Decentralized Web-Based Clinical Decision Support Using Semantic GLEAN Workflows

Decentralized clinical decision support (CDS), using the Web browser as a local application platform, fully decouples the CDS from vendor-specific EMR, removes reliance on server infrastructure, and does not require custom software. Using GLEAN, a clinical workflow can be loaded within aWeb browser to provide decentralized and specialized CDS at a point-of-care. To that end, GLEAN workflows include all knowledge needed for their local execution; the standards-based and secure data sharing with EMR, if needed; and detection of multimorbidity conflicts. This specialized CDS will execute all decision logic locally in the Web browser; using SMART-on-FHIR, locally entered data can be securely submitted to a FHIR-compliant EMR, and remote data can be retrieved. In such a decentralized setting, clinicians can securely collaborate on multimorbidity patients: (1) by sharing workflow traces, i.e., progression of their local workflows, other clinicians can keep appraised of their decision making; and (2) by leveraging medical online knowledge sources, conflicts (e.g., drug-drug, drug-interaction) between multimorbidity decisions can be detected and resolved.