User decides level of detail
Improving guideline uptake, usability and understanding at the point of care is one of our outmost goals in MAGIC. This requires making guidelines and other tools for decision support usable in any circumstance- both in acute situations, in the hospital ward, at the doctors office and in learning settings.
To make this possible guidelines need to move from paper to electronic presentation formats, as these are better suited for the complexity of information and adaptability of content.
We have, together with the DECIDE project, developed multilayered presentation formats for clinical practice guidelines and decision aids. The research and innovation underlying these presentation formats is further described in the SNAP IT project and the SHARE IT project.
In the multilayered framework, the user decides the level of detail. They get presented with the recommendation up front, but can dig down into layers of information, all the way to the primary study-information that is underlying the effect estimates for each outcome.
Multilayered evidence summaries: More recently we have started working on how to also display evidence summaries (i.e. GRADE Summary of Findings tables) in multilayered and user-friendly formats. Here we are collaborating with Epistemonikos who had a key role in developing interactive SoF-tables (iSoF) in the DECIDE project.
Isof from Epistemonikos: Using our common model for digitally structured data we are now integrating our MAGICapp with Epistemonikos to automatically display evidence summaries in their interactive Summary of Findings format. This will allow end-users to easily use the additional features these tables have, which includes a graphic slideshow that can be used for teaching and discussions.
We place the most useful information on top, to prevent guideline readers from scrolling through endless background text. The background text however, can be very important and is therefor placed only a click away.
Guidelines have a table of contents where users can navigate to the chapter they would like to read. All guidelines have a recommendation search.
The main content area with recommendations can be scrolled up and down without having to move in and out of different pages for each section.
We use the metaphor of an onion to describe an optimal guideline: the common characteristic is the layers. Sometimes, clinicians need only instruction on the optimal course of action. At other times, they may desire or need progressively more information. But whilst the onion has it’s core in the middle- buried by many layers, we place the core message in guidelines up front, as the first layer that meet the clinicians.
We have developed a model for dissemination of optimal presentation formats of guidelines on the web, in applications for smartphones and in EMRs,. We have further explored and refined these presentation formats for each layer together with DECIDE through an iterative process with brainstorming, user testing with guideline users and stakeholder feedback.
A major focus has been the format of what we will call the “top layer”, the information in the guideline that will often be the minimum for point-of-care decisions. The first layer provides a structured recommendation including the strength of the recommendation. The next layer presents what we call the key information, available a click away and a short rationale that describes the guideline panels´ judgments in moving from evidence to recommendations.
Deeper layers will provide interactive Summary of Findings tables, evidence to recommendation tables, and access to more extensive narrative summaries of the evidence, systematic reviews, and original articles. The Evidence to Recommendation and interactive Summary of Findings tables are developed in the DECIDE project.
We invite all potential users of a multi-layered framework to try it out in MAGICapp, or contact us for collaborative efforts.