Matthys B, Monnier N, Ngaradoumadji M, Toubangue Y, Delcroix P, Pereira M, Schmitz T, Armour-Marshall J, Zahorka M, Sugimoto K, Léchenne M, Revault D, Wyss K, Montolnan A
Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
University of Basel, Canton of Basel Stadt, Basel, Switzerland.
BMC Prim Care. 2025 Apr 16;26(1):113. doi: 10.1186/s12875-025-02818-w.
Digital clinical decision support systems (CDSS) enhance the quality of primary healthcare service delivery for vulnerable populations in resource-limited settings. This improvement occurs by strengthening healthcare providers' clinical skills and enabling them to operate more independently while adhering to standard treatment guidelines. From January 2019 to June 2023, we developed and implemented a digital, tablet-based CDSS for children aged 2-59 months. The phases of development, validation, and implementation, as well as lessons learnt and bottlenecks requiring attention, are analysed.
The project was carried out in three primary healthcare facilities within a health district in southern Chad, covering a population of 48,000, which includes a significant number of refugees from the Central African Republic. The intended end users were nurses, nurse assistants, and midwives, with supervision provided by health district teams.
The CDSS, based on the WHO's Integrated Management of Childhood Illness (IMCI) and national guidelines, was tailored to the context of available resources and epidemiological patterns. From the outset, the active involvement of a diverse group of local, national, and international technical stakeholders (clinicians, information and communication technology (ICT) specialists, health workers, and district health authorities) facilitated mutual knowledge sharing and product co-creation processes. The CDSS was adapted to the local context, which enhanced local ownership. However, its complexity requires significant effort from clinicians and ICT specialists for development and validation. Additionally, health centres must rely on a technical infrastructure (electricity, internet connection, and server solutions).
From the outset, a participatory approach involving key stakeholders from the local to the national level of the health system significantly contributed to the successful development and implementation of the CDSS. The sustainability of such an intervention necessitates ongoing long-term commitment. This includes establishing and maintaining the infrastructure, ensuring continuous human resources and technical expertise for implementation and quality assurance, and updating content to reflect advancements in clinical medicine.
数字临床决策支持系统（CDSS）可提高资源有限环境中弱势群体的初级医疗服务质量。这种改善是通过加强医疗服务提供者的临床技能，并使他们在遵循标准治疗指南的同时能够更独立地开展工作来实现的。2019年1月至2023年6月，我们为2至59个月大的儿童开发并实施了基于平板电脑的数字CDSS。分析了开发、验证和实施阶段，以及经验教训和需要关注的瓶颈问题。
该项目在乍得南部一个健康区的三个初级医疗设施中开展，覆盖人口48000人，其中包括大量来自中非共和国的难民。预期的最终用户是护士、护士助理和助产士，由健康区团队提供监督。
基于世界卫生组织的儿童疾病综合管理（IMCI）和国家指南的CDSS，是根据可用资源和流行病学模式量身定制的。从一开始，当地、国家和国际技术利益相关者（临床医生、信息通信技术（ICT）专家、卫生工作者和地区卫生当局）的积极参与促进了相互知识共享和产品共同创造过程。CDSS适应当地情况，增强了当地的自主权。然而，其复杂性要求临床医生和ICT专家在开发和验证方面付出巨大努力。此外，健康中心必须依赖技术基础设施（电力、互联网连接和服务器解决方案）。
从一开始，一种涉及卫生系统从地方到国家层面关键利益相关者的参与式方法对CDSS的成功开发和实施做出了重大贡献。这种干预措施的可持续性需要持续的长期投入。这包括建立和维护基础设施，确保为实施和质量保证提供持续的人力资源和技术专长，以及更新内容以反映临床医学的进展。
