If this is something you’re looking into further you may find this article of value:

Governance for clinical decision support: case studies and recommended practices from leading institutions
http://www.ncbi.nlm.nih.gov/pubmed/21252052 

Pritpal

Thanks for the question. What you’ve described sounds good, and certainly better than what I have seen in most places. I see two dimensions to this issue; how knowledge is embedded into systems and how the knowledge landscape is kept abreast of. 

Once your mini-me NICE has achieved agreement on what knowledge to embed locally, it needs to ensure there is a clear audit trail of where it is being used and who has the right to change it. The latter part of this is essential; having named individuals whose job it is to ‘own’ content is a powerful way to ensure that people (have to) care (building it into job descriptions helps). 

Who the right owners are will depend on what ‘embed’ means. If it means creating printed information using a local printer, it can be anyone (responsible). But if it means adding encoded knowledge to electronic systems then the owners need to understand the process for changing it, when required. 

Staying abreast of the knowledge landscape can be difficult. The mini-me NICE should be clear on what knowledge it monitors. My view is that it should be so-called secondary literature – systematic reviews and guidelines. It should also be clear what quality threshold to employ (there are validated tools to assess the quality of most article types). The mini-me NICE could relatively quickly agree which knowledge sources they’re checking. 

The tough part is knowing how often to check. Some areas of healthcare have a regular churn of knowledge, while others are more static. This is something else that the mini-me NICE could agree on. In my experience, there is a lot of churn in high-volume specialties, such cardiology, but less in others. The general rule of thumb amongst knowledge nerds (like me) is that you should do a good scan of the knowledge landscape every 18 months or so, although there is little ‘evidence’ to say this is right, as such. 

With this thorough approach to how and where knowledge has been embedded into local systems and an agreed approach to how the knowledge landscape is to be scanned and responded to, your mini-me NICE can operate safe in the knowledge that what’s being used in care – whether at the coal-face or at a population level – is aligned with best evidence at all times. 

I hope that makes sense. 

Pritpal