Summary

In a 2021 memorandum, President Biden instructed all federal executive departments and agencies to “make evidence-based decisions guided by the best available science and data.” This policy is sound in theory but increasingly difficult to implement in practice. With millions of new scientific papers published every year, parsing and acting on research insights presents a formidable challenge.

A solution, and one that has proven successful in helping clinicians effectively treat COVID-19, is to take a “living” approach to evidence synthesis. Conventional systematic reviews,  meta-analyses, and associated guidelines and standards, are published as static products, and are updated infrequently (e.g., every four to five years)—if at all. This approach is inefficient and produces evidence products that quickly go out of date. It also leads to research waste and poorly allocated research funding.

By contrast, emerging “Living Evidence” models treat knowledge synthesis as an ongoing endeavor. By combining (i) established, scientific methods of summarizing science with (ii) continuous workflows and technology-based solutions for information discovery and processing, Living Evidence approaches yield systematic reviews—and other evidence and guidance—products that are always current. 
The recent launch of the White House Year of Evidence for Action provides a pivotal opportunity to harness the Living Evidence model to accelerate research translation and advance evidence-based policymaking. The federal government should consider a two-part strategy to embrace and promote Living Evidence. The first part of this strategy positions the U.S. government to lead by example by embedding Living Evidence within federal agencies. The second part focuses on supporting external actors in launching and maintaining Living Evidence resources for the public good.

Challenge and Opportunity

We live in a time of veritable “scientific overload”. The number of scientific papers in the world has surged exponentially over the past several decades (Figure 1), and millions of new scientific papers are published every year. Making sense of this deluge of documents presents a formidable challenge. For any given topic, experts have to (i) scour the scientific literature for studies on that topic, (ii) separate out low-quality (or even fraudulent) research, (iii) weigh and reconcile contradictory findings from different studies, and (iv) synthesize study results into a product that can usefully inform both societal decision-making and future scientific inquiry.

This process has evolved over several decades into a scientific method known as “systematic review” or “meta-analysis”. Systematic reviews and meta-analyses are detailed and credible, but often take over a year to produce and rapidly go out of date once published. Experts often compensate by drawing attention to the latest research in blog posts, op-eds, “narrative” reviews, informal memos, and the like. But while such “quick and dirty” scanning of the literature is timely, it lacks scientific rigor. Hence those relying on “the best available science” to make informed decisions must choose between summaries of science that are reliable or current…but not both.

The lack of trustworthy and up-to-date summaries of science constrains efforts, including efforts championed by the White House, to promote evidence-informed policymaking. It also leads to research waste when scientists conduct research that is duplicative and unnecessary, and degrades the efficiency of the scientific ecosystem when funders support research that does not address true knowledge gaps.

Figure 1. Total number of scientific papers published over time, according to the Microsoft Access Graph (MAG) dataset. (Source: Herrmannova and Knoth, 2016)

The emerging Living Evidence paradigm solves these problems by treating knowledge synthesis as an ongoing rather than static endeavor. By combining (i) established, scientific methods of summarizing science with (ii) continuous workflows and technology-based solutions for information discovery and processing, Living Evidence approaches yield systematic reviews that are always up to date with the latest research. An opinion piece published in The New York Times called this approach “a quiet revolution to surface the best-available research and make it accessible for all.”

To take a Living Evidence approach, multidisciplinary teams of subject-matter experts and methods experts (e.g., information specialists and data scientists) first develop an evidence resource—such as a systematic review—using standard approaches. But the teams then commit to regular updates of the evidence resource at a frequency that makes sense for their end users (e.g., once a month). Using technologies such as natural-language processing and machine learning, the teams continually monitor online databases to identify new research. Any new research is rapidly incorporated into the evidence resource using established methods for high-quality evidence synthesis. Figure 2 illustrates how Living Evidence builds on and improves traditional approaches for evidence-informed development of guidelines, standards, and other policy instruments.

