HIFA Colleagues [*see note below]
I was able to join, remotely, the first half of the recent symposium on Clinical Decision Support Systems, held on February 8th and organised by the Swiss Tropical and Public Health Institute. It was well attended, both in person and remotely and I thought featured some highly illuminating presentations. Obviously I cannot report on the whole event but I note below a few points that particularly struck me from the morning sessions.
The first session covered the development of guidelines by WHO to assist governments and technology partners to implement WHO recommendations through incorporating them into digital systems in country settings. WHO terms these SMART guidelines [see https://www.who.int/teams/digital-health-and-innovation/smart-guidelines ]. WHO note that the process of translating and incorporating recommendations into digital systems, in line with local policies, procedures, and digital tools, can be challenging, time-consuming, and prone to error. SMART Guidelines are a new approach to representing WHO content as digital health components to preserve fidelity and accelerate uptake. [SMART = Standards-based, Machine Readable, Adaptive, Requirements-based, Testable ]
Many of the SMART guidelines are concerned, of course, with technical issues. But they also incorporate some key principles; which one hopes will be acted upon widely. For example (I quote) :
- Design with the end user. It is assumed that the implementation of digital health tools, based on the SMART Guidelines, will be adapted to the context of where the tool is deployed. This will require the implementer to work directly with health workers in their country to understand what their needs are and adapt requirements accordingly.
- Secondary use of data. Health workers are inundated with administrative tasks taking away time from delivering care and focusing on quality of care e.g. a large portion of their time is spent on reporting. Any digital tool intended for health workers should add value to health workers by increasing efficiencies. Data collected at the point of care can and should be used for reporting as well. Data required for reporting should be able to be generated from primary data collection.
Two later presentations, one on community engagement for acceptance of CDSS (Almanach), in Somalia, and another on a digital system (SysRef) for health care for refugees in Chad, provided interesting examples of application of these two principles.
The second session continued considering CDSS from the community, end-user and health system perspectives. E-health, including digital CDSS, has huge potential but implementation can run ahead of the evidence base. One of the presentations highlighted that:
- more evaluation is needed, as called for over a decade ago by WHO: see https://www.who.int/publications/m/item/call-to-action-on-global-ehealth... and in a recent Cochrane Review - Decision-support tools via mobile devices to improve quality of care in primary healthcare settings. Agarwal et al , Cochrane Database of Systematic Reviews https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012944.pub2/... )
- opportunities for enhancing more traditional, e.g. paper-based, CDSS should not be neglected, especially with a view to ensuring that health information systems focus on the decisions that health workers need to make. The talk referred to two papers:
Researching, co-creating and testing innovations in paper-based health information systems (PHISICC) to support health workers’ decision-making: mixed-methods research programme in three sub-Saharan countries ; Bosch‑Capblanch et al. Health Res Policy Sys (2021) 19:112 https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-...
and
Using and improving the PHISICC paper-based tools in the health facility laboratories: Examples of Human Centered Design taking systems thinking into practice, in Côte d'Ivoire and Nigeria. Ekpenyong et al , Frontiers Public Health. 2022 Sep 15;10:916397. https://www.frontiersin.org/articles/10.3389/fpubh.2022.916397/full )
both which I would recommend to anyone involved in work on CDSS.
Best Regards
Geoff Royston
HIFA profile: Geoff Royston is an Independent Health Analyst and Researcher, former Head of Strategic Analysis and Operational Research in the Department of Health for England, and Past President of the UK Operational Research Society. His work has focused on informing the design, implementation and evaluation of policies and programmes in health and social care, and on fostering the capabilities of others to work in these areas. Associated activities have included modelling for understanding the performance of complex systems, analysis and communication of risk, and horizon scanning and futures thinking. He has also worked on information and communication technology in the health sector, notably in leading the design and national launch of the telephone and online health information and advice service NHS Direct. He has served on both scientific and medical UK Research Council panels, and as an impact assessor for the UK higher education Research Excellence Framework. He is a member of the editorial board for the journal Health Care Management Science and in 2012 was Guest Editor for its special issue on Global Health. He has been a consultant for the World Health Organisation, is a long standing member of the EURO Working Group on Operational Research Applied to Health Services, and is an expert adviser to the mHIFA (mobile Healthcare Information for All) programme. http://www.hifa.org/projects/mobile-hifa-mhifa He is also a member of the main HIFA Steering Group and the HIFA working group on Evaluating the Impact of Healthcare Information.
http://www.hifa.org/support/members/geoff
geoff.royston AT gmail.com
[*Note from HIFA moderator (NPW): Many thanks Geoff, it's wonderful to read reflections from HIFA members who have attended events such as this. I see that all the presentations from the event are now available on the Swiss Tropical and Public Health Institute website: https://www.swisstph.ch/en/about/events/cdss-symposium-2023 ]
