DS

Core Requirement

Published

V3.0 - March 2023

DS-01.1 - Clinical Decision Overview

DS-02.1 - Decision Support Configuration

DS-03.1 - Alerts

DS-04.1 - Triage Management

DS-05.1 - Audit Logs

DS-07.3 - Alerting Senior Clinicians

DS-06.1 - Updating Decisions

DS-07.1 - Dismissing Alerts

DS-07.2 - Alerts Based on Clinical Decisions

DS-07.4 - Time Sensitive Tasks

DS-08.1 - Bespoke Alerts

DS-09.1 - Risk Based Alerts and Configuration

DCF Core Capability

As a Clinical Professional,

I want notifications of unactioned and overdue alerts and, notifications for clinical overview decision making,

So that, I can see clinical decision making adheres to best practice for the patient.

Acceptance criteria 1:

Given patient care is underway,

When notifications of care plans, pathways and protocols have been missed,

Then a clinician are reminded of these via a notification or message.

Application Function

Description

AF177 Issue alert

The ability of an application to send a clinical alert to a clinician or group of clinicians.

AF178 Escalate alert

The ability of an application to resend an alert to a relevant clinician or group of clinicians when no acknowledgement of the alert has been recorded within a configurable time period.

AF188 Escalate notifications

The ability to re-route a notification to another clinician (using pre-configured escalation rules) when no acknowledgement is received within a pre-configured timeframe.

AF315 Task Notification

The ability of the system to generate an alert when a task has not been completed within a configurable timeframe

DCF Core Capability

As a Senior Responsible Officer (SRO),

I want the appropriate users to be able to configure the decision support processes, including guidance, notifications and alerts,

So that these processes can be kept up to date with the latest clinical practices.

Acceptance criteria 1:

Given I am configuring the decision support processes,

When I save the configuration,

Then the guidance, notifications and alerts are updated for clinical users.

Acceptance Criteria 2:

Given the need to incorporate clinical guidance into the decision support configuration

When including guidance

Then such guidance should be compliant with published clinical guidelines

Supporting Application Functions

Description

AF171 Business Rules configuration

The ability of an application to support the configuration of rules based upon data which has been captured about a patient. This includes:

• Creating decision support algorithms to process data held within the application

• Setting the trigger point when algorithms should be run , e.g. when observation record, test result recorded.

• Setting the frequency upon which algorithms should be run

• Amending parameters used to set alerts

• Adding/amending variables used in algorithms

• Defining the clinicians/groups who need to receive alerts.

Standards Compliance

STD090 RCEM Clinical Guidance

DCF Core Capability

As a Clinical Professional,

I want notifications and alerts about patient preferences, patient specific risks and safety compliance, potential conflicts and anomalies, deadlines and other relevant information,

And this should be based on the relevant, evidence based, guidance, standards, and treatment options,

So that I can provide best practice clinical care as part of digital clinical workflows and care pathways.

Acceptance criteria 1:

Given when adding or modifying a patients details

When the detection of escalating risk, deteriorating clinical conditions

Then an alert is presented to the clinician to enable preventative intervention

Acceptance criteria 2:

Given when adding or modifying a patients details

When the detection of escalating risk, deteriorating clinical conditions

Electronic observation functionality is linked to Early Warning Scores (EWS), best practice guidance, or locally configured threshold

Application Function

Description

AF173 Generate clinical alerts

The ability of an application to run algorithms based upon patient data (observations, conditions, test results etc.) to proactively identify conditions or deterioration in conditions and generate clinical alerts where issues are identified (scores are beyond defined thresholds).

AF186 Clinical notification configuration

The ability of an application to enable either opt out of receiving a notification when requesting a test or to set the parameters for the specific test which would trigger a notification being sent. This function should be enabled/disabled centrally.

DCF Core Capability

As a Clinical Professional,

I want tools which support the triage and pathway allocation of patients based on best practice and evidence based guidance and, automatic detection and alerting of patients that should be transferred to a different care setting that is integrated into a digitally supported transfer of care/discharge process,

So that, patients can be transferred to a different care setting, if required.

Acceptance criteria 1:

Given when a patient transfer is considered appropriate

When the based on best practice and evidence based guidance, including

Then an automatic detection and alert is presented to the clinician

Application Function

Description

AF357 Triage support

System to provide recommendations to transfer patients based on configured best practice and evidence based guidance

• Processing must be part of a fully electronic transfer/discharge process

• System will generate appropriate alerts and manage workflow to capture clinical acknowledgement and approval/override

DCF Core Capability

As a Clinical Professional,

I want management of decision support prompts and an audit log of the decisions taken,

So that reviews can be made of decision pathways.

Acceptance criteria 1:

Given when a review/audit of patient care

When the decision pathways are being assessed

Then a audit trail of the decision support prompts is available for review and editing

Acceptance criteria 2:

Give the need to support a full audit trail,

When including audit information

Then best practice information governance should be followed based on the prevailing standards

Application Function

Description

AF179 Decision Support Audit

The ability of an application to record when an alert is generated or responded to.

AF325 Audit Reporting

The ability of an application to be able to generate audit reports and make these available to relevant users

DCF Transformation & Innovation Capability

As a Clinical Professional,

I want decision support to have rules which are configurable,

and, to be able to update records with newly configured rules,

So that, I can adjust the level of decision support for current and ongoing cases.

Acceptance criteria 1:

Given when decision support rules are updated or changed

When the decision pathways are being review

Then decision support rules can be changed and the records updated.

Application Function

Description

AF171 Business Rules configuration

The ability of an application to support the configuration of rules based upon data which has been captured about a patient. This includes:

• Creating decision support algorithms to process data held within the application

• Setting the trigger point when algorithms should be run , e.g. when observation record, test result recorded.

