AFcare (AF eClinic) is a digital health platform designed by 18North for a UK-based healthcare group focused on helping patients and charities tackle Atrial Fibrillation (AF) through assisted diagnosis and treatment planning. The platform enables self-diagnosis, caregiver assistance, and medical consultation support — all via a secure, multi-tenant web application with personalized workflows.

With AFcare, 18North built a decision-tree-driven, API-centric diagnostic and treatment engine, helping users determine their AF type, assess stroke/bleed risks, and access tailored treatment options using clinical protocols.

The client — a healthcare-led group of stakeholders with experience in clinical pathways, patient engagement, and non-profit healthcare delivery — needed a platform to empower:

• Patients managing Paroxysmal, Persistent, or Long-standing AF
• Caregivers assisting elderly or dependent users
• Medical charities and practitioners offering subsidized diagnosis

Their aim was to digitize the full AF management lifecycle, from patient history capture to follow-up instructions, with transparency, security, and audit trails aligned with GDPR and NHS interoperability principles.

1. Functional Architecture

The platform is organized into three modules:

• Diagnostic Engine:
  • Stepwise questionnaire capturing: “About You”, “Medication”, “Interventions”, “Symptoms”.
  • Risk scoring: Stroke Risk, Bleed Risk.
  • Dual path for ECG+ (Direct to PAAF, PEAF, LSAF) and ECG− (Requires Symptom Scoring → QECG, 7ECG, EVNT).
  • Invokes 8 distinct decision trees (B15.1–B15.8) to derive personalized treatment end-points.
• Treatment Planner:
  • Provides user-specific medication or procedure options (e.g., rate/rhythm control, ablation).
  • Offers revisit timelines, return logic, and explanations of interventions.
• Entity-Level Offers & Free Trials:
  • Charities or practitioners configure “first X patients free” or “Y days free usage”.
  • Intelligent logic ensures offers are not consumed by returning patients.
  • Payment triggers only when eligibility expires.

1. Technology Architecture

• Frontend: HTML5, CSS3, Bootstrap, jQuery — lightweight, responsive for mobile/desktop use.
• Backend: Java 8, Spring Boot APIs, Hibernate ORM.
• Database: MySQL, with no triggers/procedures; future-proofed for reporting and archival layers.
• Security Layer:
  • CSRF protection, tokenized APIs
  • AES-level encrypted data transit
  • GDPR audit trail with user consents and session logs
• Decision Trees: Externalized in JSON/XML, parsed at runtime to ensure zero code changes for medical logic updates.
• CMS:
  • Static content (e.g., privacy, FAQs) managed via dedicated CMS
  • Clinical modules separated to avoid accidental edits

1. UI/UX and Accessibility

• Guided flows for users based on AF familiarity.
• Content blocks for “What is AF?”, “Living with AF”, and “How We Can Help”.
• Low-fidelity prototypes transformed into browser-tested responsive pages.
• Accessibility and clarity prioritized for older patients and caregivers.

• Clinical Decision Complexity: Medical treatment decisions required parsing 8+ decision trees, factoring in patient history, symptom severity, ECG results, allergies, and medication constraints.
• Non-Linear Patient Journeys: Patients could enter at various stages — first-time users, repeat diagnoses, or care-assisted sessions — each requiring contextual handling.
• Security and Compliance: Needed strong GDPR compliance, role-based access, encrypted data flow, and consent logging.
• Multi-Tenant Flexibility: Charities and practitioners needed portal-level configuration for free trials, patient caps, and white-label settings.
• Content + Clinical Separation: Static pages (About AF, FAQs) had to be editable by admins without affecting the diagnostic engine or treatment paths.

• MVP in < 6 Weeks: Full AF diagnostic cycle delivered — from history to treatment summary.
• Decision Tree Power: Medical complexity handled via lightweight, external logic — adaptable, compliant, and low-maintenance.
• Regulatory Readiness: GDPR alignment certified by independent CISA auditors.
• Multi-Tenant Portal: Charities and practitioners self-manage usage policies — boosting adoption.
• Audit and Analytics: Logging via file-based tools (e.g., log4j); analytics for patient drop-offs, page views, symptom patterns.

AFcare demonstrates how deep medical logic, user simplicity, and regulatory compliance can coexist in a unified eClinic platform. Built for scale, auditability, and patient-centric design, it now stands as a blueprint for clinical-grade, non-hospital digital diagnosis platforms.