Clinical Decision Support Services

Shared care management and decision making between healthcare professionals, patients and their informal caregivers are key to the integrated multimorbidity care management goals.

Multimorbidity impacts on the number of medications used and the number of different and often overlapping guidelines and evidence for managing various conditions. Clinical decision support (CDS) services in the C3-Cloud system aim to support with such challenges by identifying polypharmacy cases and notifying healthcare professionals about potentially contradicting guidelines when reconciling treatment care plans. The CDS services are standards-based and developed with the Cambio CDS Platform. With digitally implemented CDS, updates/changes in clinical practice guidelines can be made available for health care workers quickly by changing the clinical rules in the CDS-component. The  CDS services work within the C3-Cloud’s Coordinated Care & Cure Platform, used by healthcare professionals to collaboratively create and manage personalised care plans.

Clinical decision support is used in the management of personalised care plans by the reconciliation of clinical guidelines for individual diseases.

In this example, blood pressure management is a high-level goal for this patient who has a history of cardiovascular disease, hypertension and Type 2 diabetes. Recent blood pressure measurements are quite high at 170/90 mmHg.

When the clinical team needs to add a new goal to this patient’s care plan, this triggers the clinical decision support service to automatically list any suggested goals. The computable suggestions can be added to the care plan and more specific details added, e.g. a target blood pressure measurement. Adding activities to the care plan also uses the clinical decision support services to suggest activities based on the patient’s context and the evidence available.

The other type of suggestions from the clinical decision support service are those that are textual suggestions from clinical guidelines, such as reminders.

C3-Cloud is tackling the polypharmacy challenge by supporting clinicians in reviewing and adjusting the medication list of their patients with multiple conditions. The integrated patient record repository ensures that the clinician can see all of the conditions and their treatments in one place. Decision support software provides guidance on the best non-clashing medication choice for any new proposed treatment, and the computerised multi-condition guidelines advise on the best aligned care plan for each patient. For example, when the clinical team wants to prescribe a medication to the patient, they do so by adding a new activity in the care plan.

In this example, if calcium channel blockers are chosen, any contraindications with the patient’s existing medications will be flagged  to warn the clinical team, who can decide on the appropriate steps.