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Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology

BACKGROUND: One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public...

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Autores principales: Haddad, Samira M, Souza, Renato T, Cecatti, Jose Guilherme, Barreix, Maria, Tamrat, Tigest, Footitt, Carolyn, Mehl, Garrett L, Syah, Inraini F, Shankar, Anuraj H, Tunçalp, Özge
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983224/
https://www.ncbi.nlm.nih.gov/pubmed/33001032
http://dx.doi.org/10.2196/16355
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author Haddad, Samira M
Souza, Renato T
Cecatti, Jose Guilherme
Barreix, Maria
Tamrat, Tigest
Footitt, Carolyn
Mehl, Garrett L
Syah, Inraini F
Shankar, Anuraj H
Tunçalp, Özge
author_facet Haddad, Samira M
Souza, Renato T
Cecatti, Jose Guilherme
Barreix, Maria
Tamrat, Tigest
Footitt, Carolyn
Mehl, Garrett L
Syah, Inraini F
Shankar, Anuraj H
Tunçalp, Özge
author_sort Haddad, Samira M
collection PubMed
description BACKGROUND: One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. OBJECTIVE: The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. METHODS: The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. RESULTS: The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. CONCLUSIONS: This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.
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spelling pubmed-79832242021-05-07 Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology Haddad, Samira M Souza, Renato T Cecatti, Jose Guilherme Barreix, Maria Tamrat, Tigest Footitt, Carolyn Mehl, Garrett L Syah, Inraini F Shankar, Anuraj H Tunçalp, Özge J Med Internet Res Original Paper BACKGROUND: One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. OBJECTIVE: The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. METHODS: The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. RESULTS: The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. CONCLUSIONS: This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability. JMIR Publications 2020-10-01 /pmc/articles/PMC7983224/ /pubmed/33001032 http://dx.doi.org/10.2196/16355 Text en ©Samira M Haddad, Renato T Souza, Jose Guilherme Cecatti, Maria Barreix, Tigest Tamrat, Carolyn Footitt, Garrett L Mehl, Inraini F Syah, Anuraj H Shankar, Özge Tunçalp. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.10.2020. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (https://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
spellingShingle Original Paper
Haddad, Samira M
Souza, Renato T
Cecatti, Jose Guilherme
Barreix, Maria
Tamrat, Tigest
Footitt, Carolyn
Mehl, Garrett L
Syah, Inraini F
Shankar, Anuraj H
Tunçalp, Özge
Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology
title Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology
title_full Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology
title_fullStr Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology
title_full_unstemmed Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology
title_short Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology
title_sort building a digital tool for the adoption of the world health organization’s antenatal care recommendations: methodological intersection of evidence, clinical logic, and digital technology
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983224/
https://www.ncbi.nlm.nih.gov/pubmed/33001032
http://dx.doi.org/10.2196/16355
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