It's time for clinical guidelines to enter the digital age

To the Editor: We agree with Olver and Von Dincklage on the need to move towards digital guidelines.1

The National Stroke Foundation (NSF) has been developing guidelines for approval by the National Health and Medical Research Council (NHMRC) for the past 8 years. By the time a guideline has been developed, submitted to the NHMRC and then released (a process that takes about 2 years), there will be new evidence that will change some recommendations (eg, new evidence for blood pressure management in haemorrhagic stroke is not captured in current guidelines2).

While we are unaware of evidence that outdated guidelines are a barrier to the implementation of evidence-based care, clinicians express concern about guidelines that are not up-to-date and are likely to affect patient care.3 We agree that better use of electronic platforms is both inevitable and beneficial for the reasons outlined by Olver and Von Dincklage.1 Online platforms also provide the vehicle for international collaboration and sharing of information with other guideline developers, thus reducing the time and cost of guideline development while improving transparency and quality.

The NSF is using a staged approach to transition its guidelines onto a wiki-based platform. Initially, we will move the current NHMRC-approved guidelines into an online “document”. Until NHMRC processes for approval of a wiki-based guideline are released, the entire guideline will need to be reviewed and approved by the NHMRC in the paper-based form, and then migrated to the online platform for implementation. This will be a costly and complex process, but it is necessary until a nationally accepted standard for developing online guidelines is released.

National standards specifically for digitally produced and maintained guidelines are urgently required.