Figure 2. Illustration of how a Living Evidence approach to development of evidence-informed policies (such as clinical guidelines) is more current and reliable than traditional approaches. (Source: Author-developed graphic)

Living Evidence products are more trusted by stakeholders, enjoy greater engagement (up to a 300% increase in access/use, based on internal data from the Australian Stroke Foundation), and support improved translation of research into practice and policy. Living Evidence holds particular value for domains in which research evidence is emerging rapidly, current evidence is uncertain, and new research might change policy or practice. For example, Nature has credited Living Evidence with “help[ing] chart a route out” of the worst stages of the COVID-19 pandemic. The World Health Organization (WHO) has since committed to using the Living Evidence approach as the organization’s “main platform” for knowledge synthesis and guideline development across all health issues. 

Yet Living Evidence approaches remain underutilized in most domains. Many scientists are unaware of Living Evidence approaches. The minority who are familiar often lack the tools and incentives to carry out Living Evidence projects directly. The result is an “evidence to action” pipeline far leakier than it needs to be. Entities like government agencies need credible and up-to-date evidence to efficiently and effectively translate knowledge into impact.

It is time to change the status quo. The 2019 Foundations for Evidence-Based Policymaking Act (“Evidence Act”) advances “a vision for a nation that relies on evidence and data to make decisions at all levels of government.” The Biden Administration’s “Year of Evidence” push has generated significant momentum around evidence-informed policymaking. Demonstrated successes of Living Evidence approaches with respect to COVID-19 have sparked interest in these approaches specifically. The time is ripe for the federal government to position Living Evidence as the “gold standard” of evidence products—and the United States as a leader in knowledge discovery and synthesis.

Plan of Action

The federal government should consider a two-part strategy to embrace and promote Living Evidence. The first part of this strategy positions the U.S. government to lead by example by embedding Living Evidence within federal agencies. The second part focuses on supporting external actors in launching and maintaining Living Evidence resources for the public good. 

Part 1. Embedding Living Evidence within federal agencies

Federal science agencies are well positioned to carry out Living Evidence approaches directly. Living Evidence requires “a sustained commitment for the period that the review remains living.” Federal agencies can support the continuous workflows and multidisciplinary project teams needed for excellent Living Evidence products.

In addition, Living Evidence projects can be very powerful mechanisms for building effective, multi-stakeholder partnerships that last—a key objective for a federal government seeking to bolster the U.S. scientific enterprise. A recent example is Wellcome Trust’s decision to fund suites of living systematic reviews in mental health as a foundational investment in its new mental-health strategy, recognizing this as an important opportunity to build a global research community around a shared knowledge source. 

Greater interagency coordination and external collaboration will facilitate implementation of Living Evidence across government. As such, President Biden should issue an Executive Order establishing an Living Evidence Interagency Policy Committee (LEIPC) modeled on the effective Interagency Arctic Research Policy Committee (IARPC). The LEIPC would be chartered as an Interagency Working Group of the National Science and Technology Council (NSTC) Committee on Science and Technology Enterprise, and chaired by the Director of the White House Office of Science and Technology Policy (OSTP; or their delegate). Membership would comprise representatives from federal science agencies, including agencies that currently create and maintain evidence clearinghouses, other agencies deeply invested in evidence-informed decision making, and non-governmental experts with deep experience in the practice of Living Evidence and/or associated capabilities (e.g., information science, machine learning).

Supporting federal implementation of Living Evidence

Widely accepted guidance for living systematic reviews (LSRs), one type of Living Evidence product, has been published. The LEIPC—working closely with OSTP, the White House Office of Management and Budget (OMB), and the federal Evaluation Officer Council (EOC), should adapt this guidance for the U.S. federal context, resulting in an informational resource for federal agencies seeking to launch or fund Living Evidence projects. The guidance should also be used to update systematic-review processes used by federal agencies and organizations contributing to national evidence clearinghouses.

Once the federally tailored guidance has been developed, the White House should direct federal agencies to consider and pursue opportunities to embed Living Evidence within their programs and operations. The policy directive could take the form of a Presidential Memorandum, a joint management memo from the heads of OSTP and OMB, or similar. This directive would (i) emphasize the national benefits that Living Evidence could deliver, and (ii) provide agencies with high-level justification for using discretionary funding on Living Evidence projects and for making decisions based on Living Evidence insights.

