As SIGN celebrates 30 years producing clinical guidelines for Scotland, Professor Angela Timoney, Chair of SIGN, looks at the future of guidelines in an increasingly fast-moving digital age, where patients are more empowered to make choices about the care they receive – and also looks at the challenges presented in an age of information overload.
Clinical guidelines have played a vital role in healthcare in Scotland for 30 years. From the weighty physical publications printed and distributed across the country in the early days of SIGN, to the increasingly digital, app-based guidelines complete with public versions of today, it has been 30 years of constant change and transformation to meet clinical demands and increasing patient power.
I’ve had the privilege of serving as Chair of SIGN Council for four years. I’ve always been conscious of this tradition that SIGN has of continuous progress and development. Turning 30 has been a great opportunity to stand back, reflect and think about how we might want things to be in the next five years, if not the next 30.
The Right Decision at the right time
Increasingly, our guidelines have developed to try and meet the needs of both the clinical community and of patients. Clinicians and patients need information speedily, and as accessibly as possible, in straightforward, easy to follow language.
Although we have had a longstanding app for clinicians, which contained our clinical guidelines, recent years have seen more of our guidelines being published on the Right Decision Service (RDS) tool.
RDS is a new app-based service delivered by Healthcare Improvement Scotland as a one-stop shop to support the best clinical and care decision making across health and social care in Scotland. The service is the first of its kind in the UK and transfer to HIS marked the next stage of its development and roll-out. The app will ensure that guidelines, and other up-to-date advice, is available in the one place, and able to go with clinicians wherever they may be – in a hospital, GP setting or in the community. We see this as a vital step forward. But it’s not just for clinicians. The tool also includes information tailored to patients and carers on a wide range of conditions.
Adapt or die? Clinical guidelines and the infodemic
Although we live in an increasingly digital and online age, there is still a place for face-to-face meetings in order to engage, share ideas and collaborate on what the future should look like.
To mark our 30th birthday, we held a one-day conference in September, jointly hosted by the Royal College of Physicians Edinburgh. We wanted to meet with those at the front line who use our guidelines and to consider the challenging issues of trust, credibility and the potential impact of artificial intelligence. We wanted people in the room, and in the workshops, feeding back directly to us throughout the day. The fact that the event was fully booked shows the continued interest in guidelines and their future role in health and care.
The problem of unreliable information
As highlighted by Professor Linda Bauld OBE in her opening address, we are all facing the challenge of an infodemic, which she described as an excessive amount of information about a problem, where the information is typically unreliable, spreads rapidly, and makes a solution more difficult to achieve.
This theme was also picked up by Dr Amir Qaseem, our keynote speaker from the American College of Physicians, who spoke about misinformation and disinformation. Disinformation is a coordinated or deliberate effort, using false or inaccurate information, with deliberate intent to mislead in order to gain power, money, or reputation. We see it online on a daily basis. In contrast, credible information is consistent with the best evidence available at the time, and is created by employing processes to reduce conflicts of interest, and promote transparency and accountability. This is what we as guideline developers focus on and share, cutting through that disinformation as a trusted voice.
Questions remain
The question of the potential impact of AI on future guideline development remains unanswered, but we have started the debate. Although the field is emerging rapidly, it is relatively immature.
As SIGN turns 31, we are standing on the shoulders of giants, and we owe it to them to look to far horizons, as they have done time and time again. The future for guidelines is exciting, challenging, and one to be shaped by teams of committed clinicians and patients ready to embrace change. We want to hear from you too. In the same way that guidelines are being placed in people’s hands through our focus on digital solutions, it is in our own hands to work together to produce the best guidelines possible and to use those guidelines to the benefit of all.
Professor Angela Timoney is Chair of SIGN Council. SIGN is part of Healthcare Improvement Scotland. Angela is a former Director of Pharmacy for two teaching boards in Scotland and is a former Chair of Scottish Medicines Consortium.
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