Transitioning to Digital Systems: The Role of World Health Organization’s Digital Adaptation Kits in Operationalizing Recommendations and Interoperability Standards

Tamrat, Tigest; Ratanaprayul, Natschja; Barreix, María; Tunçalp, Özge; Lowrance, David; Thompson, Jenny; Rosenblum, Leona; Kidula, Nancy; Chahar, Ram; Gaffield, Mary E.; Festin, Mario; Kiarie, James; Taliesin, Brian; Leitner, Carl; Wong, Sylvia; Wi, Teodora; Kipruto, Hillary; Adegboyega, Ayotunde Adenola; Muneene, Derrick; Say, Lale; Mehl, Garrett

doi:10.9745/ghsp-d-21-00320

Cited by 16 publications

(13 citation statements)

References 14 publications

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“…Furthermore, they require significant interpretation to transform into algorithms. Digital Adaptation Kits (DAKs) to guide implementers in how to interpret narrative guidelines to transform into digital platforms are currently being developed by the World Health Organization and should help address this challenge in the future [ 50 , 59 ]. Often supplementary evidence was needed to complement national and international guidelines.…”

Section: Discussionmentioning

confidence: 99%

ePOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries

et al. 2023

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Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content. To address these challenges we developed ePOCT+, a CDSA for the care of pediatric outpatients in low- and middle-income settings, and the medical algorithm suite (medAL-suite), a software for the creation and execution of CDSAs. Following the principles of digital development, we aim to describe the process and lessons learnt from the development of ePOCT+ and the medAL-suite. In particular, this work outlines the systematic integrative development process in the design and implementation of these tools required to meet the needs of clinicians to improve uptake and quality of care. We considered the feasibility, acceptability and reliability of clinical signs and symptoms, as well as the diagnostic and prognostic performance of predictors. To assure clinical validity, and appropriateness for the country of implementation the algorithm underwent numerous reviews by clinical experts and health authorities from the implementing countries. The digitalization process involved the creation of medAL-creator, a digital platform which allows clinicians without IT programming skills to easily create the algorithms, and medAL-reader the mobile health (mHealth) application used by clinicians during the consultation. Extensive feasibility tests were done with feedback from end-users of multiple countries to improve the clinical algorithm and medAL-reader software. We hope that the development framework used for developing ePOCT+ will help support the development of other CDSAs, and that the open-source medAL-suite will enable others to easily and independently implement them. Further clinical validation studies are underway in Tanzania, Rwanda, Kenya, Senegal, and India.

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Section: Discussionmentioning

confidence: 99%

ePOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries

et al. 2023

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“…Digital Adaptation Kits (DAKs) to guide implementers in how to interpret narrative guidelines to transform into digital platforms are currently being developed by the World Health Organization and should help address this challenge in the future. [49, 58] Often supplementary evidence was needed to complement national and international guidelines. This evidence should ideally be identified through systematic reviews,[59] however those are not always feasible.…”

Section: Discussionmentioning

confidence: 99%

ePOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries

Tan

Cobuccio

Beynon

et al. 2022

Preprint

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Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include its limited scope, usability, and outdated clinical algorithms. To address these challenges we developed ePOCT+, a CDSA for the care of pediatric outpatients in low- and middle-income settings, and the medical algorithm suite (medAL-suite), a software for the creation and execution of CDSAs. Following the principles of digital development, we aim to describe the process and lessons learnt from the development of ePOCT+ and the medAL-suite. In particular, this work outlines the systematic integrative development process in the design and implementation of these tools required to meet the needs of clinicians to improve uptake and quality of care. We considered the feasibility, acceptability and reliability of clinical signs and symptoms, as well as the diagnostic and prognostic performance of predictors. To assure clinical validity, and appropriateness for the country of implementation the algorithm underwent numerous reviews by clinical experts and health authorities from the implementing countries. The digitalization process involved the creation of medAL-creator, a digital platform which allows clinicians without IT skills to easily create the algorithms, and medAL-reader the mobile health (mHealth) app used by clinicians during the consultation. Extensive feasibility tests were done with feedback from end-users of multiple countries to improve the clinical algorithm and medAL-reader software. We hope that the development framework used for developing ePOCT+ will help support the development of other CDSAs, and that the open-source medAL-suite will enable others to easily and independently implement them.

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“…We were aware of related work in the FHIR community, particularly the FHIR Clinical Guidelines Implementation Guide, 34 however we did not pursue this further for this phase given our conscious decision not to focus on technical implementation standards. Our active horizon‐scanning later discovered the recent World Health Organization (WHO) Digital Adaptation Kit (DAK) 35 . The WHO DAK was designed to support multiple health domains, consistent with the WHO SMART guidelines 36,37 .…”

Section: Methodsmentioning

confidence: 99%

Modelling clinical narrative as computable knowledge: The NICE computable implementation guidance project

Scott,

Heigl,

McCay

et al. 2023

Learning Health Systems

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IntroductionTranslating narrative clinical guidelines to computable knowledge is a long‐standing challenge that has seen a diverse range of approaches. The UK National Institute for Health and Care Excellence (NICE) Content Advisory Board (CAB) aims ultimately to (1) guide clinical decision support and other software developers to increase traceability, fidelity and consistency in supporting clinical use of NICE recommendations, (2) guide local practice audit and intervention to reduce unwarranted variation, (3) provide feedback to NICE on how future recommendations should be developed.ObjectivesThe first phase of work was to explore a range of technical approaches to transition NICE toward the production of natively digital content.MethodsFollowing an initial ‘collaborathon’ in November 2022, the NICE Computable Implementation Guidance project (NCIG) was established. We held a series of workstream calls approximately fortnightly, focusing on (1) user stories and trigger events, (2) information model and definitions, (3) horizon‐scanning and output format. A second collaborathon was held in March 2023 to consolidate progress across the workstreams and agree residual actions to complete.ResultsWhile we initially focussed on technical implementation standards, we decided that an intermediate logical model was a more achievable first step in the journey from narrative to fully computable representation. NCIG adopted the WHO Digital Adaptation Kit (DAK) as a technology‐agnostic method to model user scenarios, personae, processes and workflow, core data elements and decision‐support logic. Further work will address indicators, such as prescribing compliance, and implementation in document templates for primary care patient record systems.ConclusionsThe project has shown that the WHO DAK, with some modification, is a promising approach to build technology‐neutral logical specifications of NICE recommendations. Implementation of concurrent computable modelling by multidisciplinary teams during guideline development poses methodological and cultural questions that are complex but tractable given suitable will and leadership.

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Transitioning to Digital Systems: The Role of World Health Organization’s Digital Adaptation Kits in Operationalizing Recommendations and Interoperability Standards

Cited by 16 publications

References 14 publications

ePOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries

ePOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries

ePOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries

Modelling clinical narrative as computable knowledge: The NICE computable implementation guidance project

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