Informatics enables new "point-of-care" trials

Doctors and biostatisticians have developed a new way of comparing approved treatments, with the help of electronic medical records and informatics. The Veteran Affairs Boston Healthcare System and Stanford University are pioneering the so-called point-of-care clinical trials.

Point-of-care clinical trials borrow aspects of traditional trials such as randomization of patients in the studies. They also incorporate electronic medical records, which are often a part of observational studies. Yet point-of-care trials might cost less than traditional clinical trials and allow doctors to put patients on the "best" treatments.

In Boston VA's pilot point-of-care trial, which began in October 2010, doctors have compared two standard approaches of treating hospitalized diabetics with insulin. The doctors used an electronic medical record that was programmed to randomize patients to get one of the two insulin treatments. The "best" treatment in this study is the one that leads to shorter hospital stays.

"The idea of embedding research into clinical care has been around for quite awhile but to my knowledge this is the first time that a randomized trial has been fully integrated into a hospital's informatics system," Louis Fiore, a physician at the Boston VA and lead author of an article on the trials published online in the journal Clinical Trials, said in a statement. "It demonstrates an effective way to use electronic medical records to improve health care at a local level."

While point-of-care clinical trials aren't meant to investigate experimental drugs or devices, the new trials could become an effective way to conduct comparative-effectiveness studies in which two approved treatments are compared head-to-head. The team at the Boston VA developed this approach to clinical trials with biostatistician Philip Lavori of Stanford University.

- read more on this in the report from Stanford

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