Redesign of Clinical Decision Systems to Support Precision Medicine

Clinical decision systems (CDSs) showed promising results in different areas including reminder systems, diagnostic, drug dose, prescription, and other pharma related domains. However, many aspects are subject to rethink and redesign in the era of precision medicine. Current clinical decision systems are more focusing to serve one or the other area of clinical care, imparting individualistic characteristics of a single and probably an isolated domain or sub-domain. While precision medicine requires a comprehensive data and knowledge for making precise decisions. The comprehensive knowledge shall contain information about disease sub-types, disease risk, diagnosis, therapy, and prognosis. Building such a comprehensive knowledge and executing queries to get the results from the decision support system may require federation at query level and integration at data level that is accumulated from different databases situated in one or more than one setup. In this paper, we research to provide an initial idea and guide of redesigning the CDS architecture in a way to serve the very need of precision medicine. We describe the limitation of existing CDSs, challenges to address them and propose a solution to address those challenges. This work may lay down a foundation for the architectures of futuristic CDSs in the era of precision medicine.