Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2017

Open Access 01-12-2017 | Research article

Reviewing clinical guideline development tools: features and characteristics

Authors: Soudabeh Khodambashi, Øystein Nytrø

Published in: BMC Medical Informatics and Decision Making | Issue 1/2017

Login to get access

Abstract

Background

To improve consistency and streamline development and publication of clinical guidelines (GL), there is a need for appropriate software support. We have found few specific tools for the actual authoring and maintaining of GLs, and correspondingly few analyses or reviews of GL development tool functionality. In order to assist GL developers in selecting and evaluating tools, this study tries to address the perceived gap by pursuing four goals: 1) identifying available tools, 2) reviewing a representative group of tools and their supported functionalities, 3) uncovering themes of features that the studied tools support, and 4) compare the selected tools with respect to the themes.

Methods

We conducted a literature search using PubMed and Google Scholar in order to find GL development tools (GDT). We also explored tools and Content Management Systems (CMS) used in representative organisations and international communities that develop and maintain GLs. By reading a selected representative group of five GL tool manuals, exploring tools hands-on, we uncovered 8 themes of features. All found tools were compared according to these themes in order to identify the level of functionality they offer to support the GL development and publishing process. In order to limit the scope, tools for designing computer-interpretable/executable GL are excluded.

Results

After finding 1552 published papers, contacting 7 organizations and international communities, we identified a total of 19 unique tools, of which 5 tools were selected as representative in this paper. We uncovered a total of 8 themes of features according to the identified functionalities that each tool provides. Four features were common among tools: Collaborative authoring process support, user access control, GL repository management, electronic publishing. We found that the GRADE methodology was supported by three of the reviewed tools, while only two tools support annotating GL with MeSH terms. We also identified that monitoring progress, reference management, Managing versions (version control), and Change control (tracking) were often the missing features.

