logotype

Living Guidelines 2.0

 

Background

The German health care system underlies various trends such as a continuous growth of knowledge, rapid technological developments and demographic aging. Clinics face the challenge to balance economical optimisation attempts and demanding care- and quality requirements. The complementary concepts of Clinical Practice Guidelines (CPGs) and Clinical Pathways need to keep up with these changed requirements. Improvable aspects of the current practice can be summarised as follows:

Guideline Development & Updating
  • Time- and personnel-intensive processes
  • Delayed transfer of up-to-date research findings to practice
  • No appropriate IT-support
Guideline Dissemination
  • Passive provision via databases of the respective associations
  • Proactive search by the individual physician (pull-principle)
  • Prose description, tables and graphic algorithms in one file
Implementation
  • Individual, inadequately supported development of Clinical Pathways
  • Not premeditated during the guidelines development process
Quality of Care
  • No general integration and assessment of guideline-based quality indicators (exception: oncological guidelines)
  • Weak empirical evidence
  • No compliance check with regard to guidelines

 

Clinical Practice Guidelines have not yet become part of physicians everyday life as the editors wish for [1].   Providing Clinical Practice Guidelines via internet and journals is not enough [2].

 

Vision

The Vision of Living Guidelines addresses the deficit of a quick and continuous updating process for Clinical Practice Guidelines. However, this current understanding only focuses on the steps of guideline development, updating and dissemination. The vision of Living Guidelines 2.0 broadens this narrow view by taking the stated potentials for improvement into account [4].

The goal is to ensure a guideline-adequate and quality assured health provision. Therefore, the concept of Living Guidelines 2.0 aims at a comprehensive integration and support of all steps in the guideline lifecycle.

 

Implications for R&D

  1. Content-based modularisation of Clinical Practice Guidelines
  2. IT-based Guideline-Management-System to support the development, maintenance and analysis of CPGs [3]
  3. Evaluation and enhancement of existing methods for the guideline-based development of Clinical Pathways
  4. Evaluation and further development of modelling languages for Clinical Pathways
  5. Method for the integration of guideline-based quality indicators into Clinical Pathways
  6. Development and integration of IT-modules to analyse health care data (considering privacy policy)

 

A Project Initiative by
TU Dresden, Chair of Wirtschaftsinformatik, esp. Systems Development
Deutsche Krebsgesellschaft e.V.
Frauenklinik Universitätsklinikum Erlangen

 


 

References:
[1] Kopp, I., 2011. Wie eine Leitlinie entsteht. Zeitschrift für Herz-, Thorax-und Gefäßchirurgie 25(4), pp. 217–223
[2] BMG, 2012. Nationaler Krebsplan. Available at: https://www.bundesgesundheitsministerium.de/fileadmin/dateien/Publikationen/Praevention/Broschueren/Broschuere_Nationaler_Krebsplan_-_Handlungsfelder__Ziele_und_Umsetzungsempfehlungen.pdf [Accessed September 24, 2013]
[3] Richter, Peggy; Frank, Markus; Schlieter, Hannes: Entwicklung eines Leitlinienmanagementsystems - Anforderungen und konzeptuelle Vorarbeiten. In: Proceeding der Multikonferenz Wirtschaftsinformatik (MKWI) 2016 Band II (2016), S. 679–69

[4] Beckmann, M.W.; Schlieter, H.; Richter, P.; Wesselmann, S.: Considerations on the Improved Integration of Medical Guidelines into Routine Clinical Practice - a Review and Concept Proposal. In: Zeitschrift Geburtshilfe und Frauenheilkunde 76 (2016), S. 369–376