Clinical Guidelines for the Digital Age
Adapting Clinical Guidelines for the Digital Age (ACG) was an initiative led by the Centers for Disease Control and Prevention (CDC) to improve patient care and health outcomes by ensuring that evidence-based guidance is easily accessible, and any translation is consistent with the guidelines.
The ultimate goal of ACG is seamless, quick, accurate, and consistent translation and adoption of evidence-based guidelines into patient care.
ACG considers the implementation of computable clinical guidelines for use in Clinical Decision Support (CDS) and electronic clinical quality measures (eCQMs) during guideline development and uses Fast Healthcare Interoperability Resources® (FHIR®)-based technical standards known as CPG-on-FHIR®. “A foundational tenet of CPG-on-FHIR® approach is the concept of one faithful representation of the written guideline in computable format (i.e., the computable guideline) with many ways to implement it.” Michaels, M. (2023). Adapting Clinical Guidelines for the Digital Age: Summary of a Holistic and Multidisciplinary Approach. American Journal of Healthcare Quality 38, 5, S3-11
One translation
Many Ways to Implement
ACG provides several benefits and better ways to translate critical information into digital approaches or products including speeding up application dissemination and translation facilitation; and enhances connection with patient care.
Adapted from: https://hl7.org/fhir/uv/cpg/documentation-approach-03-conformance-levels.html
Centers for Disease Control and Prevention lead an initiative connecting experts and solutions to help ensure the most up-to-date scientific evidence is followed by providers of health care and results in desired outcomes. Connecting research and evidence swiftly and accurately to those who need it most, including clinicians and patients, can help save lives. The initiative included three high-level steps:
- Multi-interested party Kaizen event, hosted by CDC in early February 2018, identifying how clinical guidelines can be better adapted for implementation in a digital age and kicking off a multi-interested party effort to redesign the process and establish standards for “computable guidelines”
- Post-Kaizen implementation period where the future state process developed during the Kaizen event is tested by interested parties and refined as it is applied to select “pilot” guidelines
- Publication and socialization of the resulting standardized process to share knowledge gained from the piloting and work towards scaling across the industry to help the scientific evidence in clinical guidelines reach patient care more easily, quickly, accurately, and consistently - beginning with a Fast Healthcare Interoperability Resources (FHIR®) Implementation Guide for computable guidelines (balloted at Health Level Seven International® (HL7®) in September 2019 and January 2024)
Adapting Clinical Guidelines for the Digital Age - American Journal of Medical Quality featured supplement including:
- Commentary: Modernizing Guidelines Development to Speed the Transfer of Science to Patient Care
- Adapting Clinical Guidelines for the Digital Age: Summary of a Holistic and Multidisciplinary Approach
- An Integrated Process for Co-Developing and Implementing Written and Computable Clinical Practice Guidelines
- An Evaluation Framework for a Novel Process to Codevelop Written and Computable Guidelines
- Adapted Kaizen: Multi-Organizational Complex Process Redesign for Adapting Clinical Guidelines for the Digital Age
The standards developed and used through Adapting Clinical Guidelines for the Digital Age support the clinical quality ecosystem by considering the entire learning health system. A computable guideline developed using CPG-on-FHIR® can be modularly reconfigured into multiple types of derivatives, such as CDS and eCQMs. In other words, the computable guidelines that represent a faithful translation of the evidence-based guidelines in computable form can be rearranged like Lego blocks into different ways to support patient care, such as supporting shared decision-making at the point of care through CDS or measuring patient outcomes through eCQMs.
Current standards: