Chapter 3 Towards Decentralised Clinical Decision Support Systems

Abstract. The sheer quantity and complexity of medical information, even within a single speciality, is beyond the power of one person to comprehend. Clinical decision support (CDS) systems have been clearly demonstrated to improve practice by removing complexity and aiding the decision making process for clinicians. However, the specific pieces of information most rel-evant to a particular clinical decision are typically scattered over a wide range of databases, applications, journals and written notes. Centralisation of knowledge is becoming less practical as the volume and complexity of data increases. Through a motivating scenario taken from the field of cancer research, we argue against complete centralisation and towards an open, de-centralised architecture, allowing domain experts to curate and maintain their own processes and data sets. We introduce the UK-based Safe and Sound project and propose an architecture based on PROforma, a formal language for describing CDS systems and OpenKnowledge, an enabling technology for decentralised agent-based systems. We demonstrate that although more com-plex to initially model, our architecture scales with increasing complexity, is more flexible and reliable than architectures which rely on centralisation