# Living guidelines published as versioned, computable rules

Source: https://onco.cc/ideas/idea-data-computable-living-guidelines/  
OnCo record `idea-data-computable-living-guidelines` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer treatment guidelines would be updated continuously and published in a form computers can read, so hospital systems, apps and decision tools update themselves the day the evidence changes.

## Summary

Guidelines are PDFs updated annually or less; software that encodes them lags further. The proposal is for major guideline bodies (NCCN, ESMO, ASCO, national bodies) to publish recommendations as structured, versioned data (HL7 Clinical Practice Guidelines on FHIR, with explicit population, intervention, evidence grade and citation), updated within weeks of practice-changing evidence, with a public change log. The Australian living stroke and COVID guidelines and MAGICapp show living, structured guidance is feasible.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Computable living guidelines will cut the median time from practice-changing publication to updated recommendation from more than a year to under 60 days, and downstream decision support will update within a further 30 days.
- Rationale: Living guidelines have been maintained for stroke and COVID-19 for years; the machine-readable layer is what allows the update to propagate to the point of care rather than stopping at a website.
- Proposed test: One guideline body publishes one disease (for example metastatic NSCLC) as computable living guidance for two years; measure update latency and the number of software systems consuming the feed.
- Maturity: early-clinical
- Actor: policy

## Sources

- HL7 CPG-on-FHIR: https://hl7.org/fhir/uv/cpg/
- MAGICapp: https://magicevidence.org/

## Connected records

- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [National Comprehensive Cancer Network (NCCN)](https://onco.cc/institutions/nccn-org/)
- collections: [ESMO Clinical Practice Guidelines & MCBS](https://onco.cc/collections/esmo-guidelines/), [NCCN Guidelines](https://onco.cc/collections/nccn/)
- fronts: [AI & Computation](https://onco.cc/fronts/ai-computation/)
- bottlenecks: [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/)
- ideas: [A plain-language explainer for every guideline recommendation, in every major language](https://onco.cc/ideas/idea-data-patient-explainers-per-recommendation/), [A public API serving the current standard of care for any cancer, stage and biomarker](https://onco.cc/ideas/idea-data-standard-of-care-api/), [Automatic flagging of retracted or corrected evidence in guidelines and decision support](https://onco.cc/ideas/idea-data-retraction-propagation/), [Decision support that cites the exact trial and guideline line it relies on](https://onco.cc/ideas/idea-data-provenance-first-decision-support/), [Expert-verified translation of guideline updates into 20 languages within 30 days](https://onco.cc/ideas/idea-data-rapid-guideline-translation/), [Real-time guideline-concordance feedback for every cancer centre](https://onco.cc/ideas/idea-data-guideline-concordance-dashboards/), [Subscribable alerts when the standard of care changes for a patient's situation](https://onco.cc/ideas/idea-data-standard-of-care-change-alerts/), [Update hospital order sets within 30 days of a guideline change](https://onco.cc/ideas/idea-data-order-set-defaults-30-days/)

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