The Centers for Disease Control and Prevention has led a multi-party initiative to redesign clinical guideline development and implementation for the digital age.
These new standards, processes and tools are designed to be more efficient than traditional approaches and are expected to increase adoption of new guidelines, reduce time to implementation, and facilitate timely updates.
Participants in the CDC-led initiative called Adapting Clinical Guidelines for the Digital Age (ACG) have authored a series of articles in a supplement to the American Journal of Medical Quality.
Besides the overview of the ACG initiative, the supplement includes articles on an integrated process for co-developing written and computable clinical practice guidelines (CPGs), an evaluation framework to assess the integrated process, and a description of the methods used within the ACG initiative to re-envision the guideline development and implementation process.
An HL7 FHIR standard for computable guidelines is incorporated throughout these articles.
Rebecca Bunnell, Ph.D., M.Ed., CDC chief science officer, says in her introductory editorial, "The articles in this supplement give readers road maps to reengineer, accelerate, and evaluate their guideline development and implementation processes and to use health information technology standards to deliver better and faster health care. Applying these concepts may help organizations better respond to health risks, diseases, and disparities."
Clinical practice guidelines are typically lengthy paper- or web-based publications, and clinicians commonly lack awareness of the new evidence. Computable CPGs are machine-readable and can be made readily available in healthcare organizations’ EHR systems. However, they are typically developed after the written guideline is published, which adds to the lag in adoption and does not allow for important clarifications in the language within the written guideline. Furthermore, guideline developers usually receive little to no feedback on the use of a CPG in practice or from healthcare providers and patients.
Beginning in 2018, the CDC launched ACG to re-engineer the production and implementation of CPGs using health information technology. One of the products of the initiative, a 12-phase integrated process for developing and implementing written and computable CPGs, includes multidisciplinary collaboration, working in parallel through an iterative process rather than sequentially, and early development of communication and evaluation plans so they are ready to launch at the time the guideline is published.
"New evidence should be able to be more quickly integrated into computable CPGs, fostering increased consistency and accurate implementation across health care organizations," the authors explain. "Further, the integrated process supports the integration of large-scale data from patients into computable CPGs. For example, the rapid cycle of knowledge gained during the COVID-19 pandemic is an example of the speed at which 'big data' from clinical practice, in combination with literature evidence, can inform computable CPGs."
The COVID-19 Digital Guideline Work Group, which included participants of the ACG initiative, applied the new computable guideline standard (“CPG-on-FHIR”) and an early version of the integrated process to rapidly develop a COVID-19 severity risk calculator to triage patients in the emergency department. This new approach may be well suited for organizations that maintain living guidelines due to its iterative and cyclical phases.
