Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Center for Research in Reproductive Health of Campinas (CEMICAMP), Campinas, Brazil.
J Med Internet Res. 2020 Oct 1;22(10):e16355. doi: 10.2196/16355.
One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as "a document containing recommendations for clinical practice or public health policy." Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the 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 health services delivery.
The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module.
The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of 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 the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms.
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 algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman's health record, and those that are adequately fulfilled trigger messages with 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.
This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module's implementation will inform the WHO's ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.
世界卫生组织（WHO）的主要任务之一是制定指南，指南被定义为“包含临床实践或公共卫生政策建议的文件”。指南是为临床实践和公共卫生政策制定信息来源设定标准的全球标准。尽管制定指南的过程非常严格，而且指南对于设定标准也很有价值，但在当地环境和护理点实施这些标准是一个有据可查的挑战。数字技术可以实现灵活的信息管理，并有助于将指南适应不同的卫生服务提供环境。
本文详细介绍了将世卫组织产前护理（ANC）指南转化为数字决策支持和患者记录应用程序的系统和迭代过程，该应用程序称为世卫组织数字 ANC 模块，用于常规在初级卫生保健环境中使用。
世卫组织召集了一组临床和数字健康专家来开发世卫组织数字 ANC 模块，作为协助医疗保健专业人员实施世卫组织基于证据的孕妇建议的工具。世卫组织数字 ANC 模块的创建包括以下步骤：定义最小可行产品（MVP）、开发临床工作流程和算法、算法测试、开发数据字典以及创建用户界面或应用程序开发。开发过程的整体时间大约为 1 年，以达到稳定的原型并最终确定数据字典和决策支持算法的基本内容要求。
第一个输出是反映通用世卫组织 ANC 指南内容的参考软件，称为世卫组织数字 ANC 模块。其中，所有可操作的 ANC 建议都有相关的数据字段和算法来确认相关任务是否完成。如果医疗保健工作者未执行世卫组织的建议，则将其保存为女性健康记录中的待办任务，而如果充分履行了建议，则会触发带有正面强化的消息。第二个输出由开发世卫组织数字 ANC 模块的不同组件的结构化文档组成，例如数据字典和临床决策支持工作流程。
这是一种通过数字系统在卫生服务提供层面促进建议的采用和调整的新方法。预计世卫组织数字 ANC 模块将支持基于证据的实践的实施，并提供监测和监督信息；然而，需要进一步的证据来了解世卫组织数字 ANC 模块如何影响世卫组织建议的实施。此外，该模块的实施将为世卫组织正在努力创建一条途径，以在数字系统中创建适应性和集成（智能）指南提供信息，以改善卫生系统的质量、覆盖范围和问责制。
