PLOS Digital Health (Jan 2023)

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.

  • Rainer Tan,
  • Ludovico Cobuccio,
  • Fenella Beynon,
  • Gillian A Levine,
  • Nina Vaezipour,
  • Lameck Bonaventure Luwanda,
  • Chacha Mangu,
  • Alan Vonlanthen,
  • Olga De Santis,
  • Nahya Salim,
  • Karim Manji,
  • Helga Naburi,
  • Lulu Chirande,
  • Lena Matata,
  • Method Bulongeleje,
  • Robert Moshiro,
  • Andolo Miheso,
  • Peter Arimi,
  • Ousmane Ndiaye,
  • Moctar Faye,
  • Aliou Thiongane,
  • Shally Awasthi,
  • Kovid Sharma,
  • Gaurav Kumar,
  • Josephine Van De Maat,
  • Alexandra Kulinkina,
  • Victor Rwandarwacu,
  • Théophile Dusengumuremyi,
  • John Baptist Nkuranga,
  • Emmanuel Rusingiza,
  • Lisine Tuyisenge,
  • Mary-Anne Hartley,
  • Vincent Faivre,
  • Julien Thabard,
  • Kristina Keitel,
  • Valérie D'Acremont

DOI
https://doi.org/10.1371/journal.pdig.0000170
Journal volume & issue
Vol. 2, no. 1
p. e0000170

Abstract

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 Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content.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