A randomized controlled trial is the accepted gold standard for accomplishing this, with inclusion and exclusion criteria that attempt to make the population homogenous, randomization that attempts to make two populations the same to eliminate bias and confounding and rigid control to keep the intervention constant. All of these aspects are simply not compatible with routine clinical care and are extremely expensive. However, a quasi-experimental design is quite compatible with routine clinical care. If our work must be judged, and it is being judged, I think we would want that to be done as accurately as possible. We also need to describe the treatment with at least the CPT code.
More detail needs to be standardized for the future.
This turns out to be a very, very large amount of data. In the practice setting, time constraints on physicians and staff make it difficult to collect data expressly for research purposes. Any research tool employed over and above standard office processes is viewed as an imposition and an unnecessary cost. Many of us have experienced the difficulty of trying to compensate for this phenomenon by hiring a special research assistant. He or she is also viewed as an imposition and an unnecessary cost.