Dunja Dreesens

36 Moreover, there are even more knowledge tools available than we could include. For example, tool types such as ‘process guideline’ and ‘modular guidelines’ were gaining momentum at the time of the review but were excluded. Based on the name, we decided that the tool type ‘process guideline’ would probably address care processes and not care content. After inquiry, ‘modular guidelines’ seemed to refer more to the development process of clinical practice guidelines, and it was therefore excluded. Moreover, we also disregarded tools developed at regional and local levels, just as tools in the domain of long-term care. Also excluded were tools developed at an international level (79, 100), some of which were not yet mainstream in the Netherlands at the time of the review, and tools from (more) commercial organisations such as pharmaceutical companies. This means that there are even more tool types available to clinicians and patients than we mentioned in this article, and we doubt if these are all clearly defined. As a number of definitions were incomplete, data extraction was more difficult than we had anticipated. Textbooks (7, 101, 102), which were consulted to determine search terms, seemed more conscientious about the terms they used than the websites. The books mostly contained definitions or descriptions, but these were sometimes in contradiction with the terms found on the websites. One could argue that the gap identified between the textbooks and the websites perhaps mirrors the gap between theory and practice (101). Most tools were primarily aimed at healthcare professionals. This could be due to the leeway of patient involvement in this area and in developing these tools to catch up. There are other users of these tools, such as the Dutch Health and Youth Care Inspectorate and healthcare insurers. These are, however, not considered to be target groups; that is, they are not mentioned in the descriptions of the majority of the tools. This might reflect the opinion of some developers in the Netherlands that these groups use the tools for other purposes then the ones for which they are intended, e.g. contracting healthcare services or enforcement. These are considered inappropriate uses, which leads to friction between these parties (39). In one of the discussions among the authors, the question surfaced whether information on target users should be part of the definition. What is the hallmark of a good definition and what needs to be included in the definition to describe a tool clearly? An interesting question related to the digital age is whether anything is ever lost or forgotten nowadays. Even though tool types and tools become obsolete or their content becomes outdated, they can often still be found on the Internet (or on PCs). This could mean that tools no longer in use are never completely forgotten, clogging up the already bulging pipeline of tool types. Another aspect of the digital age is that the tool and its medium are becoming increasingly interlinked and inseparable; apps on smartphones are a powerful example (103, 104). Tools are nowadays readily available in different forms and on different media. Looking to the (near) future, we see a digital age with an abundance of access possibilities via apps, social media and the internet, with ’[u]nlimited information on limited human bandwidth.’ (105). One could raise the question whether it is chaos we are looking at, or evolution. Like organisms, tools come into existence and gradually evolve into different ‘species’. In time, some become Chapter 2