Guidelines International Network 2009.10.28 Guidelines International Network Philadelphia, 2016 Plenary 3 Internet-Based Support for Guideline Development, Maintenance, and Adaptation in Japan; Current Situation and Future Direction Naohito Yamaguchi I am very much honored to have a chance to give a talk at this monumental 1st international conference of traditional Chinese medicine guidelines and standards. Today I am going to talk the history, current situation and future of clinical practice guidelines in Japan. Director, Minds Guideline Center, Japan Council for Quality Health Care, Professor and Chair, Department of Public Health, School of Medicine, Tokyo Women’s Medical University.

Disclosure of Interests (last 3 years) Naohito Yamaguchi I certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to affect significantly my views on the subject on which I am presenting, other than the following*: Direct Employment; Tokyo Women‘s Medical University Executuve Board Memerby; Japan Council for Quality Health Care Indirect Academic Interest; Epidemiology and Public Health

Progress in Japan In 1999, the Ministry of Health, Labor and Welfare decided to help develop 26 clinical practice guidelines for diseases of large burden in Japan, with grant-in-aid from the Ministry In 2002, the Japan Council for Quality Health Care, non-profit third-party organization for quality improvement in healthcare, launched the EBM Promotion Project funded by the Ministry to disseminate guidelines developed in Japan

EBM Promotion Project (Minds) Launched in 2002 Website opened in 2004 http://minds.jcqhc.or.jp

Minds Website (2015-) 167 guidelines developed in Japan 22 guidelines translated into English

Guideline Development Support

Textbook with extensive citation Brief History 2002 2007 2014 Handbook 2007 Handbook 2014 Format Textbook with extensive citation Clinical question + Recommendation Clinical question + Recommendation Topic Standard Knowledge Standard Knowledge Key Clinical Issues Evidence Synthesis Descriptive Descriptive Systematic review Benefit-Harm Balance COI Management Stakeholders Involvement Procedure

Minds Handbook for CPG Development 2014 Chapter 1: Overview Chapter 2: Preparation Chapter 3: Scope Chapter 4: Systematic Review Chapter 5: Recommendations Chapter 6: Finalization Chapter 7: Dissemination, Implementation and Assessment of Clinical Practice Guidelines http://minds4.jcqhc.or.jp/minds/guideline/pdf/MindsHB2014.pdf

Proposed CPG Development Process Guideline Development Group Systematic Review Team Guideline Development Group Scoping Systematic Review Formulation of Recommendation Scoping search Clinical questions Outcome selection Literature search Risk of Bias Certainty of evidence Meta-analysis Consensus formation Patients’ preference and value

Internet-based guideline editing tool: GUIDE Templates of spread sheets and text files can be downloaded to locally edit the content of guideline. Locally edited files then can be uploaded to make a draft file of guideline.

Formulation of Recommendation GUIDE Features Scoping Systematic Review Formulation of Recommendation Up Down GUIDE System DRAFT Text file Text file Text file

Flexibility Guideline developers can select and arrange filled templates to make a draft guideline. A part of filled templates can be selected to edit ready- to-use practical and brief versions of guideline in addition to detailed version with full inclusion of systematic review results.

Proposed sets of templates to edit practical version, brief version and version for the public

Modularization By modularized structure, any part of guideline can be used, for example, to give information for adaptation in other guidelines with GUIDE templates.

Guideline Adaptation Using GUIDE From Guideline A From Guideline B Scoping Adaptation Formulation of Recommendation Down Up GUIDE System DRAFT

Standardization Database of structured CPGs can be used to disseminate online with various search options Guideline B CQ CQ／目次項目 推奨／会等 推奨の強さ 解説 CQサマリー Clinical Question Recommendation Grade Explanation CQ Summary Guideline A Document of CPG Guideline C ・・・・・・・・・・ CQ Search

Minds Mobile For tablets and smartphones For practitioners to refer to guidelines at the site of care Search for a clinical question from guidelines database

One Possible Future Direction: Automation by Artificial Intelligence (AI) techniques Literature Classification/Selection Article Review Personalized risk estimation

Automation Literature DB Patient BigData Search Review Search Natural Language Processing Review Supervised Machine Learning Search Scoping Systematic Review Formulation of Recommendation Data Mining Personalized Patient BigData

Collaborators Masahiro Yoshida Akiko Okumura Yosuke Hatakeyama Yasuto Sato And other Minds staff members

Thank You!