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Electronic algorithm for thyroid nodule treatment holds potential
Electronic guidelines created to provide patient-specific decision support for clinicians to find and treat thyroid nodules show how such technology may standardize and improve quality of care and carry implications for utility in other fields of medicine, according to findings published in Endocrine Practice.
Mor Peleg, PhD, of the University of Haifa in Israel, collaborated with clinical experts and engineers to develop a computer-interpretable algorithm for US and European users based on the AACE, AME, ETA Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules.
“Guidelines are wonderful documents, but they get dated very quickly. They’re dense, they’re long, very few people except experts in the field can incorporate the nuances, and they’re not used,” Jeffrey Garber, MD, of Harvard Vanguard Medical Associates, a researcher on the study and Endocrine Today Editorial Board member, said in an interview. “The whole field of implementation science comes up with a set of questions and the methods to end up making this stuff usable for more doctors and to have an impact on more patients.”
Jeffrey Garber
Through the guideline-modeling language GuideLine Interchange Format, version 3, care algorithms were organized into a flowchart that specified the sequence of tasks required to evaluate a patient with a thyroid nodule. A second language called PROforma was employed to work with data not obtained in a rigid sequence. Tallis, a user-friendly computer program that records and displays tasks and prompts users to perform next steps, executed the work.
The thyroid guideline was selected for computerization after a call for standardization by the American Association of Clinical Endocrinologists, according to the report, but also because a marked variation in nodule diagnosis and management highlighted the need for decision support for non-expert clinicians.
“Our preliminary evaluation with 20 patient cases indicates that it provides users with evidence-based patient-specific recommendations and explanations while at the same time allowing users to deviate from the recommended strict sequencing of indicated actions,” the researchers wrote.
It was during the creation of the prototype, Garber said, that molecular markers “coincidentally became a hot item.” The work was highlighted in a Disease State Commentary issued by AACE and the American College of Endocrinologists.
With potential for use in a variety of regions, countries and resource-specific settings, the researchers have already transferred the technology to the field of diabetes. Garber said the research will be ready to present at the AACE 23rd Annual Scientific & Clinical Congress in Las Vegas.
For more information:
The “demonstrator” electronic thyroid nodule guideline described in the report can be viewed at http://demos.deontics.com/trace-review-app (username: reviewer; password: tnodule1).
Disclosure: The researchers report no relevant financial disclosures.