Table 1 Advantages of the CDSS with expected impact

Integrated management of diseases

• Main complaint and reason for consultation as entry point (symptom-based approach)

• Clinical topics were designed in a way to avoid repetitive questions in the event of an additional health problem

• Better management of a broad range of health conditions of refugees within in routine healthcare settings

• Some of the local guidelines were partially outdated and showed gaps that had to be complemented with international standard guidelines

Evidence-based decision support

• CDSS was built on national and international standard guidelines

• Integrated prompts with culturally adapted visuals, e.g. for skin diseases

• Possible diagnoses for comorbidities

• Improved diagnosis, management, awareness and knowledge of less well known conditions

• Enhanced usability of the CDSS

• Some point-of-care tests (POCTs) included in the clinical algorithms and supporting decision-making were frequently out of stock. The lack of confirmation of clinical diagnosis may have increased the referrals and generally reduced the CDSS’ added value of evidence-based support

Harmonised treatment recommendations

• Treatment advices were aligned for multiple diagnoses and adapted to local medications available (alternative treatments proposed if the first line treatment was out of stock)

• Drug recommendations were provided with automated weight-based calculation of dosages

• Reduced over prescription and over- or under dosage of medications

• Patient received treatment at health centre pharmacy

• Consideration of stock outs

• The recommended treatment was based on the restricted availability of diagnostic tests, which limited a targeted treatment. Therefore, a syndromic management was adopted to this specific setting

Pre-referral management and patient advice

• Advices for pre-referral management and treatment, and for patient management at home

• Available pre-referral management and treatment advices, which are possibly life-saving for critical conditions

• Referral was not effective due to a dysfunctional continuum of care (health centres were better equipped in terms of infrastructure und skilled health professionals than the district hospital)

Patient follow-up

• Integrated function of call up of previous visits for follow-up visits

• The patient consultation can be interrupted, e.g. for ordering a rapid test

• This function requires a functioning archiving system of patient files

Reminders and prompts

• The clinical algorithm contained reminders (patient history, examinations, investigations, diagnostic tools)

• Integrated prompts to respond to each question and to confirm key questions (e.g. weight)

• Filters to reduce typing errors

• Predefined processes prevented skipping

• Improved data quality by reducing missing and erroneous data