Clinical practice guidelines have been a staple in the medical community for the past three decades and there are thousands of current guidelines available for various topics in the United States alone. The process for developing, disseminating and implementing guidelines has evolved substantially since the first guideline was published over 30 years ago. How will this process continue to change over the next five to ten years and what trends are set to affect it?
The Trend: Living Guidelines
There is an extremely long development cycle required for each new clinical guideline, and it’s not unusual for it to take 2-3 years to publish from start to finish. Because of this, guidelines can become somewhat “outdated” by the time it publishes. Guideline authoring organizations are keenly aware of this, and as a result, have begun dabbling into a new practice known as “living guidelines”. The idea is that the guideline development process is continual and that any time something new or groundbreaking happens within the topic (e.g. new medication approval), there is a focused review done quickly to update the recommendations.
Some of the more prominent organizations to adopt the living guideline method include IDSA/AASLD (Hepatitis C Guidance), DHHS (Antiretroviral Agents for HIV-1), and more recently, the ADA (Diabetes Mellitus Standards of Care). While the concept of living guidelines is not without controversy, you can expect to see this trend not only continue, but expand in the years to come.
The Trend: Growth and Separation of Clinical Guidelines vs. Consensus Statements
Increased emphasis on meeting the 2011 IOM Standards (now, National Academy of Medicine) has caused a bit of a rift in the guideline developer community. On one hand, most developers understand the importance of these standards. The idea is to create a framework that allows for those in the healthcare community to separate the high-quality trustworthy guidelines from the rest of the pack. On the flip side, these same standards have also lead to a dramatic reduction in the number of guidelines published each year. While that in itself isn’t inherently a bad thing, the reduction in quantity can mainly be attributed to the fact that compliance with these standards has added significant time and cost to the guideline development process.
One of the biggest challenges over the next five to ten years will be balancing the perceived needs of “high quality”, and quantity. Expect to see more and more guideline developing organizations publish two types of documents on each topic – a clinical practice guideline and a consensus statement or best practices document. The guideline will attempt to adhere to the NAM standards, while the consensus statement will be less evidence, more “best practice”, and aim to fill the gap where we do not have enough information to create a true guideline.
The Trend: Computable Guidelines and Clinical Decision Support in EHRs
One of the most important factors in determining clinician adherence to guidelines is the availability of said guidelines. Drilling down even further, one of the largest factors in determining availability is the level of integration into the clinical workflow. EHRs are an integral part of most clinical workflows, and as such, incorporating guidelines into EHRs represents the next frontier of guideline implementation. There are varying levels of EHR integration. It could be as simple as embedding links to guidelines within the EHR or using info buttons, or as complicated as using the guidelines within a clinical-decision support (CDS) application. This CDS application could use patient data to return a list of possible guideline recommendations, each weighted by strength and relevancy.
Guideline Central is actually one of the companies hard at work at creating a simplified, standardized system for integrating computable guidelines into EHRs, and this is definitely an area to keep an eye on over the coming years.
In future blog posts, we will be drilling down on each of the above topics in more detail. Do you have specific questions about any of the trends above? Or do you think we forgot any major trends that will shape the future of clinical guidelines over the next five to ten years? If so, feel free to email us your thoughts and questions, and stay tuned to more frequent posts on these topics and more.