Identifying priority areas and opportunities for federally managed Living Evidence projects

The LEIPC—again working closely with OSTP, OMB, and the EOC—should survey the federal government for opportunities to deploy Living Evidence internally. Box 1 provides examples of opportunities that the LEIPC could consider.

Box 1: Example opportunities for federally managed Living Evidence Projects
Below are four illustrative examples of existing federal efforts that could be augmented with Living Evidence.
Example 1: National Primary Drinking Water Regulations. The U.S. Environmental Protection Agency (EPA) currently reviews and updates the National Primary Drinking Water Regulations every six years. But society now produces millions of new chemicals each year, including numerous contaminants of emerging concern (CEC) for drinking water. Taking a Living Evidence approach to drinking-water safety could yield drinking-water regulations that are updated continuously as information on new contaminants comes in, rather than periodically (and potentially after new contaminants have already begun to cause harm).
Example 2: Guidelines for entities participating in the National Wastewater Surveillance System. Australia has demonstrated how valuable Living Evidence can be for COVID-19 management and response. Meanwhile, declines in clinical testing and the continued emergence of new SARS-CoV-2 variants are positioning wastewater surveillance as an increasingly important public-health tool. But no agency or organization has yet taken a Living Evidence approach to the practice of testing wastewater for disease monitoring. Living Evidence could inform practitioners in real time on evolving best protocols and practices for wastewater sampling, concentration, testing, and data analysis.
Example 3: Department of Education Best Practices Clearinghouse. The Best Practices Clearinghouse was launched at President Biden’s direction to support a variety of stakeholders in reopening and operating post-pandemic. Applying Living Evidence analysis to the resources that the Clearinghouse has assembled would help ensure that instruction remains safe and effective in a dramatically transformed and evolving educational landscape.
Example 4: National Climate Assessment. The National Climate Assessment (NCA) is a Congressionally mandated review of climate science and impacts on the United States. The NCA is issued quadrennially, but climate change is presenting itself in new and worrying ways every year. Urgent climate action must be backed up by emergent climate knowledge. While a longer-term goal could be to transition the entire NCA into a frequently updated “living” mode, a near-term effort could focus on transitioning NCA subtopics where the need for new knowledge is especially pressing. For instance, the emergence and intensification of megafires in the West has upended our understanding of fire dynamics. A Living Evidence resource on fire science could give policymakers and program officials critical, up-to-date information on how best to mitigate, respond to, and recover from catastrophic megafires.

The product of this exercise should be a report that describes each of the opportunities identified, and recommends priority projects to pursue. In developing its priority list, the LEIPC should account for both the likely impact of a potential Living Evidence project as well as the near-term feasibility of that project. While the report could outline visions for ambitious Living Evidence undertakings that would require a significant time investment to realize fully (e.g., transitioning the entire National Climate Assessment into a frequently updated “living” mode), it should also scope projects that could be completed within two years and serve as pilots/proofs of concept. Lessons learned from the pilots could ultimately inform a national strategy for incorporating Living Evidence into federal government more systematically. Successful pilots could continue and grow beyond the end of the two-year period, as appropriate.

Fostering greater collaboration between government and external stakeholders

The LEIPC should create an online “LEIPC Collaborations” platform that connects researchers, practitioners, and other stakeholders both inside and outside government. The platform would emulate IARPC Collaborations, which has built out a community of more than 3,000 members and dozens of communities of practice dedicated to the holistic advancement of Arctic science. As one stakeholder has explained:

“IARPC Collaborations members interact primarily in virtual spaces including both video conferencing and a social networking website. Open to anyone who wishes to join, the website serves not only as a venue for sharing information in-between meetings, but also lowers the barrier to meetings and to the IARPC Collaborations community in general, allows the video conferences as well as the IARPC Collaborations community to be open to all, not just an exclusive group of people who happen to be included in an email. Together, IARPC Collaborations members have realized an unprecedented degree of communication, coordination and collaboration, creating new knowledge and contributing to science-informed decision making. The IARPC community managers utilize the IARPC Collaborations website not only for project management, but also to support public engagement. The website contains user-generated-content sharing system where members log-in to share resources such as funding opportunities, publications and reports, events, and general announcements. The community managers also provide communication training for two types of members of IARPC Collaborations: team leaders in order to enhance leadership skill and team engagement, and early career scientists in order to enhance their careers through networking and building interdisciplinary collaborations.”

