Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality

Delivering outstanding medical care requires providing care that is both high-quality and safe. However, while the knowledge base regarding effective medical therapies continues to improve, the practice of medicine continues to lag behind, and errors are distressingly frequent. [1] Regarding the gaps between evidence and practice, Lomas et al. [2] evaluated a series of published guidelines and found that it took an average of approximately five years for these guidelines to be adopted into routine practice. Moreover, evidence exists that many guidelines-even those that are broadly accepted-are often not followed. [3 4 5 6 7] For example, approximately 50% of eligible patients do not receive beta blockers after myocardial infarction, [8] and a recent study found that only 33% of patients had low-density lipoprotein (LDL) cholesterol levels at or below the National Cholesterol Education Program recommendations. [5] Of course, in many instances, relevant guidelines are not yet available, but even in these instances, practitioners should consider the evidence if they wish to practice evidence-based medicine, and a core part of practicing evidence based medicine is considering guidelines when they do exist.