Presentation to NSW KM Forum, Sept 2011.

1. A wiki for cancer treatment guidelines

2. What are clinical practice guidelines? “Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances’ (Field and Lohr, 1992). Content is based on a systematic review of clinical evidence - the main source for evidence-based care.

3. NHMRC Process (NHMRC = National Health and Medical Research Council) Publication Dissemination Public consultation Review Independent review Peer review Submission to NHMRC Potential changes! Approval Same procedure after 5 years!!!!

5. The review of the review of the review of the review Exhausted clinical experts!

6. Problems with written guidelines Out of date

7. Problems with written guidelines Impact?

8. General problem Storage of previous knowledge?

9. A wiki to develop and disseminate clinical practice guidelines Better & cheaper literature search, citation and critical appraisal handling Up-to-date, living guidelines (iterative publishing possible) Lots of people doing a little bit each Stakeholder engagement Transparency Flexible, scalable & affordable

10. A wiki to develop and publish guidelines

11. The new way 6) “Wiki-fication” of content & dissemination 1) Establish WP party and guideline objectives

12. Literature harvesting

13. Literature harvesting

14. Guideline development Critical appraisal of literature

15. The wiki critical appraisal form

16. Body of evidence table

17. Authors develop content,

18. Evidence summaries and recommendations

19. Example: Electronic guideline

20. Summary of recommendations

21. Guideline flowchart

22. Commenting on guidelines

23. Public consultation - Comment

24. Public consultation – Submit new evidence

25. Updating a guideline chunk The 3 sources where papers come from: 1) Automatic electronic alerts of new papers 2) The small group of authors whose expertise is the chunk, will feed in 3) The larger public, including professional bodies, external experts, health professionals, consumers, alerts

26. Updating a guideline chunk The group responsible for a chunk is a standing committee Responsible to address comments Whenever a new paper appears in their work space they analyse it and decide whether it contained new information that would alter the guideline and change the chunk accordingly and in a timely manner A chunk can be changed/updated without affecting the rest of the guidelines

27. Audit trail Each guideline content page lists a serious of appendices to provide transparency about recommendation grading and body of evidence User can also access pending evidence that hasn’t yet been incorporated

28. Guideline dissemination, implementation and evaluation Developing e-learning modules Detailed web analytics

29. Spaced Education e-learning modules Screenshot Spaced Education Online Module

30. Web analytics How people are navigating the site

31. Next steps Custom-designed skin, improved UI

32. Next steps Incentives for our volunteers Generation Y need reward The obvious: Authorship of a chunk would be recorded and possibly attract CME points? Chunk authors could be authorised to be able to use the literature reviews to write review articles for journals What else?

33. The next level?

34. Acknowledgement Prof Ian Olver, CEO Cancer Council Australia Christine Vuletich, Manager - Clinical Guidelines Network Alisha Dorrigan, Project Officer Alice Winter-Irving, Project Officer Endometrial and lung cancer working party Technical support Andrew Garrett, Lead Developer Dr Bob Jansen, IT Consultant Mediawiki skin Redwerks (web design agency) Website: wiki.cancer.org.au/australia