Background: Clinical practice guidelines (CPG) are a constructive response to the clinical situations providing systematically developed statements that include recommendations intended to optimize patient care. Despite their value, inadequate dissemination and implementation of the CPGs derail quality improvements in patient care. Traditionally, static documents (PDF, HTML pages) have been used to deliver CPGs incorporated into complex clinical situations to support physicians’ decision making, yet there still remain disparities in quality care measures of patient-centered care, patient safety, and effective treatment. In order to better engage physicians with standard care to improve patients’ outcomes, we have built a platform for interactive, computerized CPGs, which personalizes clinical contents to clinical situations. To enable clinical experts without technical expertise to write and maintain contents, we built an author-facing tool, which enables clinical experts without technical expertise to write the interactive clinical contents based on guidelines in the standardized Excel-like spreadsheet. We intended that the tool helps clinicians to make informed decisions rather than make passive decisions. This allows the clinicians to benefit from individualized education and eventually become independent of the electronic tools. We have applied the framework to the ACC/AHA Perioperative cardiovascular guideline.
Methods: We used Google App Script to build a spreadsheet-based tool (‘editing app’) for clinicians without programming skills to write and maintain the clinical contents on standardized Excel-like spreadsheets. Once the clinician authors write the contents on a spreadsheet, it is ‘translated’ into mobile applications. The user-facing app part was created by a team of clinicians and developers. The app communicates with health provider users with a conversational interface to specify the clinical circumstances and to aggregate the relevant subparts of guidelines. We conducted qualitative interviews with clinicians of different specialties on completed interactive guidelines.
Results: Five clinicians of different specialties including Internal Medicine, Pediatrics, and Urology without programming skills were able to test the editing tool by writing drafts of CPGs for various clinical problems under minimal supervision. Among different CPG modules, we chose a module of 2014 ACC/AHA perioperative cardiovascular guideline as the first primary target. In the setting of a patient’s individual medical history, current medications, functional status, the module was designed to walk through the history to aggregate relevant pieces of clinical knowledge to personalize recommendations and references to the users. It took 3 weeks to write the contents by a physician without technical expertise. The module has been appreciated by multiple clinical experts, and a formal study of compliance and usability of the module is planned to be conducted in near future. Our guideline framework may be applied to a vast array of clinical circumstances such as perioperative pulmonary risk, hypercholesterolemia guideline and others.
Conclusions: The smart guidelines interacts with users effectively providing them the most updated clinical information at the point of care. Furthermore, the clinicians may benefit from individualized education with the standard recommendations and references.