What is it about?
Electronic clinical decision support algorithms (CDSAs) are mHealth tools that guide healthcare workers through every step of the outpatient consultation to propose the appropriate diagnosis and treatment based on the entered symptoms, signs , and test results. We describe the multi-stakeholder development process of the ePOCT+ CDSA, for the management of sick pediatric outpatients in Tanzania, Rwanda, Kenya, Senegal and India. The development process took in account the most frequent illnesses healthcare workers manage in the setting of implementation, reliability and feasibility of the clinical inputs, and the clinical precision of the algorithms. In addition we describe the development of the medAL-suite, a software to easily develop and deploy CDSAs. The software was made by clinicians and IT specialist specifically for CDSAs keeping in mind the needs of clinicians using the software to develop CDSAs, or to manage patients at the bedside. medAL-creator uses a drag and drop interface to assure that the algorithms are human readable to improve interpretability and transparency of the clinical algorithms. While medAL-reader, follows the steps of healthcare workers to support them in determining the correct diagnosis and treatment.
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Why is it important?
ePOCT+ has been deployed in over 200 health facilities in Tanzania, Kenya, Rwanda, Senegal, and India. Understanding the development process is important for stakeholders and the wider digital health community to interpret future findings of ePOCT+. In accordance with the principles of digital development we hope other digital health actors can benefit from lessons learnt from this process. Notable lessons learnt, outline the importance of: 1) Including a multi-disciplinary group of stakeholders including stakeholders from the country of implementation 2) Adapting clinical algorithms to meet the clinical needs of healthcare workers 3) Adapting clinical algorithms to assure feasibility, accessibility, reliability and reliability 4) Performing usability tests, and piloting to improve user interface and user experience of the digital tools 5) A software specifically designed for healthcare workers to be able to easily develop and use the CDSAs for their specific practices
Perspectives
The development of ePOCT+ and the medAL-suite was a challenging and rewarding exercise. It was a real pleasure collaborating with such a diverse multi-disciplinary international group to assure that the clinical algorithm and software meets the needs of the diverse settings it is meant to be used in. The final product is far from what was initially conceived, demonstrating the meaningful contribution from all within this process; and will likely continue to evolve as ePOCT+ and the medAL-suite continues to be used.
Rainer Tan
Centre for Primary Care and Public Health (Unisanté), University of Lausanne
Read the Original
This page is a summary of: 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, PLOS Digital Health, January 2023, PLOS,
DOI: 10.1371/journal.pdig.0000170.
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