Future of evidence ecosystem series: 3. From an evidence synthesis ecosystem to an evidence ecosystem

The “one-off” approach of systematic reviews is no longer sustainable; we need to move toward producing “living” evidence syntheses (i.e., comprehensive, based on rigorous methods, and up-to-date). This implies rethinking the evidence synthesis ecosystem, its infrastructure and management. The three distinct production systems — primary research, evidence synthesis and guidelines development — should work together to allow for continuous refreshing of synthesized evidence and guidelines. A new evidence ecosystem, not just focusing on synthesis, should allow for bridging the gaps between evidence synthesis communities, primary researchers, guidelines developers, health technology assessment agencies, and health policy authorities. This network of evidence synthesis stakeholders should select relevant clinical questions considered a priority topic. For each question, a multi-disciplinary community including researchers, health professionals, guidelines developers, policymakers, patients and methodologists needs to be established and commit to performing the initial evidence synthesis and keeping it up to date. Encouraging communities to work together continuously with bidirectional interactions requires greater incentives, rewards and the involvement of healthcare policy authorities to optimize resources. A better evidence ecosystem with collaborations and interactions between each partner of the network of evidence synthesis stakeholders should permit living evidence syntheses to justify their status in evidence-informed decision-making