04 · 21 proprietary layers
Layer 20 of 21 · Longitudinal intelligence
DecisionLedger Tracking decisions, rationale and outcomes.
Why it's needed
What was reviewed or decided, why, and what outcome was subsequently recorded?
What it draws on
2 of 8 evidence domains.
What it produces
A structured record of review, rationale and outcomes, governed by user permissions.
Why it's essential
Layer 20 of 21.
1 · What it does
What DecisionLedger does
Over months, it becomes hard to remember why a decision was made. DecisionLedger is intended to keep a structured record of what was reviewed or decided, the rationale, and what happened next — governed by the treating oncologist's approved access workflow.
2 · Scientific question
The question it addresses
What was reviewed or decided, why, and what outcome was subsequently recorded?
Intended function
Describe the decision record or history function where implemented.
3 · Data inputs and required context
What it draws on
- 06 Treatment exposure
- 03 Clinical context
Decisions, rationale and outcomes recorded by authorised users.
4 · Scientific basis
The science behind it
Scientific basis
Decision records support continuity and accountability. Their value depends on who can write to them, whether entries can be amended, and whether changes are auditable.
5 · Output and evidence sources
What it produces
Main output
A structured record of review, rationale and outcomes, governed by user permissions.
Output type
- Structured record. A governed record of what was reviewed or decided.
6 · Why it\u2019s essential
How it powers the Twin
Gives the longitudinal view its decision history and provides context at each reassessment.
Report section
7 · Why it\u2019s needed
What it changes — for doctors, patients and researchers
Clinicians
A record of decisions and rationale that stays with the case, under your access control.
Doctor & Clinical TeamPatients & caregivers
Continuity: the reasons behind earlier decisions are not lost.
Patient & CaregiverResearchers
With appropriate consent and governance, structured decision-outcome data.
Industry & Research8 · Dependencies and limitations
Limitations
- Who can enter, amend and view records must be made clear.
- Auditability may be described only if it is implemented.
9 · Review and uncertainty
How the output is handled
Output status
An AI-assisted analytical output presented as structured findings for clinician review. It becomes part of a report only after the treating oncologist has reviewed and signed it.
How uncertainty is communicated
Each entry records its author, date and any later amendment, where implemented.
10 · Claim boundary
What this layer does not establish
It records decisions; it does not make or evaluate them.
The treating oncologist owns every decision. Every Twin report is reviewed and signed by the treating oncologist, then taken to KPCIRC's Molecular Tumour Board.
KPCIRC sign-off process