Decision support for health care: the PROforma evidence base
The PROforma language was developed at Cancer Research UK in order to provide a platform for clinical decision making, development of care pathways, and automating clinical processes. In this paper, the authors describe results of trials of PROforma in various settings and describe a planned trial of PROforma in a clinical setting.  PROforma has been evaluated in prescribing for common conditions, decision support in treatment of children with leukemia, selection of anti-retroviral protocols in HIV treatment, and in genetic counseling for Type 2 diabetes and breast cancer. Initial work evaluating PROforma in breast cancer used a series of cases that were evaluated by expert physicians. Use of PROforma for decision support led to a significant reduction in deviations from best practices. It is hoped that the CREDO system, using PROforma, will provide seamless care through diagnosis, treatment, and follow-up. Currently, PROforma is being evaluated in the CREDO system as a tool for decision support, care planning and management of interdisciplinary care throughout breast cancer treatment.
It is hoped that CREDO will improve communication and decrease fragmentation of care as patients are seen by both general practitioners and cancer specialists throughout treatment and follow-up. CREDO will provide data representations based on the needs of the clinician and will attempt to determine if quality and safety of care can be improved, if the system meets the needs of clinicians and administrators, and if patients have an improved experience. CREDO will be the first multi-center clinical trial of PROforma.