HealtheLife is collaborating with EHRC@IIITB & DHIndia Association to create a Clinical Decision Support System(CDSS) backed minimal triage application for front-line clinics. This application will help doctors screen suspected COVID-19 patients as per the latest National/State protocols. We will be making this  application available on mobile and web in time for the expected COVID-19 peak in India. In the second phase, we also plan to make the CDSS available as a service that any application can integrate with.

Emerging COVID-19 situation

In line with what has happened in other COVID-19 affected countries epidemiological experts estimate that India will start seeing a large increase in the near term. They also expect that new cases will continue to emerge for an extended period. Initiatives that government and organizations are taking to manage this situation include

• Front-line clinics by state governments
• IVR enabled call centres
• Telemedicine volunteer panels
• Arogya sethu self screening follow ups 
• Independent screening applications

The Karnataka govt alone runs ~700 fever clinics across the state as the first point of testing and screening. These clinics direct suspected cases to facilities such as COVID Care Centre, Dedicated COVID Health Centres and Dedicated COVID Hospitals, based on the results of the screening.

The need for a decision support system to fight COVID-19

During the triage of COVID-19 patients, the doctors are expected to quickly answer questions such as the following and make a decision on every patient

1. What is the chance of this patient being a COVID 19 patient?
2. If they are not , what are the chances of him/her becoming one?
3. Do their conditions need further investigation to decide on the management plan?
4. Do they need to be hospitalized? Or can they be treated at home?

As COVID-19 is a new condition, doctors have limited experience in it’s assessment & treatment and hence rely heavily on protocols from authoritative sources. To add to the confusion, these protocols themselves are evolving at a rapid pace, based on evidence gathered from the field. 

The rapid dissemination to and implementation by doctors, of updated protocols, poses a challenge because of the distributed nature of the above initiatives and strategies. It will be impossible for doctors in these clinics to keep themselves updated with the current official protocol and use it in their triage. 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.

To support doctors in this task they have to 

• Have easy access to standardized screening templates
• Supported by decision support that uses the updated protocols
• And available on demand at patient contact points

Solution using simple screening applications & clinical decision support system 

EHRC@IIITB, DHIndia & Healthelife are collaborating 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 ensuring standards compliance, we will be building this solution on our EHR.Network platform. The platform also helps with the tight budget and quick turnaround required for the solution. We will also be making the platform available free of cost, as required, for this public good 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

Our solution has many unique features that will complement existing solutions and provide a much required value addition in our fight against COVID-19 pandemic. These include

• Support for multiple evolving protocols
• Dynamic form generation for seamless UI integration
• Platform that is Indian EHR standards compliant
• openEHR based CDR that enables evolving, reusable & shared clinical models
• 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 

Please contact us if you are interested in being involved in the project or use the solutions offered by this project in your work. Please use this project page to get updates and latest information on this project.

More resources

• Project page – https://dhindia.org/2020/05/26/clinical-decision-support-system-for-covid-19-screening/
• Technical Architecture – https://ehr.network/the-covid-19-cdss-solution-technical-architecture-overview/
• API documentation for developers – https://cdss.ehr.network/covid/swagger-ui.html
• Post on EHRC website – https://ehrc.iiitb.ac.in/project/clinical-decision-support-solution-cdss
• Post on DHIndia website – https://dhindia.org/2020/05/14/dhindia-initiative-to-create-a-clinical-decision-support-solution-for-covid-19-screening