Use of the World Wide Web to implement clinical practice guidelines: a feasibility study

Area of Science:

• Medical Informatics
• Clinical Practice Guidelines
• Digital Health Implementation

Background:

• Significant investment in developing clinical guidelines.
• Effective dissemination of guidelines to physicians remains a challenge.
• Limited studies on implementing clinical guidelines in practice via the World Wide Web (Web).

Purpose of the Study:

• Assess the World Wide Web's potential for implementing clinical practice guidelines in real clinical settings.
• Identify physician-perceived obstacles to using Internet-based guidelines.
• Determine the Web's role in guideline implementation.

Main Methods:

• Developed two clinical guidelines (low-back surgery, digestive endoscopies) using a standardized panel method.
• Made guidelines accessible via the Web.
• Physicians (n=20) consulted guidelines during patient encounters; data collected via 3 questionnaires.

Main Results:

• 75% of physicians found Web-based guidelines easy to use, with an average consultation time of 3.4 minutes.
• Lack of direct Internet access in examination rooms (less than 50% of physicians).
• 75% recognized the Web's high potential for guideline dissemination; 78% would use them if generally available.

Conclusions:

• High acceptance of Web-based clinical practice guidelines among physicians.
• Key barriers include lack of office computer access and concerns about physician-patient relationship interference.
• Despite recognized potential, regular use of Web-based guidelines is limited by physician and guideline-related obstacles.