Optimising diagnosis and management of chronic disease in primary care: an implementation study of a clinical decision support software Future Health Today.

Future Health Today (FHT) is a newly developed quality improvement and clinical decision support system software designed to overlay General Practice software. This trial involves using the Future Health Today software chronic disease modules for chronic kidney disease, diabetes and cardiovascular disease that have been developed by University of Melbourne and Western Health. The software is designed to aid screening, diagnosis and management of the inter-related cardiometabolic diseases of chronic kidney disease, diabetes and cardiovascular disease. The software has a point of care tool for use by General Practitioners. It detects information in the electronic record and flags red if the patient being seen is at risk of, has undiagnosed chronic disease or would benefit from medication optimisation. The conditions covered in this trial are cardiovascular disease, chronic kidney disease and diabetes. All recommendations are based on best practice guidelines, for example the Kidney Health Australia clinical guidelines and the Australian General Practice guidelines for diabetes, cardiovascular disease and kidney disease. The point of care tool also has direct links patient information and best practice guidelines. The second component to the software is a quality improvement tool. This enables practices to recall patients who might benefit from screening or diagnosis. An example: the practice sets up a cohort of patients with diabetes whose screening blood tests are consistent with kidney disease but do not yet have a diagnosis. The practice nurse automates a recall of these patients to see their general practitioner. During a visit the general practitioner notes the Future Health Today red flag. This will prompt them to review for a diagnosis of chronic kidney disease. It will also suggest guideline directed therapies for example an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. The decision to prescribe the medication is at the discretion of the treating doctor. The clinician can also link direct to patient information regarding kidney disease and clinical guidelines. Practices will be provided with a 1 hour video call demonstration at the start of the trial run by Future Health Today staff at Melbourne University. They are also able to attend monthly drop in software demonstration sessions as required. Participating practices will also be offered a chronic kidney disease education session (anticipated 1 hour in length) facilitated by a nephrologist and renal nurse practitioner and can arrange additional education as required. A nephrologist and renal nurse practitioner are available to practices participating in the study to assist in any clinical questions. The intervention will run for three years. In addition to clinical outcomes, use of the software via review of software analytics (e.g. clicks into the software) will also be monitored to understand adherence to the intervention and if any changes in outcomes are due to the intervention.