LEIPC Collaborations could deliver the same participatory opportunities and benefits for members of the evidence community, facilitating holistic advancement of Living Evidence.

Part 2. Make it easier for scientists and researchers to develop LSRs

Many government efforts could be supported by internal Living Evidence initiatives, but not every valuable Living Evidence effort should be conducted by government. Many useful Living Evidence programs will require deep domain knowledge and specialized skills that teams of scientists and researchers working outside of government are best positioned to deliver.

But experts interested in pursuing Living Evidence efforts face two major difficulties. The first is securing funding. Very little research funding is awarded for the sole purpose of conducting systematic reviews and other types of evidence syntheses. The funding that is available is typically not commensurate with the resource and personnel needs of a high-quality synthesis. Living Evidence demands efficient knowledge discovery and the involvement of multidisciplinary teams possessing overlapping skill sets. Yet federal research grants are often structured in a way that precludes principal investigators from hiring research software engineers or from founding co-led research groups.

The second is aligning with incentives. Systematic reviews and other types of evidence syntheses are often not recognized as “true” research outputs by funding agencies or university tenure committees—i.e., they are often not given the same weight in research metrics, despite (i) utilizing well-established scientific methodologies involving detailed protocols and advanced data and statistical techniques, and (ii) resulting in new knowledge. The result is that talented experts are discouraged from investing their time on projects that can contribute significant new insights and could dramatically improve the efficiency and impact of our nation’s research enterprise.

To begin addressing these problems, the two biggest STEM-funding agencies—NIH and NSF—should consider the following actions:

  1. Perform a landscape analysis of federal funding for evidence synthesis. Rigorously documenting the funding opportunities available (or lack thereof) for researchers wishing to pursue evidence synthesis will help NIH and NSF determine where to focus potential new opportunities. The landscape analysis should consider currently available funding opportunities for systematic, scoping, and rapid reviews, and could also include surveys and focus groups to assess the appetite in the research community for pursuing additional evidence-synthesis activities if supported.
  2. Establish new grant opportunities designed to support Living Evidence projects. The goal of these grant opportunities would be to deliver definitive and always up-to-date summaries of research evidence and associated data in specified topics. The opportunities could align with particular research focuses (for instance, a living systematic review on tissue-electronic interfacing could facilitate progress on bionic limb development under NSF’s current “Enhancing Opportunities for Persons with Disabilities” Convergence Accelerator track). The opportunities could also be topic-agnostic, but require applicants to justify a proposed project by demonstrating that (i) the research evidence is emerging rapidly, (ii) current evidence is uncertain, and (iii) new research might materially change policy or practice.
  3. Increase support for career research staff in academia. Although contributors to Living Evidence projects can cycle in and out (analogous to turnover in large research collaboratives), such projects benefit from longevity in a portion of the team. With this core team in place, Living Evidence projects are excellent avenues for grad students to build core research skills, including in research study design. 
  4. Leverage prestigious existing grant programs and awards to incentivize work on Living Evidence. For instance, NSF could encourage early-career faculty to propose LSRs in applications for CAREER grants.
  5. Recognize evidence syntheses as research outputs. In all assessments of scientific track record (particularly research-funding schemes), systematic reviews and other types of rigorous evidence synthesis should be recognized as research outputs equivalent to “primary” research. 

The grant opportunities should also:

  • Support collaborative, multidisciplinary research teams.
  • Include an explicit requirement to build significant stakeholder engagement, including with practitioners and relevant government agencies.
  • Include opportunities to apply for follow-on funding to support maintenance of high-value Living Evidence products.
  • Allow funds to be spent on non-traditional personnel resources; e.g., an information scientist to systematically survey for new research.

Conclusion

Policymaking can only be meaningfully informed by evidence if underpinning systems for evidence synthesis are robust. The Biden administration’s Year of Evidence for Action provides a pivotal opportunity to pursue concrete actions that strengthen use of science for the betterment of the American people. Federal investment in Living Evidence is one such action. 

