1. Evidence, guidelines and practice: the way forward in a digital age SYDNEY 11 April, 2013 Bill Runciman Professor – Patient Safety & Healthcare Human Factors – University of South Australia - Centre for Sleep Research Research Fellow, Australian Institute of Health Innovation, University of NSW Clinical Professor – Joanna Briggs Institute, Faculty Health Sciences – The University of Adelaide President, Australian Patient Safety Foundation - Proposed framework for developing standards, indicators and tools -

2. - The need - For our system to remain affordable, we need to provide appropriate care and phase out inappropriate care For our system to remain affordable, we need to provide appropriate care and phase out inappropriate care The existing patchwork of processes is not working The existing patchwork of processes is not working Healthcare is not harnessing the power of the digital revolution Healthcare is not harnessing the power of the digital revolution We need clinical standards and tools before we can benefit from better record keeping We need clinical standards and tools before we can benefit from better record keeping

3. - The proposed method - Eight stages in the development of content Eight stages in the development of content Standardised templates, structure and language Standardised templates, structure and language Inclusive process – experts, clinicians, patients, jurisdictions and professional bodies Inclusive process – experts, clinicians, patients, jurisdictions and professional bodies Concepts and wikis, development and review Concepts and wikis, development and review Iterative ongoing process – suggestions, responses, refinements Iterative ongoing process – suggestions, responses, refinements

4. - The framework - Step 1: Select a condition Step 2: Develop draft content and distribute for review via a wiki Step 3: Review and collate comments posted by experts and consumers on the wiki Step 4: Draft first version of standards, indicators and tools based on feedback Step 5: Present version at a National meeting Step 6: Gain consensus on the content (at meeting and via Wiki as required) Step 7: Distribution/Piloting of the content Step 8: Ongoing review /updating of the content

5. - Clinical Standard - Describes an agreed clinical process that should be undertaken or an outcome that should be achieved for a particular circumstance, symptom, sign or diagnosis (or a defined combination of these) Describes an agreed clinical process that should be undertaken or an outcome that should be achieved for a particular circumstance, symptom, sign or diagnosis (or a defined combination of these)

6. - Clinical Standard - Should be evidence based, specific, feasible to apply, easy and unambiguous to measure and produce a clinical benefit and/or improve the safety and/or quality of care, at least at the population level. Should be evidence based, specific, feasible to apply, easy and unambiguous to measure and produce a clinical benefit and/or improve the safety and/or quality of care, at least at the population level.

7. - Clinical indicator - Is a measurable component of the standard, with explicit criteria for inclusion, exclusion, timeframe and setting Is a measurable component of the standard, with explicit criteria for inclusion, exclusion, timeframe and setting Must be actionable Must be actionable

8. - Clinical tool - Should implicitly or explicitly incorporate a standard or a component of a standard Should implicitly or explicitly incorporate a standard or a component of a standard Should constitute a guide to care that facilitates compliance with the standard Should constitute a guide to care that facilitates compliance with the standard Should be easy to audit, preferably electronically, to provide feedback Should be easy to audit, preferably electronically, to provide feedback Should be able to be incorporated into workflows and medical records Should be able to be incorporated into workflows and medical records

9. - Example - Smoking - Risks explained Risks explained face-to-face □ face-to-face □ pamphlet □ pamphlet □ DVD/Youtube □ DVD/Youtube □ Agree to quit? Agree to quit? Quitline contact □ Quitline contact □ Patches □ Patches □ Pills □ Pills □

10. - The benefits - National clinical standards, indicators and tools National clinical standards, indicators and tools Active consumer involvement and a common platform Active consumer involvement and a common platform Continued monitoring of care received Continued monitoring of care received Potential to link to outcomes Potential to link to outcomes Potential to inform health care policy Potential to inform health care policy Follow on from guideline development as next phase towards effective implementation of evidence Follow on from guideline development as next phase towards effective implementation of evidence We need a national body to co-ordinate and monitor the process and provide governance for ongoing review and updates of the content and tools We need a national body to co-ordinate and monitor the process and provide governance for ongoing review and updates of the content and tools