Online Practice Guidelines: Issues, Obstacles, and Future Prospects

Abstract

The "guidelines movement" was formed to reduce variability in practice, control costs, and improve patient care outcomes. Yet the overall impact on practice and outcomes has been disappointing. Evidence demonstrates that the most effective method of stimulating awareness of and compliance with best practices is computer-generated reminders provided at the point of care. This paper reviews five steps along the path from the development of a guideline to its integration into practice and the subsequent evaluation of its impact on practice and outcomes. Issues arising at each step and obstacles to moving from one step to the next are described. Last, developments that could help overcome the obstacles are highlighted. These include 1) more rapid knowledge acquisition using data mining, 2) better accommodation to imprecise knowledge in clinical algorithms using fuzzy logic, 3) development of a shareable model for guideline representation and execution, and 4) more widespread availability of clinically robust information systems that support decision-making at the point of care.

Assessing the Quality of Clinical Data in a Computer-based Record for Calculating the Pneumonia Severity Index

“…[1][2][3][4] A common reason for the reluctance to use the guidelines is the time required to complete them. Especially in hospitals with a computerized patient record (CPR), paper-based guidelines represent a duplication of data collection that should be avoided.…”

Development of a hand-held real-time decision support aid for critical care nursing

“…Consensus or expert guidelines tend to be lengthy and complex. While this contributes to their overall value, busy clinicians are frustrated if unable to quickly access the section relevant to the presenting client [80].…”

“…The "guideline movement" [80], emerging in recent years, highlights an effort to stimulate evidencebased practice. The NIH Agency for Health Care Policy Research assumed a pivotal role in the development of scientific evidence report guidelines [43].…”

Real Time Clinical Decision Support System

“…The Web-interfaced process has been developed for graphical guidelines that allow users to traverse the algorithm by flowcharts in an interactive fashion (Liem et al, 1995). The clinical benefits were highlighted by rapid knowledge acquisitions, shareable guideline models, and robust information systems while evaluating its impacts on outcomes (Zielstorff, 1998). Thus the electronic guidelines improved decision quality and physician-patients interaction significantly (Hsu et al, 2005).…”