Pediatric Informatics: Computer Applications in Child Health (Health ...

10 Evidence-Based Medicine and Pediatrics 137
of workspace and workflow to identify optimum locations for computers, printers,
and other devices becomes more complex. Sharing of computers and prioritization
of staff access may affect clinician use of resources or may determine the type of
access (handheld devices, cellular telephones). The more streamlined the access to
information, the more likely they will be used.
10.4.3 Financial Issues
Cost is the major consideration and barrier for technology acquisition and maintenance.
Solutions may include cooperation with other practices or entities (such as
hospitals or nonprofit organizations) in cost sharing or volume discounts to decrease
individual practice costs for information technology. Such sharing arrangements
may also improve communications between groups (such as a hospital and pediatric
practice or several practices) because of increased interoperability and familiarity
due to same systems in different locations. Access to EBM resources may similarly
be shared or granted through partnerships such as affiliations with other physicians
and practices, education institutions, public health registries or clinical research
projects, although such agreements should considered in the context of possible violations
of federal antikickback laws and regulatory safe harbors prior to signing. 33
The cost of EBM resource access may be reduced if open-source publication
models of peer-reviewed journals gains wider acceptance in the medical community
(Ex: Public Library of Science, PLoS, www.plos.org or BioMed Central,
http://www.biomedcentral.com/). In open-source publishing, scientific manuscripts
undergo traditional peer review, but payment for publication comes from authors or
membership institutions (which pay fees to allow its employees to publish), resulting
in free access to research studies. This public access policy is encouraged by the
National Institutes of Health, 34 and some commercial publishers are allowing free
online access to their journals after a specified period of time.
10.5 Assessing the Quality of Available Health
Information
10.5.1 Rating the Quality of Published Evidence
Ratings to assess the quality of published evidence have been developed. The
Centre for Evidence-Based Medicine 35 rates the validity of a research study on five
levels of evidence:
1. Randomized clinical trials or meta-analysis of randomized control trials = best
2. Individual cohort trial or systematic review of cohort trials
3. Case control study or systematic review of case control studies