Future of evidence ecosystem series: 1. Introduction — Evidence synthesis ecosystem needs dramatic change

To make healthcare decisions, patients, clinicians, clinical practice guideline developers, researchers, policy-makers and health system managers need a comprehensive, critical, accessible, actionable and up-to-date synthesis of all available evidence in a given condition. Systematic reviews and meta-analyses are a cornerstone of healthcare decisions. However, despite the increasing number of published systematic reviews of therapeutic interventions, the current evidence synthesis ecosystem is not properly addressing stakeholders’ needs.The current production process leads to a series of disparate systematic reviews due to erratic and inefficient planning with a process that is not always comprehensive, and is prone to bias.Evidence synthesis depends on the quality of primary research, so primary research that is not available, is biased or selectively reported raises important concerns. Moreover, the lack of interactions between the community of primary research producers and systematic reviewers impedes the optimal use of data.The context has considerably evolved, with ongoing research innovations, a new medical approach with the end of the one-size-fits-all approach, more available data, and new patient expectations. All these changes must be introduced into the future evidence ecosystem.Dramatic changes are needed to enable this future ecosystem to become user-driven and user-oriented and more useful for decision-making.