Table 2 Phases and activities, approaches and outcomes of the CDSS development and implementation
Phase, activity | Methodological approach | Outcome |
|---|---|---|
Situational analysis, organisational and infrastructure setup | ||
Situational analysis | • Appraisal of health management and services, infrastructure, technology, workforces and skills, and guidelines | • Better understanding of the local context |
Setup of partners, project team and infrastructure | • Setup of local office infrastructure, rehabilitation of health centres • Recruitment of project team • Collaboration agreements with key project partners | • Operational framework conditions created • IT architecture tailored to a local low-resource setting |
Setup of national expert group | • Setup and endorsement by the MoH of a national expert panel • Creation of a national technical working group (national expert panel members, national medical specialists) | • Compliance with quality assurance measures throughout project duration • Ensure adaptations to local context and setting |
Development and validation of the CDSS, content update | ||
Mapping of clinical guides and approval by national clinical specialists | • Selection and approval clinical guidelines and local priority medical conditions | • Medical conditions and reference documents for clinical algorithm development build on local needs and take into account low-resource setting |
Design, external review and approval of draft algorithms | • Clinical algorithms build on national and on standard international guides and on a symptom- and syndrome-based approach • Revision and refinement of clinical algorithms based on repeated reviews by end users and national clinical specialists | • Consideration of the local setting (epidemiological and sociocultural factors, available resources and skills, national policy) • Adaptation and formal approval of clinical algorithms |
Digitisation of algorithms, prototype piloting | • Digitisation of clinical algorithms via an automatic transcription programme • Pilot test of a CDSS prototype | • Digitised algorithms (interrogatory) are ready for testing • Functionality of CDSS tested, major issues identified |
Testing and validation | • Definition and execution of IT-related system and integration tests on interrogatory • Priorisation and scoring of clinical algorithms to be tested based on clinical diagnoses and selected key criteria (likelihood, clinical severity, epidemiological risk, knowledge) • Systematic testing of diagnoses with defined high scores • Development, review, and approval of clinical vignettes • Testing of clinical vignettes with CDSS interrogatory by clinicians • Adaptation of drawn and digitised algorithms based on feedback, repeated testing until no single issue is detected • Final review and approval of tested clinical algorithms by national clinicians | • Validation of IT logic • Priorisation of health issues for clinical testing • Clinical validation of digitised algorithms • Issues on clinical approach, diagnosis and validation of clinical vignettes identified and addressed |
Implementation and evaluation of the CDSS | ||
End user training and CDSS launch | • Preparation of training course and material • Training of national trainers and of end users • Assessment of participant’s skills via pre- and post-test • Participants feedback on training (evaluation form) • Launch of the CDSS | • National clinical, analytical and teaching skills strengthened • Participant’s evaluation to improve following trainings |
Update and content adaptation | • Regular feedback on the CDSS by end users • Technical working group of national clinical and IT specialists created to regularly update the tool | • Ensuring crucial adaptations |
Evaluation of the use | • End user satisfaction study conducted | • Evaluation of five satisfaction indicators (adaptation, adoption, acceptability, feasibility and sustainability) of the CDSS 6 and 16 months after implementation |