September 6, 2023 — Novel standards, processes, and tools to redesign guideline development and implementation, pioneered through a multi-partner initiative led by the Centers for Disease Control and Prevention (CDC), 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, published in the Lippincott portfolio by Wolters Kluwer.
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. A new standard for computable guidelines is incorporated throughout these articles and vetted and published through Health Level 7®, an international standards development organization.
Rebecca Bunnell, PhD, MEd, 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."
CPGs 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 and or from healthcare providers and patients.
New integrated process and computable guideline standards address the challenges of guideline uptake and adherence
Beginning in 2018, the CDC launched ACG to reengineer 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.
A Call to Action: Using ACG's Approach to Improve Clinical Guidance
Guideline development organizations have a game-changing opportunity to enhance the uptake of clinical guidance by implementing the standards, processes, and tools developed through the ACG initiative. Despite the existing hurdles, it's clear that applying the ACG products to more guideline development and implementation efforts is a crucial next step. The goal is to achieve a seamless, efficient, accurate, and consistent translation and adoption of evidence-based guidelines in patient care. Read how in the "Adapting Clinical Guidelines for the Digital Age" special issue:
Modernizing Guidelines Development to Speed the Transfer of Science to Patient Care
CDC Leadership Commentary about the ACG initiative and its importance in patient care and outcomes.
Introduces the articles in the journal supplement.
Adapting Clinical Guidelines for the Digital Age: A Holistic and Multidisciplinary Approach
An overarching summary of the ACG initiative.
Details on the use of a multidisciplinary, multi-organizational holistic approach that produced interrelated standards, processes, and tools.
Details a new integrated process model for iterative co-development of written and computable guidelines, early integration of implementation and testing, communication and dissemination strategies, and evaluation.
An Evaluation Framework for a Novel Process to Co-develop Written and Computable Guidelines
Details a framework and tool to evaluate the integrated process across phases in terms of process, product, and outcome.
Details the adaptations made to the Kaizen method – part of Lean methodology – to support complex, multidisciplinary processes that involve multiple organizations using the ACG initiative to illustrate its application.
Kaizen is a Japanese philosophy for continuous improvement.
Read Supplement Here