Conclusion

The results can promote sector discussion and eventual agreement on important tool functionality. It may aid tool and GL developers towards more efficient, and effective, GL authoring.
Appendix
Available only for authorised users
Literature
1.
Jaspers MW, Smeulers M, Vermeulen H, Peute LW. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. J Am Med Inform Assoc. 2011;18(3):327–34.CrossRefPubMedPubMedCentral
2.
Merritt TA, Palmer D, Bergman DA, Shiono PH. Clinical practice guidelines in pediatric and newborn medicine: implications for their use in practice. Pediatrics. 1997;99(1):100–14.CrossRefPubMed
3.
Steinberg E, Greenfield S, Mancher M, Wolman DM, Graham R. Clinical practice guidelines we can trust.1st edition. US National Academies Press; 2011.
4.
5.
Khodambashi S, Nytrø Ø, editors. Tool Support for Maintaining Clinical Guidelines: A Case Study. ECIME2015-9th European Conference on IS Management and Evaluation: ECIME 2015; 2015: Academic Conferences and publishing limited.
6.
Kristiansen A, Brandt L, Alonso-Coello P, Agoritsas T, Akl EA, Conboy T, et al. Development of a novel multilayered presentation format for clinical practice guidelines. Chest. 2015;147:754–63
7.
Shiffman RN, Michel G, Rosenfeld RM, Davidson C. Building better guidelines with BRIDGE-wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability. J Am Med Inform Assoc. 2012;19(1):94–101.CrossRefPubMed
8.
Brozek J, Oxman A, Schünemann H. GRADEpro, version 3.2 for windows. 2012.
9.
Guyatt G, Vandvik PO. Creating clinical practice guidelines: problems and solutions. Chest. 2013;144(2):365–7.CrossRefPubMed
10.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral
11.
12.
Cruzes DS, Dyba T, editors. Recommended steps for thematic synthesis in software engineering. Empirical Software Engineering and Measurement (ESEM), 2011 International Symposium on; 2011: IEEE.
13.
Vandvik PO, Brandt L, Alonso-Coello P, Treweek S, Akl EA, Kristiansen A, et al. Creating clinical practice guidelines we can trust, use, and share: a new era is imminent. Chest. 2013;144(2):381–9.CrossRefPubMed
14.
Treweek S, Oxman AD, Alderson P, Bossuyt PM, Brandt L, Brożek J, et al. Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE): protocol and preliminary results. Implement Sci. 2013;8:6.CrossRefPubMedPubMedCentral
15.
Kristiansen A, Vandvik P, Alonso-Coello P, Rigau D, Brandt L, Guyatt G. 313WS electronic multilayered guideline format: a novel structure and presentation of trustworthy guidelines at the point of care. BMJ Qual Saf. 2013;22(Suppl 1):A9–A10.CrossRef
16.
Brozek J, Akl E, Falck-Ytter Y, Kunstman P, Meerpohl J, Mustafa R, et al. P307 guideline development tool (GDT)–web-based solution for guideline developers and authors of systematic reviews. BMJ Qual Saf. 2013;22(Suppl 1):82.CrossRef
17.
Brozek J, Akl E, Falck-Ytter Y, Kunstman P, Meerpohl J, Mustafa R, et al. 046 guideline development tool (GDT)–web-based solution for guideline developers and authors of systematic reviews. BMJ Qual Saf. 2013;22(Suppl 1):A26-A.CrossRef
18.
19.
Höhne W, Karge T, Siegmund B, Preiss J, Hoffmann J, Zeitz M, et al. An internet portal for the development of clinical practice guidelines. Appl Clin Inform. 2010;1(4):430.CrossRefPubMedPubMedCentral
20.
Höhne W, Karge T, Siegmund B, Preiss J, Hoffmann J, Zeitz M, et al. An internet portal for the development of clinical practice guidelines. Appl Clin Inf. 2010;1:430–41. http://​dx.​doi.​org/​10.​4338/​ACI-2010-04-RA-0027.​ For personal or educational use only. aci-journal org. 2015:12-01CrossRef
21.
Peleg M. Computer-interpretable clinical guidelines: a methodological review. J Biomed Inform. 2013;46(4):744–63.CrossRefPubMed
22.
23.
24.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.CrossRefPubMed
25.
26.
27.
28.
Elmagarmid A FZ, Hammady H, Ilyas I, Khabsa M, Ouzzani M. Rayyan: a systematic reviews web app for exploring and filtering searches for eligible studies for Cochrane Reviews. 2014 21–26 Sep.
29.
Institute JB. Joanna Briggs Institute system for the unified management, assessment and review of information (JBI SUMARI). 2014.
30.
31.
32.
33.
Babineau J. Product review: covidence (systematic review software). J Can Health Libr Assoc. 2014;35(2):68–71.CrossRef
34.
Rada G, Pérez D, Capurro D, editors. Epistemonikos: a free, relational, collaborative, multilingual database of health evidence. Medinfo IMIA and IOS Press; 2013.
35.
Rathbone J, Hoffmann T, Glasziou P. Faster title and abstract screening? Evaluating Abstrackr, a semi-automated online screening program for systematic reviewers. Syst Rev. 2015;4(1):1.CrossRef
36.
37.
Rathbone J, Carter M, Hoffmann T, Glasziou P. Better duplicate detection for systematic reviewers: evaluation of systematic review assistant-Deduplication module. Syst Rev. 2015;4(1):1–6. 10.​1186/​2046-4053-4-6.CrossRef
38.
39.
