25 years ago I set out on a mission to provide the most useful information to healthcare professionals at the point of care.
This mission guided me through many personal decisions, business decisions, partnership decisions, editorial decisions, and prioritization decisions. Doing the best we can for the most people with whatever we have to work with, and orienting towards growth and scaling, have also been substantial guiding principles—applying these to an important and compelling mission provides an extraordinary force to reach unprecedented results.
I manifested this mission in the product, company and team called DynaMed and partnered with EBSCO in 2005 to advance this mission. Technically I sold a company and became an employee but mentally I partnered with EBSCO to extend this mission with a “5-year plan” at the time. In 2010 as DynaMed made tremendous growth spurts in editorial, technology and business developments all at once I presented one my favorite “team update” presentations showing how we have completed our “Five-year Mission to Go Where No Database Has Gone Before” and announce plans for the next 5-year mission.
Over these 10 years EBSCO developed a collection of clinical reference products and EBSCO Health became a prominent department within EBSCO Information Services. In 2015 the DynaMed team had grown sufficiently to advance without depending on my daily attention. The next 5-year mission saw the development of DynaMed Plus, the extension of scaled evidence-based methods for research synthesis to the scaled development of evidence-based recommendations, and I passed the editorial authority to Peter Oettgen to continue the mission to provide the most useful information to healthcare professionals at the point of care.
One of the most rewarding results of DynaMed development over 20 years at this point is that it made Evidence-Based Medicine (EBM) real – transforming an academic, philosophical ideal into a practical expectation – being “taken for granted” in this context is a tremendous and rewarding achievement.
Freed from the daily responsibilities of such a scaled system I extended my mission to provide the most useful support for healthcare decision-making. This led to the creation of an Innovations and EBM Development Team within EBSCO Health and too many innovations and developments to mention them here. One substantial domain I had the opportunity to advance further was Shared Decision Making (SDM) and EBSCO Health acquired and developed Option Grid, HealthDecision, and DynaMed Shared Decisions to provide scalable tools. One day, like DynaMed did for EBM, we will look back and see that we helped move SDM from the academic ideal to the practical expectation.
Parallel to these team, product and business developments, I had many engagements in the global communities to advance the broader Evidence Ecosystem at the conceptual layer. Publications in the past 5 years include:
- RAPADAPTE for rapid guideline development: high-quality clinical guidelines can be rapidly developed with limited resources
- EBHC pyramid 5.0 for accessing preappraised evidence and guidance
- The GRADE Working Group clarifies the construct of certainty of evidence
- Defining certainty of net benefit: a GRADE concept paper
- GRADE guidelines 26: Informative statements to communicate the findings of systematic reviews of interventions
- Consistency of recommendations for evaluation and management of hypertension
- Thrombolysis with alteplase 3-4.5 hours after acute ischemic stroke: trial reanalysis adjusted for baseline imbalances
During this time I became active in multiple working groups and committees across national and international organizations in the EBM and clinical decision support (CDS) domains. In 2017 the EBM community charged me with finding the first steps to provide interoperability solutions at the technology level for handoffs across the Evidence Ecosystem. In 2018, having learned how Health Level 7 International (HL7®), a standards development organization, created Fast Healthcare Interoperability Resources (FHIR®) to provide interoperability for the healthcare domain after decades of need, I proposed to extend FHIR to support “Evidence Based Medicine Knowledge Assets” and the EBMonFHIR project was created. In less than 2 years (which is rapid in the world of standards development) we created a functional model for expressing Evidence (evidence variables, statistics and certainty of the findings) in computable (machine-interpretable, precise, unambiguous) form.
Over the past 6 months a small, barely perceptible string of RNA (now labeled SARS-CoV-2) changed life as we know it. In mid-March 2020 a heavy demand for information about COVID-19 from professionals of multiple types seeking information of many types stimulated a team from 4 or more EBSCO departments to create and maintain a COVID-19 Information Portal. One of DynaMed’s customers (a health system with over 100 hospitals) reached out to me with an immediate demand for clinical decision support for COVID-19 treatment. They wanted DynaMed-level synthesis of evidence for immediate decision-making with literally life-and-death outcomes but the evidence itself was not ready for DynaMed inclusion (the evidence not being published in peer-reviewed journals yet). We figured out how to accurately identify and represent available results from randomized trials that included pre-peer review data and make it available for immediate use – check out https://www.gps.health/COVID19TrialResults/.
These 2 COVID-related solutions could provide some rapid information support at a time when the information need was felt by everyone to be most demanding and chaotic, doing what we can to “flatten the curve” of information anxiety. But the information support needs for overcoming COVID-19 go far beyond providing databases for dissemination and delivery of information. There are deep needs to accelerate the identification, evaluation and dissemination of the evidence itself and support the Evidence Ecosystem. Requests for the EBMonFHIR project to support these needs came from several international efforts and global collaboration across government, industry, academia, nonprofits, and consortia is occurring like never before.
On March 30, 2020 I announced the creation of COVID-19 Knowledge Accelerator (COKA), a virtual organization that is coordinating people from more than 25 organizations in 7 countries working together across 10 active working groups to develop and advance interoperability standards for COVID-19 knowledge.
I had not previously considered a mission more important for me than to provide the most useful support for healthcare decision-making, let alone consider changing a lifetime mission with relatively short periods of reflection and decision to action, but the most useful support I can provide now is in the “precursor” stages to accelerate our knowledge development. My next mission is now to enable standard-based machine-interpretable expression of knowledge, especially related to healthcare and scientific evidence.
I am ending my role of Chief Medical Knowledge Officer for EBSCO Information Services effective July 31, 2020 and meeting this new mission as Chief Executive Officer of Computable Publishing LLC.
“I cannot do all the good that the world needs, but the world needs all the good that I can do.”This quote by Jana Stanfield captures a lot of my thinking in this major transition. The most impactful thing I can do right now is to make science machine-interpretable and help everyone advance our knowledge at the speed of thought.
Brian S. Alper, MD, MSPH, FAAFP, FAMIA
CEO, Computable Publishing LLC
http://computablepublishing.com Making Science Machine-Interpretable
“It only takes a pebble to start an avalanche.”