CONSULT: Collaborative Mobile Decision Support for Managing Multiple Morbidities

The provision of healthcare to people with long-term conditions is a growing challenge, which is particularly acute for the growing proportion of the UK population that suffers from multiple morbidities. Research has established that involving patients in the management of their own disease has long-term health benefits. Advances in wireless sensor technology means that it is practical for patients to monitor a wide range of health and wellness data at home, including blood pressure, heart function and glucose levels, without direct supervision by medical personnel. The advent of smart phone technologies, appearing widely throughout the nation's population, enables the exciting possibility of putting state-of-the-art intelligent decision-support systems into the hands of the general public. However, such sensor data is currently disconnected both from the patient context, provided by the Electronic Health Record, and from the treatment plan, based on current best-evidence guidelines and customised by the patient's GP. In cases of multi-morbidities, there is no clear strategy for combining multiple guidelines into a coherent whole. Furthermore, personalised treatment plans are rigid and do not dynamically adapt to changes in a patient's circumstances. Finally, the record of patient condition and decisions made is not routinely captured in a standardised way, preventing learning from feedback about treatment effectiveness. To address these problems, CONSULT will combine wireless "wellness" sensors with intelligent software running on mobile devices, to support patient decision making, and thus actively engage patients in managing their healthcare. Our software will use computational argumentation to help patients follow treatment guidelines and will learn details specific to individuals, personalising treatment advice within medically sound limits. Critically, the software will detect conflicts in treatment guidelines that frequently arise in the management of multiple morbidities. The software will provide advice regarding which treatment options to follow, when the conflicts can be resolved by the patient and when a resolution requires an intervention from a clinician. The software will thus help patients handle routine maintenance of their conditions, while ensuring that medical professionals are consulted when appropriate. This will enable patients to take charge of their own conditions, while being fully supported in both traditional and new ways. By routinely capturing the data provenance of the recommendations made, actions taken and the resulting patient progress, the software will provide valuable insights into the effectiveness of treatments and underlying guidelines in multi-morbidity scenarios. The technology will be evaluated across multiple dimensions in a proof-of-concept study, engaging stroke patients, their carers and medical professionals, while capitalising on King's College London's world-leading position in stroke research and its established patient groups, particularly those connected to the South London Stroke Register programme. Helping patients to govern their own care will reduce the demands made on medical professionals, while reaping the health benefits of self-management. Integrating live information from monitoring devices will make it possible to distinguish between situations that need attention from medical professionals, and those that do not, reducing the number of extra appointments that patients and doctors need to schedule. Using live information will also make it possible to detect changes in the course of a disease, allowing pre-emptive actions to be taken, and thus reducing the amount of time that someone suffering from a long-term condition may have to spend in hospital. Overall, our approach will not only provide more efficient care, but also allow care to be better tailored to the needs of each individual.