DHIndia initiative to create a clinical decision support solution for COVID-19 screening


DHIndia is happy to announce the collaboration with EHRC@IIITB & Healthelife to create a Clinical Decision Support System (CDSS) for COVID-19 screening. The collaboration will also include the creation of a minimal triage application for front-line doctors.

These tools will be designed to enable the doctors to screen suspected COVID-19 patients using the the latest National/State protocols. The collaborating parties intend to make this application available on mobile and web in the next couple of weeks time. Subsequently, we also plan to offer “CDSS as a Service” for 3rd party applications.

Plans to address the growing threat of COVID-19

Based on the experience in other countries, it is projected that India will start seeing a large increase in COVID-19 cases in the next couple of weeks. This trend is expected to continue and new cases are expected to emerge for an extended period. To manage this pandemic situation, many initiatives from the government and community organizations are being put in place to support the current healthcare system. These include the front-line clinics by state governments, IVR enabled call centres, volunteer panel of doctors, many private telemedicine applications etc.

DHIndia continues to play a major role in many such initiatives such as collaboration with TSI on the free telemedicine guidelines training for doctors. Another initiative that we have taken up in collaboration with CAHO, HIMSS & CHIME is to come up with a qualified registry of telemedicine application providers to help healthcare professionals make the right choice with technology. This process is in advanced stages and the first release is expected shortly.

Supporting doctors with digital tools such as clinical decision support in their COVID-19 fight

As part of our continuing evaluation of the situation, we believe that doctors are going to need support in terms of digital tools such as a COVID-19 CDSS. As the pace of infection picks up, doctors will be required to make fast decisions with minimal peer support and advise the patients appropriately. The margin of error is very small considering the seriousness of the problem.

COVID-19 is a new condition and the healthcare community has limited experience in it’s assessment & treatment. Due to this they rely heavily on protocols from authoritative sources to support their work. To add to their confusion, these protocols themselves are evolving at a rapid pace, based on evidence gathered from the field.

The rapid dissemination of this evolving knowledge to all the doctors to enable them to adopt their practice suitably poses a challenge because of the distributed nature of remote care strategies required. Doctors in the frontline will find it impossible to keep themselves abreast of the protocol updates in time. We expect this problem to become more severe as the numbers increase and the doctors do not get enough time to use the traditional paper based assessment.

Considering the above, we feel that the need of the hour is to use digital technologies to make standardized screening templates and centrally managed CDSS available to doctors on demand at patient contact points. The CDSS being centrally managed, can be kept updated with the latest protocols so that the doctor gets the correct decision support at all times.

Solution using simple screening applications & clinical decision support system

Healthelife & EHRC@IIITB are collaborating with us to solve the above problem and provide support to the front-line doctors. We are building simple COVID-19 screening applications and a COVID-19 clinical decision support system as a voluntary initiative. To make the application scalable and to ensure standards compliance, we will be building this solution on Healthelife’s EHR.Network platform. The platform also helps with the tight budget and quick turnaround required for the solution. Healthelife has also agreed to deploy their platform free of cost for a limited period to support this initiative.

The key highlights of the proposed solution are

  • Decision Support backed COVID-19 screening tool
  • Protocols curated by a panel of expert physicians
  • Simple mobile and web applications for tele-triage
  • “CDSS as a service” for 3rd party applications
  • Support for multiple protocols – state/central/custom
  • Centrally managed CDSS protocols for rapid updates across the board
  • Standards based EHR repository, useful for analysis & public health research
  • Extensible to continuing clinical management of patients
  • Dashboards & reports on screening patterns

EHRC will be developing the screening applications and making them available free of cost to any doctor or organization for use in COVID-19 screening. We also plan to offer CDSS as a service and automated screening form definitions for 3rd party applications in subsequent phases so that they can also start offering COVID-19 CDSS to their users.

DHIndia association will lead the effort at curating a panel of experts and doctors to validate the protocols that are supported by the solution.

Uniqueness of our solution

As the solution is being built on the openEHR compliant clinical data repository, the clinical data models that support the screening and CDSS can be modelled independent of the backend. This brings in enormous advantage when building a solution that needs a very high level of flexibility to evolve the data sets, protocols and decision support algorithms.

Some of the other uniqueness of the proposed solution include

  • Support for multiple evolving protocols
  • Dynamic form generation for seamless UI integration
  • Platform that is Indian EHR standards compliant
  • Coded and computable data for intelligent insights – SNOMED CT, openEHR
  • OECD “Privacy by Design” principles for data privacy
  • Implements OWASP top 10 web security guidelines

As the collaborating organizations have deployed all their existing resources and tools into this project, we have released a beta version of the mobile application for field testing. If you are interested in knowing more about the project and/or contribute to it, please feel free to contact us


AUTHOR PROFILE:

Electrical Engineer with 20+ years of entrepreneurship background. Started career with BHEL and worked with international companies in Power generation sector for 10 years before switching to entrepreneurship in technology sector. Active in the Digital Health domain since 2012, with focus on standards compliant EHR systems. Started Healthelife, the present startup in 2016 to break out of the provider centric HIT paradigm and build a person centric EHR platform that is capable of managing EHR of a person for his/her entire 80+ year life.