gms | German Medical Science

EbM in Qualitätsmanagement und operativer Medizin
8. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

22.03. - 24.03.2007 in Berlin

Creating an Internet Infrastructure for Collaborative Evidence Based Guideline Development

Meeting Abstract

EbM in Qualitätsmanagement und operativer Medizin. 8. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.. Berlin, 22.-24.03.2007. Düsseldorf, Köln: German Medical Science; 2007. Doc07ebm006

The electronic version of this article is the complete one and can be found online at:

Published: March 15, 2007

© 2007 Niederstadt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




The development of evidence-based guidelines is very time- and resource-consuming. Especially a development process that aims at integrating the highest possible expertise in evidence based medicine with the best clinical expertise regarding the given guideline topic, is extremely resource-consuming, which is widely regarded as one of the major obstacles to the development of such guidelines. Even a very concise guideline construction process will easily lead to the retrieval of several thousands of references from the large biomedical databases. The collaborative work of sifting through all those references, complementing retrieval results with publications from other sources, excluding unwanted material and screening full-text-articles for final inclusion into guideline-statements normally comprises the manual back-and-forth-delivery of database excerpts, literature-lists, inclusion- and exclusion checklists, full-text-documents, and evidence reports and in-process guideline fragments. All this sending by post and email leads to a lot extra organisational work, as well as creating time-delays and possibilities of errors, as well as loss of data. Modern web-based technologies can reduce part of this communication effort and prevent errors due to media disruption (information has to be transported by means of email, text-documents, on CD-ROM, on paper, etc.) and collation errors when integrating "returning" information into the projects literature databases.


During the definition phase of a multidisciplinary evidence based guideline, clinical experts specified several areas of clinical uncertainty. An evidence research specialist translated those clinical problems into search questions and performed a series of database searches. Almost 3000 references were accumulated for analysis at this stage of guideline development. The spread of information was shifted from the traditional model of moving information in many directions towards a common web-platform. This cooperative workspace integrates an open source groupware system (phprojekt™) with a commercial system of online reference and citation management (Refworks™). The reference management within this solution is unique in that it allows for multiple ways of structuring and presenting bibliographic information. It allows for the display of selected lists of references together with accompanying explanations (RefShare™), which helps to keep complexity at a manageable level for clinician experts. It also enables online discussions regarding the values and merits or shortcoming of individual publications contained in the selected bibliographic listings.

In addition, since it is available over the World Wide Web, the online literature management allows for the integration of secure file servers providing full text archiving of all relevant publications.


An internet-based platform integrating technological implementations of social software concepts was set up as the main community interchange platform and central project status reference for an evidence based guideline development project. By utilising this platform, the exchange of project documents and literature became an almost automatic process, whilst at the same time promoting scientific discussion and collaborative work. It has to be stated, however, that not everyone found it easy to adapt to this new style of working - and the actual gain in work efficiency would have been enlarged by ensuring sufficient computer and internet literacy levels amongst all participants.


Making use of collaborative web technologies allows working groups with locations dispersed throughout a country to work seamlessly together. It serves to speed up guideline development and helps especially with data exchange in the process of evidence selection and aggregation by making a lot of data conversion and -collation efforts superfluous.

Utilising features that facilitate scientific discussion theoretically would also lead to enhancing participant's input in quantity and quality, and thus eventually contribute to an overall quality improvement in the guideline development process. In our experience this aspect of collaborative networking is one that needs more than technology alone to become a reality. Possible additional factors that will make collaboration over the web, not just efficient, but also a fruitful collective experience of sharing and exchanging ideas are something that remains to be discussed.


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