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Embedding decision support across Scotland’s health and social care

The national decision support programme is a key deliverable for Scotland’s Digital Health and Care Strategy.

The programme mission is to provide a ‘Once for Scotland’ source of digital tools that empower professionals and citizens to make the best decisions possible about their health and care. 

These tools enable easy access to evidence and the practical use of that evidence tailored to people’s individual needs.

National roll-out

From 2022-2025, the Scottish Government is funding a national roll-out of the decision support programme, to embed decision support as the norm in the day to day decisions that practitioners and citizens make about health and care. The key enabler of this scale up and spread is the Right Decision Service – the Once for Scotland decision support platform which delivers decision support tools for health and social care.

The opportunity for NHS Boards, Health and Social Care Partnerships and social care organisations across Scotland to:

• Adopt and spread existing decision support tools created by the Right Decision Service.
• Work with the national team to use the Right Decision Service to build decision support tools for local priorities – e.g. around remobilisation and recovery, service transformation, strengthening community and self-management support.

5 key target areas:

1. Supporting social care in the community

Examples of decision support tools include:

• The Home Care Decisions web and mobile app to support registered care workers with assessment and management, palliative care and communicating with the wider healthcare team.
• The Adult Support and Protection app

2. Supporting urgent and unscheduled care

Examples include:

• Paediatric unscheduled care app for NHS Grampian, supporting sepsis screening, the PEWS early warning score and condition-specific pathways.
• Patient Flow Navigation Pathway Tool for call handlers taking emergency department referrals in NHS Forth Valley.
• Mobile app to support implementation of the Acute Coronary Syndrome pathway in NHS Greater Glasgow and Clyde emergency care.

3. Reducing waiting times

Developments include:

Working with NHS Greater Glasgow and Clyde to explore use of machine learning and of structured algorithms to identify highest risk patients received as urgent cancer referrals.

4. Improving routine care

Examples include:

• Eight NHS Boards are using the Right Decision Service to deliver local guidelines and pathways as web and mobile apps.
• High risk prescribing decision support alerts integrated with primary care electronic health record systems.

5. Self-management and shared decision-making

There is a growing range of decision support apps for patients and citizens, including:

• Long COVID symptom diary – enables people to record their symptoms and share with their healthcare professional.
• Dementia wellbeing app, including an interactive wellbeing diary and Getting to Know Me form to share with health and care professionals.
• Managing medicines, for people taking multiple medicines. Includes an interactive form for patients to record personal outcomes and impact of their medicines, to share with healthcare professionals for their medicines review.

Right Decision Service builder tools

The Right Decision Service provides tools to:

1. Translate guidelines, research evidence, best practice and large datasets into computerised knowledge. This includes:
   • Rules or algorithms – including calculators and scoring tools,  questions and answers that guide users to the correct recommendation
   • Visual pathways with links to supporting evidence and resources
   • Guidelines structured and formatted to highlight critical actions in decision-ready format
   • Shared decision aids for collaborative decisions by patient and professional
2. Deliver this computerised knowledge through web and mobile apps and integrated with care record systems

Examples of decision support tools delivered so far:

• Right Decision Service web and mobile apps
• Videoclip, below, showing integration of high risk prescribing decision support with primary care E H R systems

Impact

• Over 100 decision support toolkits in active use, nationally and locally
• Average of 57,254 engaged sessions annually per app
• Partnerships with 12 boards, Scottish Care, the ALLIANCE, RCGP, Macmillan, 3 Scottish Govt programmes
• Many examples of improving consistency and quality of care and improving patient safety:
  • “This is the realisation of a quest for a single portal of information …….a catalyst for smoother and more efficient patient journeys.” Associate Medical Director, NHS Lanarkshire
  • “A game-changing clinical calculator tool.” Consultant, NHS Lothian
  • “A fantastic addition to improve safe prescribing.”  GP, NHS Tayside

To discuss opportunities for your service to benefit from Right Decision Service tools, contact the Programme Director for Knowledge and Decision Support – ann.wales@dhi-scotland.com

The Right Decisions mega-app and website is the Once for Scotland go-to place for quick and easy access to tools to support health and care professionals to make safe decisions "on the go," based on validated evidence. It also supports a growing range of tools to support self-management and shared decision-making by patients, carers and members of the public. 

All resources are produced by and for Scotland’s local and national health and care organisations. 

The Right Decisions mega-app is a core component of the Right Decision Service, which is led and managed by the Digital Health & Care Innovation Centre (DHI).  

All content delivered through the Right Decisions app is owned and governed by the internal governance processes of the organisation or programme responsible for that content.

Individual Health Boards (national and territorial) are responsible for the safety of the clinical services they provide directly to patients.  This includes the provision of digital tools and services that are made available to their staff to use in the day to day delivery of clinical care. It is the responsibility of Health Boards to seek and gain assurance that any such device is fit for purpose, is being used as intended and that staff have been appropriately supported in its use. Individual clinicians equally have a professional responsibility for their clinical practice and are required to use their professional judgement in the use of any digital product either for their own use or to be used by a patient.

In order to use the Right Decision Service to deliver content, all NHS Boards are required to have a coordinated strategic approach to delivery, implementation and governance of decision support. Each Board has a Decision Support Lead to coordinate and facilitate this approach.  Services and programmes seeking to deliver content and tools through the Right Decision Service need to have a documented process in place for maintenance, review and updating of their content.

Link to:  Accessibility statement 

Link to: Browser and device compatibility statement

These statements are provided by Tactuum Ltd, the company which provides the underpinning technology for the Right Decisions platform.

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