Quality and safety of clinical practice

A duty of care

In "Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality" David Bates established an influential direction for ensuring that clinical knowledge systems should be trustworthy and safe.

In "A quality and safety framework for point-of-care clinical guidelines" Fox and Bury proposed a set of principles and a methodology for developing and documenting computer-interpretable guidelines. They suggested that we must address at least four requirements when creating and disseminating applications and services that are intended to be used for supporting clinical practice:

  1. A systematic publishing life-cycle for the creation and maintenance of the medical knowledge base 
  2. Rigorous engineering to ensure application integrity and platform reliability
  3. Explicit safety and hazard management at runtime
  4. Comprehensive on-line documentation to support quality and accountability to users

These are challenging objectives and OpenClinical.net aims to adhere to these principles as far as possible in the development and use of content on Repertoire. However this is clearly a work in progress and will only advance if we achieve engagement by a significant professional and user community. The project team and particularly the Point of Care journal will encourage authors to follow these principles by including documentation which addresses quality and safety issues with their submissions. The project team also invites all members of the OpenClinical community to provide feedback on how we are doing and suggest improvements to the services that OpenClinical provides via the discussion board and blogging facilities on the site.

Background papers

"A quality and safety framework for point-of-care clinical guidelines" at Proc AMIA 2000

"Clinical decision support systems: a discussion of quality, safety and legal liability issues" at Proc AMIA 2002

"Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality" JAMIA 2003

"Quality and safety of decision support systems" Discussion paper and draft OpenClinical protocol at OpenClinical.org

See also OpenClinical.org: search the site with "safety" and similar search terms  to find relevant resources (NB the www.OpenClinical.org web site carries a lot of useful material but was only maintained until 2010).