Brozek J, Oxman A, Schünemann H. GRADEpro.[computer program]. Version 32 for windows. 2008.
40.
Khodambashi S, Gilstad H, Nytrø Ø. Usability evaluation of clinical guidelines on the web using eye-tracker. Stud Health Technol Inform. 2016;228:95.PubMed
41.
Khodambashi S, Nytrø Ø, editors. Usability Evaluation of Published Clinical guidelines on the Web: A Case Study. 2016 IEEE 29th International Symposium on Computer-Based Medical Systems (CBMS); 2016: IEEE Conference Publicationsm. doi:10.​1109/​CBMS.​2016.​11.
42.
Khodambashi S, Wang Z, Nytrø Ø. Reality versus user's perception in finding answer to clinical questions in published National Guidelines on the web: an empirical study. Procedia Comput Sci. 2015;63:268–75.CrossRef
43.
Khodambashi S, Perry A, Nytrø Ø. Comparing user experiences on the search-based and content-based recommendation ranking on stroke clinical guidelines-a case study. Procedia Comput Sci. 2015;63:260–7.CrossRef
44.
Khodambashi S, Gilstad H, Nytrø Ø. Usability evaluation of clinical guidelines on the web using eye-tracker. Medical informatics Europe (MIE 2016); 2016: Accepted, under publishing process.
45.
Peleg M, Tu S, Bury J, Ciccarese P, Fox J, Greenes RA, et al. Comparing computer-interpretable guideline models: a case-study approach. J Am Med Inform Assoc. 2003;10(1):52–68.CrossRefPubMedPubMedCentral
46.
De Clercq PA, Blom JA, Korsten HH, Hasman A. Approaches for creating computer-interpretable guidelines that facilitate decision support. Artif Intell Med. 2004;31(1):1–27.CrossRefPubMed
47.
48.
49.
Qaseem A, Forland F, Macbeth F, OllenschlÃĪger G, Phillips S, van der Wees P. Guidelines international network: toward international standards for clinical practice guidelines. Ann Intern Med. 2012;156(7):525–31.CrossRefPubMed
50.
Terrace L. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care. 2003;12:18–23.CrossRef
51.
52.
WHO. WHO Handbook for Guideline Development: World Health Organization; 2012 2012.
53.
54.
55.
56.
West SL, King V, Carey TS, Lohr KN, McKoy N, Sutton SF, et al. Systems to rate the strength of scientific evidence: Agency for Healthcare Research and Quality, US Department of Health and Human Services; AHRQ Publication No. 02-E016 April 2002.
57.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.CrossRefPubMedPubMedCentral
58.
Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest. 2006;129(1):174–81.CrossRefPubMed
59.
60.
Shiffman RN, Michel G, Krauthammer M, Fuchs NE, Kaljurand K, Kuhn T. Writing clinical practice guidelines in controlled natural language. Controlled Natural Language: Springer; 2010. p. 265-280.
61.
Organization WH. International statistical classification of diseases and health related problems (The) ICD-10: World Health Organization; 2004.
62.
63.
Miller G, Britt H. A new drug classification for computer systems: the ATC extension code. Int J Biomed Comput. 1995;40(2):121–4.CrossRefPubMed
64.
Liu S, Ma W, Moore R, Ganesan V, Nelson S. RxNorm: prescription for electronic drug information exchange. IT Prof. 2005;7(5):17–23.CrossRef
65.
Nelson SJ, Johnston WD, Humphreys BL. Relationships in medical subject headings (MeSH). Relationships in the Organization of Knowledge: Springer; 2001. p. 171-184.
66.
67.
McDonald CJ, Huff SM, Suico JG, Hill G, Leavelle D, Aller R, et al. LOINC, a universal standard for identifying laboratory observations: a 5-year update. Clin Chem. 2003;49(4):624–33.CrossRefPubMed
68.
Lindberg DA, Humphreys BL, McCray AT. The unified medical language system. Methods Inf Med. 1993;32(4):281–91.PubMed
69.
70.
Beale T, Heard S, Kalra D, Lloyd D. OpenEHR architecture overview. The OpenEHR Foundation. 2006.
Metadata
Title
Reviewing clinical guideline development tools: features and characteristics
Authors
Soudabeh Khodambashi
Øystein Nytrø
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2017
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-017-0530-5

Other articles of this Issue 1/2017

BMC Medical Informatics and Decision Making 1/2017 Go to the issue

Research article

Identifying incident colorectal and lung cancer cases in health service utilisation databases in Australia: a validation study

Research article

EsPRit: ethics committee proposals for Long Term Medical Data Registries in rapidly evolving research fields - a future-proof best practice approach

Erratum

Erratum to: Multiscalar cellular automaton simulates in-vivo tumour-stroma patterns calibrated from in-vitro assay data

Research article

Involving members of vulnerable populations in the development of patient decision aids: a mixed methods sequential explanatory study

Research article

Routine health information system utilization and factors associated thereof among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia

Research article

Health care public reporting utilization – user clusters, web trails, and usage barriers on Germany’s public reporting portal Weisse-Liste.de