Problem knowledge couplers: reengineering evidence-based medicine through interdisciplinary development, decision support, and research

The rapid growth of medical knowledge is creating a demand for new ways of providing information in support of evidence-based medical practice. Proble m Knowledge Couplers are a clinical decision support software tool that off er a new approach to this growing problem. Couplers are developed through a collaboration among clinicians, informaticians, and librarians. They recog nize that functionality must be predicated upon combining unique patient in formation, gleaned through relevant structured question sets, with the appr opriate knowledge found in the world's peer-reviewed medical literature. Tw o pilot studies indicate that couplers can meet the gold standards of decis ion making within both a primary care and. a specialty practice. Issues rem ain about how to best integrate Problem Knowledge Couplers into clinical pr actice and whether large-scale outcomes research will support the findings of pilot studies. However, Problem Knowledge Couplers represent a promising approach that might portend a new model for health care delivery in the ne xt millennium.