Living Evidence has emerged as a powerful mechanism for translating scientific discoveries into policy and practice. The Living Evidence approach is being rapidly embraced by international actors, and the United States has an opportunity to position itself as a leader. A federal initiative on Living Evidence will contribute additional energy and momentum to the Year of Evidence for Action, ensure that our nation does not fall behind on evidence-informed policymaking, and arm federal agencies with the most current and best-available scientific evidence as they pursue their statutory missions.

Frequently Asked Questions

The Living Evidence model can be applied to any sector or scientific field. While the Living Evidence model has so far been most widely applied to the health sector, Living Evidence initiatives are also underway in other fields, such as education and climate sciences. Living Evidence is domain-agnostic: it is simply an approach that builds on existing, rigorous evidence-synthesis methods with a novel workflow of frequent and rapid updating.

It does not take long for teams to develop sufficient experience and expertise to apply the Living Evidence model. The key to a successful Living Evidence project is a team that possesses experience in conventional evidence synthesis, strong project-management skills, an orientation towards innovation and experimentation, and investment in building stakeholder engagement.

As with evidence synthesis in general, cost depends on topic scope and the complexity of the evidence being appraised. Budgeting for Living Evidence projects should distinguish the higher cost of conducting an initial “baseline” systematic review from the lower cost of maintaining the project thereafter. Teams initiating a Living Evidence project for the first time should also budget for the inevitable experimentation and training required.

No. Living Evidence initiatives are analogous to other significant scientific programs that may extend over many years, but receive funding in discrete, time-bound project periods with clear deliverables and the opportunity to apply for continuation funding.

Living Evidence projects do require funding for enough time to complete the initial “baseline” systematic review (typically 3-12 months, depending on scope and complexity), transition to maintenance (“living”) mode, and continue in living mode for sufficient time (usually about 6–12 months) for all involved to become familiar with maintaining and using the living resource. Hence Living Evidence projects work best when fully funded for a minimum of two years.

If there is support for funding beyond this minimum period, there are operational advantages of instantiating the follow-on funding before the previous funding period concludes. If follow-on funding is not immediately available, Living Evidence resources can simply revert to a conventional static form until and if follow-on funding becomes available.

Living Evidence is rapidly gaining momentum as organizations conclude that the conventional model of evidence synthesis is no longer sustainable because the volume of research that must be reviewed and synthesized for each update has grown beyond the capacity of typical project teams. Organizations that transition their evidence resources into “living” mode typically find the dynamic synthesis model to be more consistent, more feasible, easier to manage, and easier to plan for and resource. If the conventional model of intermittent synthesis is like climbing a series of mountains, the Living Evidence approach is like hiking up to and then walking across a plateau.

New initiatives usually need specific resourcing; Living Evidence is no different. The best approach is to identify a champion within the organization that has an innovation orientation and sufficient authority to effect change. The champion plays a key role in building organizational buy-in, particularly from senior leaders, key influencers within the main evidence program, and major partners, stakeholders and end users. Ultimately, the champion (or their surrogate) should be empowered and resourced to establish 1–3 Living Evidence pilots running alongside the organization’s existing evidence activities. Risk can be reduced by starting small and building a “minimum viable product” Living Evidence resource (i.e., by finding a topic area that is relatively modest in scope, of importance to stakeholders, and is characterized by evidence uncertainty as well as relatively rapid movement in the relevant research field). Funding should be structured to enable experimentation and iteration, and then move quickly to scale up, increasing the scope of evidence moving into living mode, as organizational and stakeholder experience and support builds.

One of the advantages of the Living Evidence model is that the project team can gradually evolve over time (members can join and leave as their interests and circumstances change). This is analogous to the evolution of an ongoing scientific network or research collaborative. In contrast, the spikes in workload required for intermittent updates of conventional evidence products often lead to burnout and loss of institutional memory. Furthermore, teams working on Living Evidence are often motivated by participation in an innovative approach to evidence and pride in contributing to a definitive, high-quality, and highly impactful scientific initiative.

While dissemination of conventional evidence products involves sharing several dozen key messages in a once-in-several-years communications push, dissemination of Living Evidence amounts to a regular cycle of “what’s new” updates (typically one to two key insights). Living Evidence dissemination feeds become known and trusted by end users, inspiring confidence that end users can “keep up” with the implications of new research.

