Will 'Computable' Clinical Guidelines Be Compatible with Personalised Care?

Abstract

Introduction: The potential benefits from digitalisation processes will only be fully realised if the conceptual challenges they uncover are accepted and addressed, alongside the technical ones such as interoperability. Will 'computable' clinical guidelines be compatible with personalised care if the definition of the relevant disease embeds preferences that pre-empt those of the individual patient?

Method: As a case study we investigated the definition of diabetes in glycaemic management guidelines.

Result: The dominant component of its definition - HbA1c ≥6.5% - embeds the consensus preference judgement of a 2009 International Expert Committee.

Discussion: This preference-sensitive threshold for the diagnosis of diabetes has subsequently been endorsed in many guidelines relating to glycaemic management, though there are signs of awareness and concern with its implications.

Conclusion: Those seeking to digitalise guidelines by making them 'computable' need to acknowledge and address their inbuilt preference-sensitivity - if they wish to further care that respects patient's preferences.

Keywords: clinical guideline; computable; diabetes; patient’s preferences.