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Real data transforming the real world
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  1. Rachel Dean
  1. Rachel Dean is the director of clinical research and excellence in practice for VetPartners.
  1. email: rachel.dean{at}vetpartners.co.uk

Abstract

This month Rachel Dean says using all sorts of data can support innovation and safety.

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This is an exciting time – the availability of clinical data and the harnessing of it on a large scale is becoming more and more possible in veterinary practice.

‘Big data’ is a buzz phrase that is used all the time – but size doesn’t always matter!

The data held within practice management software systems are vast and rich and are one source of real data that can improve our evidence base.

However, these data are collected for recording individual patient health records, managing appointments and effective invoicing, not for research or improving care, so the limitations need to be recognised. Data are only useful and effective if they are collected for the correct purpose, analysed in an appropriate way and then applied suitably to the clinical setting. The phrase ‘rubbish in, rubbish out’ in relation to data must be recognised, as bad data, bad analysis or bad interpretation could lead to changes that could harm patients.

The evidence-based medicine (EBM) manifesto states we need to also ‘support innovation, quality improvement and safety through the better use of real-world data’,1 and we have to achieve this if we are going to have a better evidence base for clinical decision making.

The evidence base isn’t just made up of academic research papers, it includes data generated from and used by practices, as well as pharmacovigilance data and it leads to new ways of doing things – innovation.

Innovation in its modern meaning is a new idea, creative thoughts or new imaginations in the form of a device or method.2

Good innovation starts with an industry need, and the veterinary professions and allied professionals are well placed to deliver innovation in animal health. Innovation is also a team sport not an academic pursuit and it doesn’t just refer to a new bit of kit or a digital solution. It can be a new surgical technique or a method of delivering care in the clinic (eg, starting a rabbit-only clinic), or an alternative way of supporting farmers (eg, helping to reduce their carbon footprint).

Innovation in veterinary healthcare must be undertaken within a sound ethical framework. While progress means we need to push our boundaries, we should ensure we work within our regulatory framework and with our regulators, as well as constantly challenge ourselves, to ensure the focus of the innovation is to improve the outcomes of our patients.

Quality improvement is one of the most powerful ways of making sure we use real data to know how good our clinical services are and the benefits we give patients. Quality improvement can often be hidden behind some very confusing, depressing-sounding lingo but it is a vital part of evidence-based veterinary medicine (EBVM) and I promise you it is not dull – it can save lives.

As my previous columns have described, academic research can be a rich source of evidence for clinical practice if undertaken and reported appropriately, but it can only tell us about the population studied.

If we want to know about our population of patients and make a difference to their care we need to look at real data generated in practice and ask ourselves: ‘Is that good enough?’ And if the answers are no, then the clinical team needs to have the power to change.

We have a duty to our patients to ensure we know the risks as well as the benefits of the treatments and procedures we perform

Excellent care is safe to provide. So we have a duty to our patients to ensure we know the risks as well as the benefits of the treatments and procedures we perform.

The evidence base required to get a drug licensed will have some safety data published in the research and SPC (summary of product characteristics), but this will frequently relate to just a few side effects in a relatively small number of animals. Many devices, supplements, diagnostic tests, and so on, are not regulated in the same way so we have no idea about their safety profiles.

Whatever the safety information shows us it is not until we have used it in thousands of patients in practice that we will truly know if it is safe. We all have a responsibility to report and collate safety data on the interventions we use in practice – these real-world data are as important as efficacy data.

Together we can use these real-world data to transform care. This will involve academics, corporates, practitioners, charities, regulators and more. Innovation, hand in hand with the safety of our patients, is in these data.

Putting evidence in practice

This column is one in a series making the case for a new approach to EBVM. Please contribute to the debate.

If you would like to share your experiences or an opinion on EBVM with Vet Record readers, please email: vet.editorial@bmj.com

References

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