Vision VI: Collapsing Databases

Three Databases Going Virtual

Three enormous health databases are in the process of going virtual or electronic. The first of these is the Clinical Research Database or CRD. On the back end of the Vioxx withdrawal, conflict of interest concerns, and legitimate health consumer desires for early access to discovery information, major research databases are moving toward open transparency. For better or worse, the public will soon have ready access to the vast majority of positive and negative results of studies at the time of completion. These results will be electronic and readily transferable, far and wide. (1,2)

The second database is the Continuing Medical Education or CME database. It, too, is going electronic. In fact, projections are that 50% of all U.S. CME will be electronic by 2016, and eCME has been demonstrated to be effective. It is likely that within ten years, the vast majority of CME will be virtual and will be applied in real time rather than in episodic segments. Handheld devices are increasingly standard medical equipment in caring encounters, providing immediate database support to the patient/physician relationship during the evaluative and joint decision making process. This allows experts to quite confidently predict that in a preventive health care system where information is overwhelmingly the dominant health care product, CME will be inter-changeable and indecipherable from the care itself. (3)

And this brings us to the third database, CCE or Continuing Consumer Education. The consumer movement continues to evolve from educational empowerment to active engagement and inclusion in the health care team. 80% of Internet users in 2010 accessed health information on the web. (4) Patients and their families will increasingly demand access to the same hand-held hardware and information software that the other care team members are using. This will help avoid any confusion that might arise from multitracked information and accelerate the need for simple and well- designed educational products. By using the same devices and educational platforms, issues of standards and problems of incompatibility that might compromise the primary “home to care team to home” loop will melt away.

Two Translation Gaps

Three large growing databases – CRD, CME, CCE – have gone virtual and are widely accessible. What remains are two translation gaps. (5) The first is between CRD and CME, and it ensures that discoveries will take many years to penetrate and inform clinical practice. If, for example, a study reveals that it is safer and better for mother and child to provide epidural anesthesia at 2 cm rather than 5 cm dilation, and that doing so not only does not increase Csection rates but ensures safer, more comfortable labor and better Apgar scores for the baby, under our past system, this knowledge transfer to practice would be a multiyear affair. With virtual CRD and CME, there exists the ability to collapse those databases upon each other and almost immediately affect practice behavior changes coincident with a new discovery.

If CRD and CME will collapse upon each other, CME and CCE will in many ways become one and the same. Thus, the frantic efforts to develop Personal Health Records on the one hand and Electronic Medical Records on the other are already raising entrepreneurial eyebrows. Are these not, after all, one and the same? Does not all clinical data originate with the people? Do they not loan this data to the people in whom they have the greatest trust and confidence – their physicians, nurses, and other caregivers? And if our records are one and the same, should we not also use the same informational resources to support our joint decision-making? Wouldn’t this be the best way to help us stay on the same page and avoid any chance of miscalculation, misinformation, or mistake?

Information Domination

As we move from intervention to prevention, health care will be information dominated product or service, and this product will be anchored by three massive, collapsing databases – discovery (CRD), medical (CME) and consumer (CCE) – with primary ownership residing where the data originated, with the people, and provided primarily to the people caring for the people.

Killer applications that allow health care to move from intervention to prevention to strategic health planning will emerge on the consumer side with health care professionals moving toward the people to support confidence, trust and relationship building. By utilizing the same software, information will double connect the people to the people caring for the people, rather then serving as a double check on each other.


1. Greener M. Drug Safety On Trial. EMBO Reports. 2005.

2. PhRMA Statement Supporting Enhanced Transparency. Aug. 2, 2010

3. Harris JM. The growth, characteristics, and future of online CME. The Journal of Continuing Education in The Health Professions

4. Fox S. Health Digital Divide. Pew Research Center. Feb. 1, 2011.

5. Haynes B and Haines A. Getting research findings into practice: Barriers and bridges to evidence based clinical practice. BMJ 1998; 317: 273,1998

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