Publication of Living Evidence can take many forms. Typically, the core evidence resource is housed in an organizational website that can be easily and frequently updated, sometimes with an ability for users to access previous versions of the resource. Living Evidence may also be published as articles in academic journals. This could be intermittent overviews of the evidence resource with links back to the main Living Evidence summaries, or (more ambitiously) as a series of frequently updated versions of an article that are logically linked. Multiple academic journals are innovating to better support “living” publications.

Living Evidence requires continual monitoring for new research, as well as frequent and rapid incorporation of new research into existing evidence products. The volume of research identified and incorporated can vary from dozens of studies each month to a few each year, depending on the topic scope and research activity.

Even across broad topics in fast-moving research fields, though, the overall findings and conclusions of Living Evidence products change infrequently since the threshold for changing a conclusion drawn from a whole body of evidence is high. The largest Living Evidence projects in existence only yield about one to two new major findings or recommendations each update. Furthermore, any good evidence-synthesis product will contextualize conclusions and recommendations with confidence assessments.

Living Evidence projects, due to their persistent nature, are great opportunities for building partnerships with stakeholders. Stakeholders tend to be energized and engaged in an innovative project that gives them, their staff, and their constituencies a tractable mechanism by which to engage with the “current state of science”. In addition, the ongoing nature of a Living Evidence project means that project partnerships are always active. Stakeholders are continually engaged in meaningful, collaborative discussions and activities around the current evidence. Finally, this ongoing, always-active nature of Living Evidence projects creates “accumulative” partnerships that gradually broaden and deepen over time.

Living Evidence resources make the latest science available to all. Conventionally, the lack of high-quality summaries of science has meant the latest science is discovered and adopted by those closest to centers of excellence and expertise. Rapid incorporation of the latest science into Living Evidence resources—as well as the wide promotion and dissemination of that science—means that the immediate benefits of science can be shared much more broadly, contributing to equity of access to science and its benefits.

The activities that use research outputs and evidence resources (such as Living Evidence) to change practice and policy are often referred to as “knowledge translation”. These activities are substantial and often multifaceted interventions that identify and address the complex structural, organizational, and cultural barriers that impede knowledge use.

Living Evidence has the potential to accelerate knowledge translation: not because of any changes to the knowledge-translation enterprise, but because Living Evidence identifies earlier the high-certainty evidence that underpins knowledge-translation activities.

Living Evidence may also enhance knowledge translation in two ways. First, Living Evidence is a better evidence product and has been shown to increase trust, engagement, and intention to use among stakeholders. Second, as mentioned above, Living Evidence creates opportunities for deep and effective partnerships. Together, these advantages could position Living Evidence to yield a more effective “enabling environment” for knowledge translation.

Technologies such as natural language processing, machine learning and citizen science (crowdsourcing), as well as efforts to build common data structures (and create Findable, Accessible, Interoperable and Reusable (FAIR) data), are advancing alongside Living Evidence. These technologies are often described as “enablers” of Living Evidence. While such technologies are commonly used and developed in Living Evidence projects, they are not essential. Nevertheless, over the longer term, such technologies will likely be indispensable for creating sustainable systems that make sense of science.

Yes. To our knowledge, the first example of a Living Evidence project commissioned by a U.S. government agency is “Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain”, commissioned by the Agency for Healthcare Research and Quality (AHRQ)’s Effective Health Care Program and developed and maintained by Dr. Roger Chou and colleagues at the Pacific Northwest Evidence-based Practice Center. The team describes their experiences and practical considerations in this report.

Footnotes

  1. As defined by IARPC’s 2022-2026 Arctic Research Plan, a priority area is a “broad cross-cutting theme that needs additional research, supports one or more policy drivers, meets the mission and interests of more than one Federal agency, and engages multiple existing collaboration teams and non-Federal partners.” [↪]
  2. National “evidence clearinghouses” are portals that collect, organize, assess, and share evidence on a variety of programs and practices in a particular domain (for instance, the Department of Education maintains a “What Works” clearinghouse for evidence on a variety of topics in education). Many of these clearinghouses have developed protocols for synthesizing insights from a collection of individual assessments. [↪]