4 Steps to Best-In-Class Guideline Dissemination with Indico Solutions

Clinical Guidelines and Evidence Summaries are the key vehicles for advancing new medical treatments and decision considerations to clinicians at the point of care. More than CME content, clinical guidelines (scientific statements, position statements, etc.) represent the consensus interpretation of current evidence for subsequent clinical decision making. Without guidelines, clinicians would be required to read large volumes of empirical literature and decide upon potentially changing their guidance to patients without the benefit of their peer group assessment of the evidence. This is a task that is beyond the capacity of most busy clinicians given the ever-increasing preponderance and variability of evidence.

There are many organizations across most medical disciplines that have committed to developing high quality guidelines. This is an important prerequisite for implementation, going from empirical evidence to improved clinical care. Yet most guideline developers rely on a publication centric model of implementation, too often PDF based and unsuited for the point of care. Understandable, because   until recently, multichannel dissemination support was an expensive luxury. Indico changes that.

Creating a high-quality guideline is critical, however equally important is disseminating the guideline to its target audience in their preferred pathways. Indico Solutions has built a modern, multi-channel dissemination platform specifically for guideline developers to get their guidelines to the point of care.

Accessing guidelines through a journal experience (print or electronic) is rarely adequate for point of care decision making. The point of care conundrum, best illustrated by small screen mobile devices, is that clinicians need rapid display of potential best available evidence to the clinical situation they are facing. They simply do not have the time to find the right publication then read (or even text search) through dozens of pages to potentially find what they need – not to mention trying to do it on a small screen. The good news, getting your guidelines from journal publications/PDFs to the healthcare setting can be achieved easily and economically using the Indico Clinical Guidelines Platform.

There are four key steps to building your own Guideline Dissemination Library of which you only need to complete the first step. From there you provide Indico with your guideline content and Indico does the rest.

The first step, the most important, is undertaken by you, the guideline developer. In this stage after you’ve published your guideline, transmit it to Indico. We take these files (word or publisher XML files) as the basis for the remaining steps.

We have developed advanced importing tools that can parse content from Microsoft Word or from Journal XML files into a flexible structured database representation.

This importing process identifies and divides the content into its relevant

• Sections
• Recommendations
• References

All of these items are incorporated into our database so they can be managed in subsequent steps.  It is important that the content is divided into its component parts so clinicians do not have to skim through entire documents find relevant content.  Moving away from large PDF files and web pages is integral to dissemination in the healthcare setting. After the content is imported into the platform internal links are created in line with the original guideline intentions.

Figure 1. Guideline Content in the Indico Platform
1. Content broken into sections
2. Internal Guideline links

The system also allows for any collateral documents/files/links to be attached to the guideline. This collateral can include patient handouts, slide shows webinars and so on.

To improve searching of guidelines by both clinicians and EMR systems, metadata needs to be assigned and indexed for all the guideline sections and recommendations. Indico has developed proprietary technology to develop an ontology that reflects your specific keywords, abbreviations, acronyms and SNOMED terminology. This process is complicated as proper allocation of metadata needs to be able to manage synonyms in a broad sense and acronyms specific to the specialty.

Accounting for acronyms and abbreviations is an important part of this process as many guideline recommendations rely heavily on their use but are not necessarily consistent within and across guideline publications. Failing to account for this leads to a substandard user experience.

Figure 2. The Use of Acronyms and Abbreviations in Recommendation Development

After the metadata is mapped to the content it is ready to be published in the Indico Guideline Platform. The Indico Platform then disseminates the guideline content in its required forms to the pathways identified in step 4.

Indico supports three key dissemination pathways for your guidelines.  They are

1. Web pages
2. Android Play Store
3. iOS App Store

Step four involves releasing your content into all of your chosen pathways.