From Clinical Decision Support to Equity-Aware Decision Support: A Conceptual Architecture for Digital Health Systems

Clinical Decision Support Systems (CDSSs) are key components of modern digital health infrastructures, supporting evidence-based clinical decision-making and improving quality of care. However, most existing CDSS focus mainly on clinical outcomes and guideline adherence, with limited attention to broader health system objectives such as equitable access to care and efficient resource allocation. As health systems face growing pressures from ageing populations, multimorbidity, and constrained resources, there is an increasing need for decision-support systems that integrate equity and economic considerations. This paper proposes a conceptual framework for Equity-Aware Decision Support (EADS) in digital health systems. The framework extends traditional CDSS by incorporating three complementary intelligence layers: clinical intelligence from health data and care pathways, equity intelligence capturing socio-demographic and geographic disparities in access, and economic intelligence reflecting costs and resource utilisation. By integrating these dimensions within a unified digital health architecture, equity-aware decision support can help clinicians, healthcare managers, and policymakers identify access inequalities and improve system-level decision-making.