Tool for electronic disclosure of guidelines

1. Introduction

Over the last two decades, hundreds of guidelines have been published in the Netherlands. For many topics, evidence-based guidelines have become available. For quite a few topics, there are even multiple guidelines (monodisciplinary and multidisciplinary) that sometimes contradict each other. For professionals (and patients) it is therefore becoming increasingly difficult to keep abreast of all the guidelines and revisions. This means that there is sometimes much to be desired in the implementation of guidelines. There are also many derivative products, such as indicator sets, care standards, patient versions and decision aids.

The ongoing production of guidelines and revisions thereof requires requirements for findability. Increasingly, use is made of electronic databases, in which guidelines are classified according to a certain approach. In the Netherlands, there are now more than 10 such databases available on the internet. The structure of these databases varies from simple to advanced and the content, accessibility, functionality and topicality vary widely. At the same time, there are major differences in the ways in which the guidelines are presented and how specific details can be found in the guidelines themselves. Sometimes the same guidelines can also be found in different databases, although it is not always clear that they are the same guidelines. Not only the ‘findability’ but also the ‘searchability’ (including usability and applicability) of guidelines deserves attention. This tool focuses on improving these characteristics of electronic databases.

2. Definitions

The ‘findability of guidelines’ relates to the amount of time and number of steps that are required to find the desired guideline on a certain topic. The first search should return a list of relevant guidelines with as little ‘noise’ as possible (guidelines not relevant to the search). This is partially determined by the quality of the key words and the search capabilities.

The ‘searchability of guidelines’ relates to the time needed for the searcher/health care provider to get an answer to a specific question. This may relate to the content of the guideline and recommendations but also to the method and background information. For this purpose, the guideline should be clearly structured in a layered format with more depth in underlying layers (for example, recommendations, conclusion, evidence, other considerations and appendices with background information).

3. Objectives

This tool serves the following objectives:

  • Improving the findability of guidelines (planned, under development and completed) and
  • Improving the searchability of guidelines.

4. Findability

At this moment there is no central Dutch website where all the guidelines related to Dutch health care for a broad target group can be found. Recently the Quality Institute of the Dutch Health Care Insurance Board carried out a study on a National Register (Landelijk Register). This National Register contains all professional standards and will provide a wide health care overview. The databases that are available are often limited to a topic such as a condition or profession. Below is an overview of the characteristics of these databases in regard to guidelines.

Tabel 1. Beschikbare richtlijndatabases in Nederland

Database Initiator Target group Contents Public content? Availability Search function
Artsennet KNMG Doctors in NL
  • Guidelines
  • Protocols
  • Cooperation agreements for doctors
  • Consensus
Public: yes, but not everything Direct PDFs
Through other sites
  • Via doorlink naar alle richtlijn­organisaties in NL
  • By using a search filter: medische disciplines
  • By using key words (Google GSA)
Diliguide CBO Guideline users: patients, professionals and guideline developers
  • Patient versions and information
  • Guidelines
  • Indicators
  • E-learning modules
yes Download­able as HTML, PDFs
  • By using a search filter: aandoeningen
  • By using key words
GGZ Guidelines National Steering Committee Multidisciplinary guideline development in the GGZ Trimbos Institute Doctors who work with patients who have a psychiatric condition and the patients themselves Evidence-based guidelines and derived products such as summaries, patient versions, decision aids yes PDFs and modules for some guidelines
  • By using a navigation structure
  • By using key words (not for searching in PDFs)
KNGF Guidelines KNGF (multidisciplinary) guidelines, evidence statements yes Download­able as HTML, PDFs
  • By using a search filter: Richtlijnen
  • By using key words
Database Initiator Target group Contents Public content? Availability Search function
Kwaliteitskoepel 29 scientific associations- and the Dutch association for medical specialists OMS Medical specialists
  • Guidelines (409)
  • indicators (2)
  • Guides (12)
  • Standards (12)
  • Quality registrations (5)
  • Patient information:
    • Patient versions (14)
    • Summaries
yes PDFs
  • By using a search filter: specialisations
  • By using key words
Nederlands Centrum Jeugdgezondheid (Dutch Centre for Youth Health Care) NCJ Professional practitioners in Dutch youth care (JGZ)
  • Guidelines (15 and 11 in development) and summaries
  • Scheduling of guidelines
yes PDFs
  • None
Nederlands JeugdInstituut (Dutch Youth Institute) NJi Professionals in the youth sector
  • Instruments (questionnaires, checklists, schedules), guidelines (13)
  • Protocols
partially sometimes PDFs; often referring to other sites; sometimes only descriptions
  • By using a search filters: work field, alphabet
  • By using key words
Nederlands Huisartsen Genootschap (Dutch college of GPs) NHG
  • GP guidelines
  • Pharmacology therapeutic guidelines
  • LESA’s and LTA’s
  • Multidisciplinary guidelines
  • NHG viewpoints
  • Leaflets on rare diseases
yes, in 3 months PDFs standard; they are also available as HTML text
  • By using a search filters: organ, alphabet
  • By using key words
Database Initiator Target group Contents Public content? Availability Search function
Nederlandse Vereniging voor Arbeids- en Bedrijfs­geneeskunde NVAB Company doctors
  • Guidelines
  • Tools (knowledge tests, newsletters)
yes PDFs
  • By using a search filter: organ
  • By using key words
Oncoline IKNL
  • Doctors and other care providers who are involved in oncological and palliative care
  • For patients: kanker.nl
Richtlijnen voor oncologische en palliatieve zorg yes
  • Download­able as a PDF
  • Module in the text in HTML
  • Download­able for PDA
  • By using a search filters: topic, methodology, region
  • By using search term or key word
Regieraad Regieraad Everyone in the Netherlands
  • Guidelines
  • Indicators
  • LESA’s
  • Decision aids
  • CQIs for 100 selected conditions
yes PDFs or by using other sites
  • By using a search filter: topic
  • By using key words

To improve the findability and searchability of guidelines, a national guideline should meet the following criteria:

  • The database contains information for a broad target group of health care professionals and health care users.
  • The guidelines in the database are public.
  • The guidelines are available in both HTML and PDF format.
  • The database includes transparent representation of the basis for recommendations for each review question.
  • In addition to guidelines, the database also contains products that are related to the guidelines, such as indicator sets, patient leaflets, knowledge gaps, decision aids, etc.
  • The database also contains guidelines that are under development or have been scheduled.
  • The guidelines and parts of the guidelines can be easily printed and downloaded.
  • The database has various entry points for searching, namely by key words and free text (preferably using instant view), but also by using search filters (e.g. by condition, part of the care process, or complaint). At all times, the searcher must know their location in the Register of decentralised databases.
  • The database offers the possibility of publishing different sorts of guidelines and standards (evidence-based and consensus-based).
  • The database allows the user to create a personal profile so the user can go directly to their ‘favourite’ guidelines and/or can be kept informed of any changes.
  • All guidelines should have the same cover page so that a uniform presentation and search capabilities are created.
  • The database has a function to alert the owner of the guideline when new information needs to be provided.

5. Literature

  • Brouwers MC, Kho ME, Browman GP, et al. AGREE II: Advancing guideline development, reporting and evaluation in health care. CMAJ 2010;182(18):E839-E842.
  • Guidelines International Library (G-I-N). www.g-i-n.net
  • National Guideline Clearinghouse. guideline.gov
  • Regieraad Kwaliteit van zorg. Richtlijnen voor richtlijnen. Regieraad, 2012