Adapting Clinical Guidelines for the Digital Age

Diagram of HL7 implementation guide for the representation of clinical practice guideline recommendations in FHIR (“CPG-on-FHIR”)

Connecting CDC research and evidence swiftly and accurately to those who need it most, including clinicians and patients, can help save lives.

This matters more than ever. As the role of public health in our nation’s health care system is broadening and overlapping, we now have more connectivity than ever before.

CDC, through the Deputy Director for Public Health Science and Surveillance, is leading an initiative called “Adapting Clinical Guidelines for the Digital Age.” This enterprise-wide approach is working strategically to connect experts and solutions that can help ensure our most up-to-date scientific evidence is followed and results in desired outcomes.  This initiative developed out of an agency-wide workgroup formed in 2016, and focuses specifically on improving the transmission of clinical guidelines by finding better ways to translate critical information into digital approaches or products.

Better Connection to Patient Care

“You can’t influence clinical practice to have public health impact if clinicians aren’t adhering to our guidelines”

Chesley Richards, MD, MPH, FACP, CDC Deputy Director for Public Health Science and Surveillance

Many CDC programs, directly or in partnership with other organizations, develop clinical guidelines, recommendations, or best practices, which serve as evidence-based disease-specific “maps” for clinical practice.

CDC guidelines lead to many healthcare improvements—from faster adoption of discoveries from outbreaks, to greater clarity in screening for cancer and chronic diseases, to setting immunization standards.

Despite our guidelines’ utility, CDC programs that track effectiveness have found that there are a variety of barriers to the implementation of this critical information—including the way information is transmitted.

We must do better. The Adapting Clinical Guidelines for the Digital Age initiative is part of CDC’s ongoing efforts to help ensure that guideline information isn’t just scientifically accurate, but gets in the right hands at the right time.

Lost in Translation

Although clinical guidelines are intended for providers to review, providers need something easy to use when it comes to guidelines. But making things easier to use can create an opportunity for information to be incorrectly condensed or translated. Instead, electronic health record (EHR) vendors, third party app or content developers, and IT teams at health systems translate the information in the guidelines into a format that can be harnessed as Clinical Decision Support (CDS).

What often happens during this transition is similar to the age-old game of telephone: different actors interpret and then pass along information with a slightly or greatly varied understanding. Complex messages and nuanced information erode with each transition of the guideline, losing the clarity of the initial guidance and leading to reduced adherence and potential medical errors.

What is Clinical Decision Support?

CDS is a tool for enhancing health-related decisions and actions by patients, providers and others to improve health and care delivery. CDS interventions draw from a rich palette of options that ideally make the right thing to do easy. Examples include highlighting care needs (such as for disease screening and management) in individuals and populations through dashboards and registry reports, as well as addressing those needs through evidence-based order sets and judicious use of notifications tied to appropriate action.

If clinical guideline translation is improved, health can be improved. The goal of CDS is to simplify and tailor medical information for clinicians to make it easier to diagnose and treat each patient.

Finding What Works

To make sure our information gets to the right people at the right time in the clearest, most useful way, we need strategies, experience, and champions working together to overcome the telephone game roadblocks in place.

The CDC’s Clinical Decision Support workgroup, initiated by the Office of Public Health Scientific Services, with representation throughout the agency, was started in 2016 to help standardize and improve our approach to clinical decision support. Feedback from stakeholders reveals that CDCs biggest value-add in the industry would be to help the guidelines more easily translate into digital products used in patient care settings. Based on these findings, the workgroup is developing an agency-wide strategy to help get CDC’s evidence-based guidance quickly, accurately, and consistently into patient care.

To help get a better understanding of how potential changes might impact stakeholders, the workgroup is planning a multi-stakeholder event in February 2018 that will bring together groups involved in different phases of guideline implementation and use.

Start of the Multi-Stakeholder Initiative, February 2018

The week-long “Adapting Clinical Guideline for the Digital Age” meeting gathered stakeholders responsible for different stages of guideline use, dissemination, and adoption in order to get an overall picture of how each part of the process works.

More detailed meeting information can be found on the meeting page.

Page last reviewed: March 6, 2020
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