They come from rules you can inspect.
Pharmacy is built on evidence-based practice. Markoste+ applies that same rigour to clinical decision support — structured patient data, peer-reviewed guideline databases, deterministic rule evaluation, and your own custom clinical rules. Reliable, repeatable, and reviewable every single time.
Generative AI is a powerful tool for many tasks. Clinical guideline screening is not one of them.
Three steps. No black box. Every stage transparent and reviewable.
Extract & Review
Automated parameter extraction reads your clinical report — medications, medical conditions, blood test results, eGFR, falls history, and clinical observations.
Before analysis runs, you review the extracted parameters and can adjust any value. You stay in control of what gets evaluated.
You can adjust any parameter before screening begins.
Rules Engine
Patient parameters run against a structured database of published, peer-reviewed clinical guidelines. 95 STOPP/START v3 rules. ACB burden scoring. Cascade detection. 15 evidence-based deprescribing guides.
The rules engine is 100% deterministic. No probabilistic inference. No language model generation. Pure rule evaluation against structured guideline data and any custom rules you have created.
100% deterministic. Same inputs and active rules, same output, every time.
Consistent Results
Reproducible clinical flags — every single time. STOPP flags for potentially inappropriate prescribing. START flags for omitted medications. ACB risk levels. Deprescribing guide recommendations. Your own custom rule flags.
Published flags cite their source rule and guideline. Custom flags show the rule you created, so you can review them in the context of your own workflow.
Every flag is transparent, whether published or custom.
Markoste+ is built on the same published clinical standards that pharmacists already know and trust — and lets you add your own configurable rules alongside them.
Gold Standard
O’Mahony et al., Eur Geriatr Med, 2023
73 STOPP rules · 22 START recommendations
The internationally recognised gold standard for identifying potentially inappropriate prescribing (STOPP) and prescribing omissions (START) in older adults. Version 3 (2023) is the most current iteration.
Cognitive Burden
King & Rabino, acbcalc.com, 2024
Per-drug burden scores · risk stratification
Anticholinergic Cognitive Burden scoring quantifies the cumulative cognitive and functional risk from a patient’s full medication profile. Scores of 3+ are associated with increased risk of cognitive impairment, falls, and hospitalisation.
NPS MedicineWise Endorsed
Primary Health Tasmania, 2022
15 evidence-based clinical guides
Step-by-step clinical guides covering when and how to safely deprescribe, including tapering schedules, monitoring parameters, and management of withdrawal. Endorsed by NPS MedicineWise.
Cascade Detection
Structured cascade pattern database
Precipitant → ADR → new drug identification
Detects when a medication is likely being used to treat an adverse effect caused by another medication in the patient’s profile — one of the most consistently under-recognised drivers of inappropriate polypharmacy.
Drug Classification
Continuously maintained classification database
18 drug class categories · brand → generic mapping
Brand names are normalised to generics, salts and formulations are stripped, and each drug is mapped to a standardised class for consistent, formulation-agnostic rule evaluation.
Always Current
Updated as new versions are released
STOPP/START · ACB · Deprescribing guides
As newer guideline versions are published and accepted into clinical practice, the Markoste+ CDS database is reviewed and updated. You are always working from current evidence, not a static snapshot.
Markoste+ includes key clinical resources such as STOPP/START, ACB scoring and deprescribing guides. But every pharmacist also develops a personal knowledge base over years of practice: patterns, red flags, local priorities and medicine combinations they know to watch closely.
Custom Rules let you turn that knowledge into your own Markoste+ flags. When a report is generated, Markoste+ checks your active custom rules and pops up any triggered flags for pharmacist review. Available on Professional and Founding plans, and during your free trial after you complete account registration.
Example custom rule
Flag spironolactone when potassium is greater than 5.5 mmol/L.
Set up flags that match the work you do most often, the patients you review, and the clinical risks you want to keep front of mind.
The key warnings you normally carry in memory can be applied consistently whenever a report is generated.
Custom flags are prompts for pharmacist review. You remain responsible for deciding what matters clinically for the patient.
Clinical efficacy isn't just about what you catch — it's about what never slips through.
Systematic screening checks the extracted patient parameters against the built-in STOPP/START v3 ruleset and any active custom rules. Under time pressure, cognitive load can cause even experienced pharmacists to miss a flag. Markoste+ helps keep those checks consistent.
Every pharmacist in your practice can apply the same published evidence rules, plus any custom rules your organisation chooses to configure. The same medication in the same clinical context triggers the same active rule check irrespective of who is reviewing or when.
Published flags cite the guideline name, rule code, and recommendation text. Custom flags show the rule you configured, so you can explain what triggered the prompt and decide what matters clinically.
Parameters extracted from your clinical report are presented for your review before analysis runs. Adjust any value — medications, conditions, observations, lab results. The analysis reflects what you know about the patient.
What previously required cross-referencing multiple guideline documents — STOPP criteria, ACB tables, cascade patterns, deprescribing protocols — now surfaces in seconds, structured and linked, within your existing workflow.
Markoste+ is not here to replace your clinical judgement. It is here to bring published evidence and your configured custom flags into view promptly, so your judgement is as informed as it can be.
Markoste began as a time-saving documentation tool for clinical pharmacists — AI-powered transcription so you spend less time writing and more time with patients.
It has grown into something more. Today, Markoste is the only platform in Australia that combines AI-assisted clinical documentation with a fully deterministic clinical decision support engine — built on the same evidence-based guidelines that underpin pharmacy practice.
Not just documentation. Not just scheduling. Complete clinical intelligence — from transcript to evidence-based medication review — in one platform.
Markoste Scribe
AI-powered transcription and clinical documentation
Markoste+ CDS
Deterministic clinical flags from published guidelines and configured custom rules
Analytics & Governance
Practice intelligence and clinical governance reporting
We are building something exciting for Markoste+ Custom Rules: a dedicated forum where pharmacists will be able to share the clinical rules they have created, include their references, and help other Markoste pharmacists adapt those rules for their own reporting workflows.
Over time, this will grow into a practical library of shared knowledge — turning the experience of individual pharmacists into reviewable, actionable prompts that can support better medication review across the Markoste community.
Share custom rules with references
Discover rules created by other pharmacists
Build a growing clinical knowledge library
Watch this space.
Join Australian clinical pharmacists who rely on Markoste+ for systematic medication review prompts — grounded in published guidelines and the custom rules you choose to configure, not clinical guesswork.
Australian data residency · All clinical decisions remain with the reviewing pharmacist