• Setting the frequency upon which algorithms should be run

• Amending parameters used to set alerts

• Adding/amending variables used in algorithms

• Defining the clinicians/groups who need to receive alerts.

DCF Transformation & Innovation Capability

As a Clinical Professional,

I want, to be able to view, action or override alerts

and provide a clinical reason if the alert was overridden

So that, my judgement is not clouded by unhelpful alerts.

Acceptance criteria 1:

Given a user is sent an alert,

When the alert is received by the user,

Then the alert can be viewed, responded to or overridden

Application Function

Description

AF174 Review Patient Alerts

The ability of an application to be able to display relevant alerts to a clinician and for the clinician to be able to respond to them. The application must allow a clinician to be able to override an alert and provide a clinical reason for why the alert has been overridden which is stored against the patient record.

AF175 View and Respond to Patient Alerts

The ability of an application to flag to a user an alert when the predefined factors are met and for the user to be able to provide an auditable acknowledgement that they have actioned the alert. (Need to clarify what is required in terms of acknowledgment)

DCF Transformation & Innovation Capability

As a Clinical Professional,

I want to see alerts based on clinical condition,

and be able to adjust alerts with exceptions,

So that, I can prioritise alerts.

Acceptance criteria 1:

Given a user is sent an alert,

When an alert is received by a user,

Then the alerts will be different based on clinical condition,

and, these alerts will be able to be adjusted including creating exceptions.

Application Function

Description

AF174 Review Patient Alerts

The ability of an application to be able to display relevant alerts to a clinician and for the clinician to be able to respond to them. The application must allow a clinician to be able to override an alert and provide a clinical reason for why the alert has been overridden which is stored against the patient record.

AF175 View and Respond to Patient Alerts

The ability of an application to flag to a user an alert when the predefined factors are met and for the user to be able to provide an auditable acknowledgement that they have actioned the alert. (Need to clarify what is required in terms of acknowledgment)

DCF Core Capability

As a Clinical Professional,

I want to view alerts including their NEWS2/MEWS scores,

So that, I have early warning of deterioration in a patient's condition.

Acceptance criteria 1:

Given a senior clinician is using the system,

When an alert is generated regarding the deterioration of a patients condition,

Then a senior clinician should be alerted if the patients NEWS2/MEWS score is below a certain threshold.

Application Function

Description

AF173 Generate clinical alerts

The ability of an application to run algorithms based upon patient data (observations, conditions, test results etc.) to proactively identify conditions or deterioration in conditions and generate clinical alerts where issues are identified (scores are beyond defined thresholds).

AF178 Escalate alert

The ability of an application to resend an alert to a relevant clinician or group of clinicians when no acknowledgement of the alert has been recorded within a configurable time period.

DCF Transformation & Innovation Capability

As a Clinical Professional,

I want to view alerts for task lists and, time sensitive tasks,

So that, I am informed of delay before the time window closes.

Acceptance criteria 1:

Given a clinician is using the system,

When an alert is time sensitive,

Then alerts against task lists and, time sensitive tasks are distinguishable.

Application Function

Description

AF178 Escalate alert

The ability of an application to resend an alert to a relevant clinician or group of clinicians when no acknowledgement of the alert has been recorded within a configurable time period.

AF302 View Task List

This is the ability to create a view of outstanding tasks by Patient or Clinician

The application should allow lists to be configured including:

• Reordering, e.g. by clinical priority, time since task allocated

• Filtering, e.g. by category of task, location etc.

DCF Transformation & Innovation Capability

As a Clinical Professional,

I want configurable alerts in observations,

and, I want to be able to set bespoke alerts (alert types) and parameters,

So that, alerts are tailored to clinical needs.

Acceptance criteria 1:

Given a clinical user with the correct access is viewing observations,

When entering or reviewing observations data,

Then alerts can be configured within the observations.

Application Function

Description

AF176 Configure alerts

The ability to configure alerts based on custom parameters to ensure alerts can be tailored to clinical need for a range of scenarios

DCF Transformation & Innovation Capability

As a Clinical Professional,

I want to view alerts based on configurable risk rules and, in the order of risk stratification,

So that, I am aware and can manage risk factors in treatment.

Acceptance criteria 1:

Given the need to configure risk rules based on risk stratification

When updating or reviewing risk rules

Then risk rules can be configured based on risk stratification

Acceptance criteria 2:

Given the need to configure rules around risk

When configuring risk rules

Then such configuration should comply with the standards for Clinical Risk Management and follow published clinical guidelines

Application Function

Description

AF171 Business Rules configuration

The ability of an application to support the configuration of rules based upon data which has been captured about a patient. This includes:

• Creating decision support algorithms to process data held within the application

• Setting the trigger point when algorithms should be run , e.g. when observation record, test result recorded.

• Setting the frequency upon which algorithms should be run

• Amending parameters used to set alerts

• Adding/amending variables used in algorithms

• Defining the clinicians/groups who need to receive alerts.

AF182 Calculate Risk Scores

The ability to calculate risk scores, e.g. risk of re-admission, risk of morbidity based upon a patients medical history which can be presented to clinicians to support clinical decision making.

Standards Compliance

STD090 RCEM Clinical Guidance

STD017 Clinical Risk Management: its Application in the Manufacture of Health IT Systems

STD016 Clinical Risk Management: its Application in the Deployment and Use of Health IT Systems

The full list of standards applicable to the secondary care setting are contained at the link below

• Secondary Care Standards

The following standards apply more specifically to the requirements on this page

STD090 RCEM Clinical Guidance

STD017 Clinical Risk Management: its Application in the Manufacture of Health IT Systems

STD016 Clinical Risk Management: its Application in the Deployment and Use of Health IT Systems

STD085 The Core Information Standard

Provide Medication