Summary

The period August 2019 to July 2020 saw DHI take on leadership and management of the national decision support programme for the Scottish Government. In this capacity, DHI consolidated the Right Decision Service national decision support platform, established national governance arrangements, completed the research and development phase of the programme and submitted a business case for adoption and scale-up of decision support.

From April to July 2020, the decision support programme also delivered the first stage of its response to the Covid-19 pandemic.

Impact & Value

Support for a national approach:

  • 2019-2020 developments built on the University of Edinburgh independent evaluation, which confirmed strong support from clinicians and policy leads for the national programme approach of national leadership and coordination, and a Once for Scotland decision support platform. Benefits identified by stakeholders included greater integration of care, patient safety, guideline adherence, preventive care, patient self-management, and shared decision-making

High usage of applications created by the Right Decision Service tools:

  • Polypharmacy app for managing multiple medicines – 3680 users per month
  • Antimicrobial prescribing app – 3364 users per month
  • COVID apps –7027 users in the 2-3 months since the launch of apps between April and June 2020 and end of July 2020

Confirmation of evidence base for the impact of decision support:

  • DHI supported the Scottish Government to commission an independent review by Healthcare Improvement Scotland of the evidence base for the benefits of decision support. This review confirmed that decision support tools improve the quality and safety of practitioner decision-making, reducing unwarranted variation and clinical error

Adoption readiness – Territorial and national Boards and clinicians have confirmed their willingness to engage in organisation-wide implementation and adoption of decision support:

  • NHS Greater Glasgow and Clyde, NHS Lanarkshire, and NHS Ayrshire and Arran have executive-level and lead clinician sponsorship to be early adopters implementing decision support across their Boards. Glasgow and Lanarkshire have a corporate agreement to use the Right Decision Service as their primary means of delivering local guidelines via the web and mobile apps. Decision support for COVID identified two further early adopters - NHS Tayside and NHS Fife
  • Healthcare Improvement Scotland has confirmed at an executive level that decision support is key to the delivery of its digital and innovation strategy and their intention to build on quick wins achieved through joint working with DHI
  • The Royal College of General Practitioners and BMA in Scotland reaffirmed their support for the decision support programme and have formally endorsed the development of a decision support toolkit for GP remote consultation

Progress to date

Key developments during the period covered by this report include:

  • Creation of a multi-professional National Decision Support Oversight Group. This has senior stakeholder representation from Scottish Government, national and territorial boards, the British Medical Association and the third sector
  • Creation of a Coordinating Framework setting out principles, standards and guidelines for the development of decision support within the national programme and through other initiatives supported by Scotland’s health and social care
  • Production of an implementation and evaluation framework, commissioned from the University of Oxford Primary Care team which has a high profile in digital health research
  • Production of the business case for 3-year early adopter phase of decision support programme, and refresh of this business case to reflect the new priorities emerging as a result of the Covid-19 pandemic
  • Use of the decision support builder tools within DHI’s Right Decision Service platform to expand patient-specific, rules-based decision support for management of polypharmacy and chronic pain. This now covers the full range of the national polypharmacy guidance and issues prompts at point of opening a patient record and at point of issuing a prescription, successfully demonstrated to clinicians with user feedback
  • Co-design of a self-management app and website for people with multiple conditions and taking multiple medications, based on a digital health literacy survey, interviews and workshops in two NHS Boards
[The Right Decision Service] is the realisation of a quest for a single portal of information and finally gives us a modern and user-friendly platform which can be accessed by all health care staff…. this will prove to be a catalyst for development of further integrated care pathways with smoother and more efficient patient journeys.

Associated Medical Director, NHS Lanarkshire

Next Steps

The next phase of work will focus on deploying decision support to support the immediate priorities of Covid-19 and service remobilisation. It will aim to integrate decision support more closely with wider national digital developments and to further transition to ownership of decision support delivery by NHS Boards, to maximise its long-term contribution to health and social care priorities.

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