JMIR Publications

ABSTRACT

Background:

One of the key mandates of the World Health Organization is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the gold standard in terms of information source for shaping clinical practice and public health policies. Despite the rigorous development process and 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 delivery of health services.

Objective:

To detail the systematic and iterative process to transform the WHO ANC guidelines into a digital decision-support and patient record application for routine use in primary health care settings, known as the WHO ANC reference software module.

Methods:

WHO convened a team with clinical and digital health expertise to develop a WHO digital ANC module, as a tool to assist healthcare professionals to implement 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 creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and 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/or algorithms to confirm whether the associated task was performed. Recommendations, based on WHO guidance, which were not carried out, are saved as pending tasks on the woman’s health record, and those that were adequately fulfilled receive 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 facilitating the adoption and adaptation of guidelines through digital systems at the health service delivery level. While it is expected that the WHO digital ANC module supports the implementation of evidence-based practices and provides information for monitoring and surveillance, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will serve as a basis for future efforts to develop computable guidelines in anticipation of subsequent incorporation of artificial intelligence and predictive analytics. Clinical Trial: n.a.