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

Abstract

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 Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content.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.

The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms

“…The CDSA, comprising the clinical algorithm (ePOCT+) and software platform (medAL- suite ), described in more detail elsewhere [ 45 , 46 ], uses decision logic to guide healthcare providers through consultations based on demographic and clinical information they enter about an individual child. The algorithms are drafted by country-specific clinical algorithm development groups in consultation with MoH, based on national IMCI (0–2 and 2–59 month modules) and other relevant child health guidelines.…”

Quality of care when using a digital clinical decision support algorithm to manage sick children at primary care health facilities in Tanzania: a cross-sectional cluster randomized controlled trial (DYNAMIC study)

“…The intervention involved equipping health facilities with ePOCT+, an electronic clinical decision support algorithm on an Android based tablet (Fig 1 ), along with associated point-of-care tests (C-Reactive Protein, Hemoglobin, pulse oximetry), training, and mentorship. ePOCT+ prompts the healthcare provider to answer questions about demographics, symptoms, signs, and tests [23]. Based on the answers, ePOCT+ proposes one or more diagnoses, treatments, and management plans, including referral recommendation.…”

“…ePOCT+, a digital CDSA, was developed based on insights from two previous generations of CDSAs [21, 22], specifically addressing challenges by our CDSAs and others, such as limited scope and information technology difficulties [23]. The aim of the present study was to assess whether this CDSA associated with point-of-care tests, training, and mentorship, would improve quality of care for sick children compared to usual care, by comparing adherence to IMCI in a pragmatic cluster randomized trial.…”

A digital health algorithm to guide antibiotic prescription in pediatric outpatient care: a cluster randomized controlled trial

“…We developed ePOCT+, a new CDSA with point-of-care tests, to address these challenges 28 . The scope of ePOCT+ was expanded from previous versions of the CDSA 20 , 29 to include infants under 2 months and children up to age 14 years, and to address syndromes and diagnoses not considered by other CDSAs 30 .…”