Using clinical guidelines in an eLearning context

1. Using clinical guidelines in an eLearning context Josep Blat, Ayman Moghnieh, Toni Navarrete, José Luis Santos (Universitat Pompeu Fabra) Francis Casado (Fundació Barcelona Media) TENCompetence Open Workshop on Service Oriented Approaches and Lifelong Competence Development Infrastructures Manchester, 11th-12th January, 2007

2. Introducing Clinical guidelines • Definition: “Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” (Institute of Medicine, 1990) • Other common names: • medical guidelines • clinical practice guidelines • clinical protocols

3. Introducing Clinical guidelines • A clinical guideline addresses a specific medical problem, at one or more stages (prevention, diagnosis, therapy,…) • It summarises consensus information related to the medical problem, and • It provides a protocol of decisions and actions to be taken. Examples of actions: • Specific clinical tests to be carried out • Specific medications

4. Example of a guideline algorithm Example taken from the Clinical guideline for the prevention of colorectal cancer (Asociación Española de Gastroenterología, Sociedad Española de Medicina de Familia y Comunitaria, Centro Cochrane Iberoamericano)

5. Publishing guidelines • There exist repositories of guidelines, mainly at the national level • National Guideline Clearinghouse (NGC), USA, more than 2,000 guidelines: http://www.guideline.gov • Guidelines published in unstructured way (PDF or similar) • Different schemas have been developed to model guidelines • GLIF: the most complete and widespread

6. Running clinical guidelines • Currently developing a tool for enabling family doctors to run the guideline for the prevention of colorectal cancer • A subset of GLIF have been selected to model the guideline, comprising: • Elements related to the decision workflow • Elements related to didactic materials (that can be associated to the overall guideline or to specific sections) • A Java library for managing our subset of GLIF is being developed • It will be the base for the “Guideline execution engine”

7. Running clinical guidelines

8. Running clinical guidelines

9. Clinical guidelines in an eLearning context • Objectives of clinical guidelines: • To standardize medical care, improving quality and reducing risks • To improve efficiency and to reduce costs • Valuable tool in the education of medical professionals and patients • Studies show that practice-based education through guidelines and decision support systems improve the detection of diseases

10. Clinical guidelines in an eLearning context • Medical students and professionals can learn from clinical guidelines: • “Theory”: guidelines contain a systematic review of the scientific evidence related to a specific medical problem • Application to practice: guidelines determine the decisions to be taken in each situation • Execution of guidelines with real patients’ data • Guidelines also provide helpful information for patients that want to be informed on their situation

11. Four scenarios where guidelines are used in an eLearning context

12. Scenario 1 • A Medicine degree student registers the subject “Gastroenterology”, which has an eLearning module based on clinical guidelines • She has to analyse the scientific evidence related to each guideline • She has to study the corresponding decision workflows • She will put these concepts into practice through solving specific cases with real patients’ data • She will communicate with other peers in order to share advice and ask for support • Example of using guidelines and their executions in the context of formal learning. Communication is an important issue here too

13. Scenario 2 • A person is suffering from syndromes that might be related to colorectal cancer • Her doctor recommends her to use an interactive clinical guideline as part of a learning program dedicated to the patients under colorectal cancer diagnosis • The system fills the patient’s copy of the clinical guideline with a part of the information in her doctor’s copy • The system simplifies medical matters in order to make the process understandable by non-medical persons • Example of customization of the information and its visualisation

14. Scenario 3 • A family doctor is trying to diagnose a patient with unfamiliar set of symptoms in order to prevent the development of colorectal cancer • He uses an online eLearning and knowledge sharing system through which he can maintain relationships with other doctors and solicit support • The system uses clinical guidelines, as well as a repository of real patient’s executions • Colleagues can respond to questions from peers quickly and efficiently without having to spend a lot of time of studying the relevant case. • Example of using guidelines as the base of a learning community

15. Scenario 4 • A doctor has got a new job position and needs to refresh his knowledge about gastroenterology • He uses an interactive clinical guideline designed to simulate the diagnosis and prevention measures associated with real cases • By trial and error, he is able to recuperate and update his skills in the area of gastroenterology in a short period of time without taking classes or training courses • Example of a process of refreshing memory in a context of informal learning

16. Conclusions • Clinical guidelines can be used in the context of formal and informal learning • In the case of medical professionals, it is a good example of lifelong learning based on competences acquisition

17. Future work • Definition of a business pilot that uses clinical guidelines and their executions in the TenCompetence client • Definition of a repository containing clinical guidelines, as well as executions of real patients • Development of a middleware to enable the communication between the TENCompetence client and the repository and engine

18. Proposed architecture

19. Thanks for your attention