & Family Welfare, Government of West Bengal, explained his observations saying, “Covid-19 enabled massive digital adoption in healthcare within India’s healthcare system. It is only because of technology that information exchange, consultations and treatments were possible even during several lockdowns. Technology has the power to provide a much-organised medium for approaching evidence-based medicine. Moreover, along with the practicing clinicians, junior faculty and new graduates are now enthusiastic about understating and adopting technology. Evidence based medicine should be the norm going forward as it improves knowledge and skills of a clinician.”

Prof Dr Kameshwar Prasad, Padma Shri Recipient, Director, RIMS, Ranchi, Former Head of Neuroscience Department, AIIMS, New Delhi emphasised by saying, “Covid-19 propelled digitization across healthcare, that prompted the adoption of Clinical Decision Support System (CDSS). For instance, in the initial phase of pandemic, HCQ picked its popularity and people blindly started stocking it up. Only after collecting evidence from several research, it came out clear that HCQ neither prevents disease nor helps in recovery. This is a brilliant example to understand the importance and role of evidence-based medicine. Moreover, I believe that CDSS not only should be used for individual patients for improved outcomes but should also be utilised when the decisions are taken for public health decisions such as providing evidence for vaccines, etc. CDSS is a sophisticated and a smart digital tool. For example, tools like UpToDate give out a summary of evidence for the treatment regime. If a clinician is writing a prescription, the computer will prompt for the corrections in case the prescription is inconsistent or does not match with the guidelines.”

Harish Ramachandran, Country Manager, Clinical Effectiveness, Wolters Kluwer, India highlighted, “In my view, CDSS essentially takes care of two parameters, i.e., providing value for the entire care team and ensuring improved patient outcomes. Here technology plays a crucial role for providing easy accessibility. For example, in UpToDate the clinician gets constant feedback and alerts. Also, it provides prompt searches and bookmarks to access clinical evidence in no time. The idea is to enable clinicians to arrive at a decision easily at point of care. They can also integrate it with EMR as we move towards a cloud-based infrastructure. Furthermore, UpToDate has guidelines from India, which is regularly updated, for the reference of the users. Several Indian physicians’ author for UpToDate, making it a concentrated effort while moving forward to strengthen our ecosystem.”

Dr Harsh V Agarwal, Specialist, Internal Medicine, Woodlands Multi Speciality Hospitals added by sharing his observations,” During my residency in the USA, I learned that every medical decision provided to the patient must be evidence based. While presenting our case to the professor, quoting the evidence for our treatment regime (including medicine and hospitalization) was a part of guidelines. While in India, I observed the lack of a centralised system for the guidelines and protocols. So, if we have guidelines supported by clinical trial and research, an evidence-based medicine approach can get mandated in India as well”.

Dr Amitabh Saha, Consultant, Internal Medicine & Critical Care, Medica Super Specialty Hospital said, “Evidence-based medicine develops from all the research done on any disease or treatment for better understanding. For instance, when Covid-19 hit us, we were paranoid as we had no information about the virus. We initiated the treatment with regular antiretroviral and anthelmintics. Only after going through the collected evidence received from phase II & III trials, we were able to gather the intelligence. Our system is ready to conduct clinical trials which were not possible 15 to 20 years back, with the right healthcare digital tools, we can truly strengthen the healthcare delivery.”

The discussion also highlighted that lack of practical knowledge triggers medical errors, which still stands up to be a massive concern in our healthcare delivery. Therefore, an evidence-based medicine approach with the implementation of CDSS is expected to pave the way for improved patient and clinical outcomes. The journey of evidence-based practise is perhaps a slow but steady one. If we train the existing clinicians and the new medical graduates to streamline the data efficiently, evidence-based medicine can redefine the healthcare ecosystem.

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