Tool Support for Maintaining Clinical Guidelines: A Case Study

Clinical guideline development is a complex and time-consuming process. Authors involved in the development of clinical guidelines need appropriate software support to develop the guidelines and to publish them in a sufficiently formal and systematic way as the contents require constant maintenance through the lifetime of the guidelines. This paper presents the results of a case study performed on the process of maintaining national clinical guidelines in Norway. The aim of the case study is to identify challenges and issues the guideline authors face during the process of updating, especially with respect to information systems support. Eight selected authors from four different organizations involved in the process of authoring, disseminating, and updating the guidelines participated in the study. Semi-structured interviews were conducted to collect feedback about the provided information systems in their organizations. In addition, the subjects were observed during a normal workday while maintaining guidelines. Analysis of the results shows gaps and shortcomings in the present information systems. The information systems designed to support guideline authors are neither integrated in a desired way nor do they fulfil the users' needs in terms of functionality. Some observed deficits are: proper reference management systems, standardized terminologies, version controls, archiving systems, tracking of updates, and provisions of proper guideline templates. In addition, the lack of process support by the information systems forces additional external communication between different guideline authors. The case study results contribute to establishing a common understanding of requirements for designing an integrated guideline development infrastructure.