Research and Tools
Frameworks, methodologies and technological
solutions for GRADE guidelines
Platforms for guidelines and point of care resources
Among several initiatives and platforms used to create and disseminate guidelines to users point of care is the MAGIC Authoring and Publication Platform (MAGICapp). MAGICapp represents a web-based platform that allows digital and structured authoring, dissemination and dynamic updating of evidence summaries, recommendations and decision aids.
The PICO linked data model applied in MAGICapp breaks down the concept of a guideline document into discrete elements of content. This way of digitally structuring data allows content to be published in multilayered and flexible formats, usable on all devices and facilitates adaptation and dynamic updating of individual recommendations in a living guideline model. The linked data structure - combined with a coding module for annotating PICO questions and recommendations with terms from various structured terminologies and making the data available through an API – allows for connections (EHR, other platforms), re-use and sharing of data across the Ecosystem.
The Digital and Trustworthy Evidence Ecosystem
Despite globally recognized advances in research methods and systems for evidence-based health care, society faces challenges in delivering high quality and evidence-based health care to patients. Contributing to these challenges are an exponential growth of published research of limited value for society, combined with an epidemic of overdiagnosis and overtreatment - as well as underuse of effective interventions. Such insights have resulted in international calls and initiatives to increase value and reduce waste in research and health care.
Clinical practice guidelines, aiming to provide guidance based on best current evidence about patient management, represent key information resources for health care professionals. Some however, call for "a post-guidelines era" in health care, given well recognized problems and limitations, including how guidelines fail to provide timely information at the point of care. In an era where digitally structured data and the internet have revolutionized access to information "anywhere, anytime, on any device", the health care sector seems to lag behind.
Enhancing the evidence ecosystem
This case study demonstrates feasibility of more efficient evidence synthesis and dissemination while adhering to the highest standards of trustworthiness, within the Evidence Ecosystem. In this case study we looked at innovations concerning increased patient involvement, stringent conflict of interest management, new medical publishing processes and new formats.
The case study also highlights limitations in making the Ecosystem work fully, with the critical steps of successful implementation and improvement of care remaining unanswered. The facilitation of rapid change in practice is itself a daunting challenge. Potential obstacles for practice-change in this case include cardiologists reluctant to change practice before the local protocols or the international guidelines on which they usually rely upon change, heart surgeons’ reluctance to lose a group of patients on whom they are used to operate, and a paucity of leadership in applying best current evidence in hospital programs.
