The Right Decision Service is the national decision support service for Scotland’s health and social care.  Its mission is to provide a ‘Once for Scotland’ source of digital tools that enable health and care staff and citizens to make safe decisions quickly ‘on the go,’ based on validated evidence. These decision support tools put evidence into the hands of staff and citizens by working through day-to-day technology – web and mobile apps, and embedding in electronic care systems.

Support for national strategic priorities

Delivery of the Right Decision Service is endorsed by Scottish Government Digital Health and Care as a key objective within Scotland’s Digital Health and Care Strategy and the Health and Social Care Data Strategy.  The national Vision for Value-Based Health and Care and the Action Plan for Value-Based Health and Care  underline the role of the Right Decision Service as a key enabler of safe and timely care, improving consistency in practice and  helping to maximise benefit from existing resource.

National roll-out and transition to Healthcare Improvement Scotland

The Right Decision Service was originally developed in its pilot form, and implemented with early adopters, by the Digital Health and Care Innovation Centre. Scottish Government Digital Health and Care is now funding a three-year national scale-up, from April 2022 to end of March 2025. A key element of this national roll-out is transitioning of ownership of the Right Decision Service to Healthcare Improvement Scotland. The Right Decision Service now sits within the Evidence and Digital Directorate of Healthcare Improvement Scotland.  This is helping to embed the Right Decision Service as a mainstream NHS resource and is laying foundations for delivery as a long term core NHS service.

Components of the Right Decision Service

The Right Decision Service comprises:

• A national platform which delivers web and mobile decision support tools via the Once for Scotland RDS app and website and decision support integrated with electronic care record systems.
• A ‘no-code’ decision support builder toolset. This enables trained editors in local and national teams to translate guidelines, research evidence and best practice and large datasets into computerised knowledge which is then delivered through web and mobile apps and electronic care systems.
• Governance, implementation support and training to facilitate embedding of decision support in day to day activities across health and social care.

Adoption at scale

During the first year of the national roll-out programme, the Right Decision Service already provided evidence of  adoption at scale:

• 12 of the 14 territorial boards, 6 health and social care partnerships, 4 national NHS Boards, 3 national social care organisations, 8 national programmes, are using the RDS to deliver decision support tools that support their priorities.
• Over 150 tools are delivered through the Right Decision Service platform, packaged into web and mobile apps and patient-specific alerts and recommendations embedded in electronic care systems.
• Between 1 January and mid-December 2022, the Right Decision Service as a whole received 1,005,865 unique users and 6.5 million page views. This includes several apps that went live only between April and September 2022.
• NHS Tayside and NHS Lothian have embarked on organisation-wide implementation of the Right Decision Service high risk prescribing decision support in primary care E H R systems. NHS Ayrshire and Arran, NHS Forth Valley, NHS Greater Glasgow and Clyde, NHS Dumfries and Galloway have approved pilots as a precursor to wider roll-out.

Supporting value-based health and care priorities

The Right Decision Service delivers a range of tools that support top priorities for value-based health and care priorities

• Urgent and unscheduled care – including web-based decision support for patient flow in emergency care; a web and mobile app to support primary care practitioners in paediatric unscheduled care; and patient-specific alerting to prevent medicines-related harm and emergency admissions.
• Integrated care – including a web and mobile app to support assessment, management, timely escalation and reporting around deteriorating residents in care homes; access to adult support and protection guidance.
• Improving routine care – Translation of national and local guidelines and pathways from 11 territorial boards, 4 national Boards and 8 national programmes into decision-ready format and delivering them into the hands of practitioners through web and mobile apps.
• Supported self-management and shared decision-making. Tools delivered so far include shared decision-making web and mobile toolkits for long COVID – led by SIGN; dementia wellbeing and medicines management (led by SG Effective Prescribing).

A survey in January 2023 of 36 Right Decision Service Leads across 12 organisations showed that the Right Decision Service is enabling safer, better quality care and better use of available resource:

• 79% of RDS Leads indicate that RDS tools are already improving patient safety in their organisations.
• 74% advise that RDS tools have improved quality of patient care, and 65% indicate that they are driving up consistent evidence-based practice.

Examples include:

• The proportion of junior doctors in NHS GGC able to find the correct paediatric guideline for a series of clinical scenarios rose from 22% pre-RDS to 84% post-RDS.
• “Utilised frequently during anaesthetic emergencies, during covid pandemic, management of complex patients in Operating Room.”
• “Targeting high risk individuals to make prescribing safer.” In the following videoclip,  Dr Scott Jamieson describes the benefits to patient safety and quality of care of the high risk prescribing decision support tool embedded in electronic health record systems.

•  77% confirmed that RDS tools are enabling better use of available resource.
• 64% reported that RDS tools are saving staff time
• 62% stated that RDS tools have reduced costs.

Examples include:

• “Streamlining access to guidance and evidence-based decision support so that it is instantly accessible when and where clinicians need it.”

• “The flow navigation decision support tool has helped identify increasing numbers of patients who can be managed via a non-admitted pathway.”