The Clinical Intent Flow ensures that the clinical purpose for accessing information, issuing an alert, making a referral, or requesting action is explicit when care moves between teams or organisations.
Without explicit clinical intent, systems optimise for activity rather than appropriateness. Data is accessed because it is available. Alerts fire because thresholds are crossed. Referrals move because pathways exist — not because the clinical purpose is clear to the receiving team.
In distributed care, intent cannot be safely inferred from context. It must be declared.
Governance responsibilities
The Clinical Intent Flow establishes clear governance responsibilities whenever clinical actions or information cross organisational boundaries.
This includes:
- responsibility for declaring the clinical purpose of an access, referral, alert, or request
- visibility of declared intent to receiving clinicians and services
- traceability between intent, action taken, and outcome
- support for data minimisation based on declared purpose, without restricting clinical judgement
Clinical Intent governance ensures that actions are assessed by appropriateness, not volume — and that clinical decisions remain defensible and reviewable when care spans organisations.
Common failure modes
When clinical intent is implicit or assumed, predictable failure modes emerge:
- Data accessed without a clear clinical purpose. Information is technically available, but clinically unjustified.
- Alerts that signal activity rather than need. Systems optimise for sensitivity, generating noise instead of decision support.
- Referrals received without decision context. Receiving teams cannot tell what problem they are being asked to solve.
- Care delivered for convenience rather than necessity. Pathways substitute for judgement when intent is unclear.
- Post-incident reviews cannot establish why actions occurred. Activity is visible. Clinical reasoning is not.
These are not clinician failures. They are failures of intent governance.
Clinical safety implications
Data Coordination Board (DCB) 0129 / 0160 framing
From a clinical safety perspective, the Clinical Intent Flow mitigates systemic hazard classes associated with inappropriate, unnecessary, or misdirected care — particularly in distributed, multi-organisation pathways.
In DCB 0129 / 0160 terms, these hazards include:
- Actions taken without clear clinical justification. Activity occurs, but purpose is absent or ambiguous.
- Alerts acted upon without understanding their decision intent. A response is triggered, but the reasoning behind it is not transferred.
- Information accessed beyond what is required for care delivery. Data minimisation fails because intent is unstated or implicit.
- Escalation pathways triggered without ownership of the underlying decision. Responsibility moves, but clinical rationale does not.
By making clinical purpose explicit at runtime, the Clinical Intent Flow enables safety cases to assess appropriateness, not just correctness — and supports clinical assurance across organisational boundaries without centralising control or constraining professional judgement.
Clinical Intent failures often cascade into Alert & Responsibility failures — when purpose is unclear, alerts cannot be correctly prioritised, and responsibility for acting on them becomes ambiguous.
What this feels like in practice
When clinical intent is explicit, clinicians notice immediately:
- You understand why information was shared, not just that it was
- Alerts feel relevant rather than interruptive
- Referrals arrive with decision context, not just history
- You spend less time second-guessing and more time deciding
- Safety reviews focus on judgement, not reconstruction
This is not bureaucracy. It is clinical reasoning made visible.
What this is not
The Clinical Intent Flow is not:
- a workflow engine
- a utilisation management tool
- a productivity or throughput metric
- a constraint on clinical autonomy
It does not dictate what decision to make.
It ensures that the clinical reason for making a decision is explicit when care, information, or responsibility crosses organisational boundaries.
That distinction matters: governance of intent, not control of outcomes.
Future iterations will add worked examples and assurance artefacts as the framework is applied in practice.