Reviewing clinical guideline development tools: features and characteristics.

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.

The development and feasibility of a personal health-optimization system for people with bipolar disorder.

BACKGROUND: People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies. METHODS: Based on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed. RESULTS: Seventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient's preferences. The mean ± SD (median) system usability score of the patient-oriented subsystem was 71 ± 18 (73). The mean ± SD (median) system usability score in the summative usability testing was 78 ± 18 (75), well above the norm score of 68. Feedback from the questionnaire was generally positive. Eighteen out of 23 components in the system are not required in international standards for patient decision aids and clinical practice guidelines. CONCLUSION: We have developed the first evidence-based health-optimization system enabling patients, clinicians, and caregivers to collaborate in optimizing the patient's health on a shared platform. User tests indicate that the feasibility of the system is acceptable.

A Systematic Literature Review on Evaluation of Digital Tools for Authoring Evidence-Based Clinical Guidelines.

To facilitate the clinical guideline (GL) development process, different groups of researchers have proposed tools that enable computer-supported tools for authoring and publishing GLs. In a previous study we interviewed GL authors in different Norwegian institutions and identified tool shortcomings. In this follow-up study our goal is to explore to what extent GL authoring tools have been evaluated by researchers, guideline organisations, or GL authors. This article presents results from a systematic literature review of evaluation (including usability) of GL authoring tools. A controlled database search and backward snow-balling were used to identify relevant articles. From the 12692 abstracts found, 188 papers were fully reviewed and 26 papers were identified as relevant. The GRADEPro tool has attracted some evaluation, however popular tools and platforms such as DECIDE, Doctor Evidence, JBI-SUMARI, G-I-N library have not been subject to specific evaluation from an authoring perspective. Therefore, we found that little attention was paid to the evaluation of the tools in general. We could not find any evaluation relevant to how tools integrate and support the complex GL development workflow. The results of this paper are highly relevant to GL authors, tool developers and GL publishing organisations in order to improve and control the GL development and maintenance process.

An Experimental Comparison of a Co-Design Visualizing Personal Drug Information and Patient Information Leaflets: Usability Aspects.

Providing patients with specific information about their own drugs can reduce unintentional misuse and improve compliance. Searching for information is time-consuming when information is not personalized and is written using medical vocabulary that is difficult for patients to understand. In this study we explored patient information needs regarding visualizing of drug information and interrelationships by conducting a total of four co-design workshops with patients, other users and pharmacists. We developed a prototype and drug ontology to support reasoning about drug interactions. We evaluated individual performance in finding information, understanding the drug interactions, and learning from the provided information in the prototype compared to using patient information leaflets (PILs). We concluded that interactive visualization of drug information helps individuals find information about drugs, their side effects and interactions more quickly and correctly compared to using PILs. Our study is limited to co-morbid patients with transient ischaemic attack with several chronic diseases.

Usability Evaluation of Clinical Guidelines on the Web Using Eye-Tracker.

Publishing clinical guidelines (GLs) on the web increases their accessibility. However, evaluating their usability and understanding how users interact with the websites has been neglected. In this study we used Tobii eye-tracker to analyse users' interaction with five commercial and public GL sites popular in Norway (four in Norwegian and one English of US origin (UpToDate)). We measured number of clicks and usage rate for search functions, task completion time, users' objective and perception of task success rate. We also measured learning effect for inexperienced users. We found a direct correlation between participant's satisfaction regarding website usability and the time spent, number of mouse clicks and use of search function to obtain the desired results. Our study showed that users' perceived success rate was not reliable and GL publishers should evaluate their website regarding presentation format, layout, navigation bar and search function.

Computer-Interpretable Clinical Guidelines: A Review and Analysis of Evaluation Criteria for Authoring Methods.

There are a variety of authoring tools and methods for producing computer-interpretable clinical guideline (CIG). This work is a review of the evaluation of tools and methods currently in use to author CIGs. The aim of this paper is to present the results of a literature review on the evaluation criteria. Both controlled database search and a subsequent snowballing were used to identify relevant literature. The evaluation criteria and evaluation methods of CIG-related themes were manually identified in the found literature. Based on the 32 relevant papers found, 68 evaluation criteria were identified which were then classified into ten themes. We identified the most and least frequently mentioned areas of concern in evaluation which indicate areas that have been neglected in system evaluation.

Lessons Learnt from Evaluation of Computer Interpretable Clinical Guidelines Tools and Methods: Literature Review.

Representation of clinical guidelines in a computer interpretable format is an active area of research. Various methods and tools have been proposed which have been evaluated based on different evaluation criteria. The evaluation results in the literature and their lessons learnt can be a valuable learning resource in order to redesign and improve the tools. Therefore, this research investigates the lessons learnt from the evaluation studies. Broad search in literature together with a purposeful snowball method were performed to identify the related papers that report any type of evaluation or comparison. We reviewed and analysed the lessons learnt from the evaluation results and classified them into 17 themes which reflect the suggestion concerns. The results indicate that the lessons learnt are more focused on tool functionalities, integration, sharing and maintenance domain. We provide suggestions for the area which had less attention.

Filling the gap between guideline development and formalization process - a requirement analysis.

Clinical guidelines are made to aid diagnosis, management and treatment of patients. Authoring, publishing, updating and maintaining clinical guidelines are time-consuming, labour-intensive and complex. Unfortunately, it is time-consuming to search and retrieve patient-specific recommendations in free-text documents. Literature is rich with methods proposed to support encoding of clinical guidelines into computer-interpretable formats (CIG). However, there is a lack of studies covering the actual guideline development and authoring. So, the objective of this research is to explore gap between tools and methods for authoring guideline content and for designing and implementing computer-interpretable guidelines. Towards this objective, we have performed a user requirements analysis to arrive at a set of design recommendations. The resulting functionality framework can be used to design and develop authoring tools for the entire life-cycle of the computerized clinical guideline.

Evaluation of the clinical process in a critical care information system using the Lean method: a case study.

BACKGROUND: There are numerous applications for Health Information Systems (HIS) that support specific tasks in the clinical workflow. The Lean method has been used increasingly to optimize clinical workflows, by removing waste and shortening the delivery cycle time. There are a limited number of studies on Lean applications related to HIS. Therefore, we applied the Lean method to evaluate the clinical processes related to HIS, in order to evaluate its efficiency in removing waste and optimizing the process flow. This paper presents the evaluation findings of these clinical processes, with regards to a critical care information system (CCIS), known as IntelliVue Clinical Information Portfolio (ICIP), and recommends solutions to the problems that were identified during the study. METHODS: We conducted a case study under actual clinical settings, to investigate how the Lean method can be used to improve the clinical process. We used observations, interviews, and document analysis, to achieve our stated goal. We also applied two tools from the Lean methodology, namely the Value Stream Mapping and the A3 problem-solving tools. We used eVSM software to plot the Value Stream Map and A3 reports. RESULTS: We identified a number of problems related to inefficiency and waste in the clinical process, and proposed an improved process model. CONCLUSIONS: The case study findings show that the Value Stream Mapping and the A3 reports can be used as tools to identify waste and integrate the process steps more efficiently. We also proposed a standardized and improved clinical process model and suggested an integrated information system that combines database and software applications to reduce waste and data redundancy.