Characterisation of Clinical Practice Guideline Changes

Yamiko Joseph Msosa, C. Maria Keet, Melissa Densmore


Sub-Saharan Africa is facing a double crisis of high disease burden and shortage of healthcare resources. To cope with this challenge, many countries have adopted the practice of task-shifting with clinical practice guidelines (CPGs) as a key component. It is not unusual for CPGs to be revised or proved wrong, spurring frequent updates of state-mandated CPGs. This negatively affects maintainability of healthcare applications using those CPGs. Therefore, it is essential that the types of CPG changes are understood in order to develop clinical decision support systems that are maintainable through adequate support for CPGs. We take a bottomup approach to analyse successive sets of CPGs so as to elucidate and characterise types of CPG changes over time. The identified 10 type of changes in decisions, actions, and recommendations are exhaustive and affect fine-grained structural components of a CPG. We also determined their occurrences using Malawi’s HIV CPGs of 2008, 2011, and 2014 as case study. The results showed that the number of changes, as well as the type of changes that occur in successive versions, varies widely.


  1. Bates, D. W., Kuperman, G. J., et al. (2003). Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. JAMIA, 10(6):523-530.
  2. Chawani, M. S. (2014). A Cross-case Analysis of the Effects of EMR Deployment on Antenatal Care Services in Rural Health Centres in Malawi. Journal of Health Informatics in Africa, 2(1).
  3. Chen, L., Evans, T., et al. (2004). Human resources for health: overcoming the crisis. The Lancet, 364(9449):1984-1990.
  4. Coiera, E. (2003). Guide to Health Informatics. Oxford University Press Inc.
  5. de Clercq, P., Kaiser, K., and Hasman, A. (2008). Computer-interpretable guideline formalisms. Studies in Health Technology and Informatics, 139:22-43.
  6. Douali, N., Csaba, H., et al. (2014). Diagnosis Support System based on clinical guidelines: comparison between Case-Based Fuzzy Cognitive Maps and Bayesian Networks. Computer Methods and Programs in Biomedicine, 113(1):133-143.
  7. Douglas, G. P. et al. (2011). Simplicity and usability: Lessons from a touchscreen electronic medical record system in Malawi. Interactions, 18(6):50-53.
  8. Field, M. J. et al. (1992). Guidelines for Clinical Practice:: From Development to Use. National Academies Press.
  9. Fraser, H. S. F., Biondich, P., et al. (2005). Implementing electronic medical record systems in developing countries. Informatics in Primary Care, 13.
  10. Fulton, B. D. et al. (2011). Health workforce skill mix and task shifting in low income countries: a review of recent evidence. Hum Resour Health, 9(1):1.
  11. Hotez, P. J. and Kamath, A. (2009). Neglected tropical diseases in sub-saharan africa: Review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis, 3(8):e412.
  12. Kaiser, K. and Miksch, S. (2009). Versioning computerinterpretable guidelines: Semi-automatic modeling of living guidelines using an information extraction method. AIM, 46(1):55-66.
  13. Lewis, Z. L., Mello-Thoms, C., et al. (2011). The feasibility of automating audit and feedback for ART guideline adherence in Malawi. JAMIA, 18(6):868-874.
  14. Michalski, R. S. (1983). A theory and methodology of inductive learning. In Michalski, R. S. et al., editors, Machine Learning, Symbolic Computation, pages 83- 134. Springer Berlin Heidelberg.
  15. Msosa, Y. J., Densmore, M., and Keet, C. M. (2015). Towards an architectural design of a guideline-driven EMR system: A contextual inquiry of malawi. In Proceedings of ICTD, ICTD 7815, pages 49:1-49:4. ACM.
  16. Peleg, M. (2013). Computer-interpretable clinical guidelines: A methodological review. Journal of Biomedical Informatics, 46(4):744-763.
  17. Peleg, M. and Tu, S. (2006). Decision support, knowledge representation and management in medicine. Yearb Med Inform, 45:72-80.
  18. Shiffman, R. N. (1997). Representation of clinical practice guidelines in conventional and augmented decision tables. JAMIA, 4(5):382-393.
  19. Silver, H. F., Dewing, R. T., and Perini, M. J. (2012). The Core Six: Essential Strategies for Achieving Excellence with the Common Core. ASCD.
  20. Sordo, M. et al. (2003). GELLO: An Object-Oriented Query and Expression Language for Clinical Decision Support. AMIA Annual Symposium Proceedings, 2003:1012.
  21. WHO Regional Office for Africa (2014). Implementation of Option B+ for prevention of mother-to-child transmission of HIV: the Malawi experience. Technical report, The World Health Organisation.
  22. Willis-Shattuck, M. et al. (2008). Motivation and retention of health workers in developing countries: a systematic review. BMC Health Services Research, 8(1):247.
  23. Zachariah, R., Ford, N., et al. (2009). Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 103(6):549-558.
  24. Zamborlini et al. (2014). Towards a conceptual model for enhancing reasoning about clinical guidelines. In Miksch, S. et al., editors, Knowledge Representation for Health Care, number 8903 in LNCS, pages 29- 44. Springer.

Paper Citation

in Harvard Style

Msosa Y., Keet C. and Densmore M. (2016). Characterisation of Clinical Practice Guideline Changes . In Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2016) ISBN 978-989-758-170-0, pages 248-255. DOI: 10.5220/0005664302480255

in Bibtex Style

author={Yamiko Joseph Msosa and C. Maria Keet and Melissa Densmore},
title={Characterisation of Clinical Practice Guideline Changes},
booktitle={Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2016)},

in EndNote Style

JO - Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2016)
TI - Characterisation of Clinical Practice Guideline Changes
SN - 978-989-758-170-0
AU - Msosa Y.
AU - Keet C.
AU - Densmore M.
PY - 2016
SP - 248
EP - 255
DO - 10.5220/0005664302480255