Finding reliable evidence-based answers during an infodemic
Scientific evidence about COVID-19 keeps growing and changing, and clinical decision support software solutions can help clinicians keep pace.
When the COVID-19 pandemic started in December 2019, little was known about the SARS-CoV-2 virus –about its genetic sequence, viral structure, or the pathophysiology by which it could infect and cause disease in humans. The widespread public health impact has created a global emergency and an urgent need to understand COVID-19 for more effective response and recovery efforts.
For the first time in human history, the developing science around a pandemic has been widely shared and discussed among the general public. Expansive coverage in the news and on social media has contributed to an abundance of both information and misinformation, also known as an infodemic.1
Low-quality science, misleading headlines and misinterpreted study results have contributed to confusion and frustration. Adding to the turmoil, early scientific evidence is subject to change because medical research is by nature iterative and self-correcting. In a rush to advance the science, peer-review processes have been accelerated, which has exposed the general public to numerous early findings that were subsequently found to be untrue. As of this writing, 36 peer-reviewed COVID-19 publications have been retracted.2
One high-profile example of evolving science in the public view is the research around using hydroxychloroquine as a treatment for COVID-19.3 Early observational studies showed that it might have an effect, and the media was quick to cover this positive news. Access to COVID-19 related drug information in Micromedex® increased in March 2020 and remained elevated for about two months, with information about hydroxychloroquine being sought most frequently.
Several randomized controlled trials have since demonstrated that hydroxychloroquine does not improve clinical outcomes or prevent disease and may be associated with adverse events.4, 5 The National Institutes of Health halted one ongoing hydroxychloroquine study after an interim analysis showed no evidence of benefit.6 When people rely too heavily on early information, they may have difficulty accepting new reports, even if the subsequent information is from more credible, rigorous trials.
What clinicians should expect from their clinical decision support tools
According to the National Institutes of Health (NIH) and National Library of Medicine (NLM) resource LitCOVID, nearly 60,000 articles have been published on COVID-19 since January.7 No single person can keep up with all that literature, and critical healthcare decisions cannot wait.
The volume and iterative nature of the science around COVID-19 makes trusted clinical decision support tools invaluable to busy, practicing clinicians. The content in these tools should have certain characteristics, including:
- Evidence-based – Rigorous scientific content should come from the latest, high-quality sources of information.
- Frequently updated – Content should be updated to reflect most recent advances in the knowledge base.
- Actionable – It should also enable robust clinical decision making by including depth, such as study details, comparative efficacy, guideline recommendations, and detailed adverse effects and disease management options.
This period of disruption has required clinical decision support vendors to pivot quickly to adapt to changing needs without sacrificing quality. The editorial team at IBM Micromedex® solutions, for example, more frequently conducted routine content surveillance and developed a new curation process to review preliminary data, which resulted in an increase in publication of drug monograph information. The editorial team at DynaMed also shifted priorities and the Infectious Disease publishing group has devoted multiple team members to keep up with COVID-19 research.
Evidence-based, timely and actionable information is critically important for clinicians, especially during a pandemic or any period when scientific information is rapidly evolving. As healthcare providers think about how they can best support their clinical enterprise during this challenging time – and emerge smarter afterward – they should put in place the set of tools that can deliver on these three characteristics.
- “Managing the COVID-19 infodemic: Promoting health behaviors and mitigating the harm from misinformation and disinformation” a Joint statement by WHO, UN, UNICEF, UNDP, UNESCO, UNAIDS, ITU, UN Global Pulse and IFRC
- Information from Retraction Watch, The Center for Scientific Integrity, NY. Accessed Oct. 19, 2020
- Willis VC, Arriaga Y, Weeraratne D, Reyes F, Jackson GP. A narrative review of emerging therapeutics for COVID-19. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2020, Jul 20, published online ahead of print, https://doi.org/10.1016/j.mayocpiqo.2020.07.004. PMID: 32838206. PMCID: PMC7369591.
- Oriol Mitjà, PhD, et al. Hydroxychloroquine for Early Treatment of Adults with Mild Covid-19: A Randomized-Controlled Trial, Clinical Infectious Diseases, ciaa1009, https://doi.org/10.1093/cid/ciaa1009
- David R. Boulware, M.D., M.P.H., et al A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. August 6, 2020N Engl J Med 2020; 383:517-525 DOI: 10.1056/NEJMoa2016638
- The National Institutes of Health media advisory, “NIH halts clinical trial of hydroxychloroquine: Study shows treatment does no harm, but provides no benefit” June 20, 2020