Clinical decision support systems (CDSS) have the potential to lower the number of unnecessary deaths of children under the age of five by helping healthcare providers and healthcare systems deliver better quality treatment in resource-constrained settings; scientists have concluded.

The scientists arrived at the conclusion after completing a review of how these systems influence the quality of care with reference to examples. They also did a review of the current and future priorities for the design, implementation and evaluation of the systems.

“CDSS, digital tools which generate recommendations for healthcare providers based on patient-specific information, show promise. By strengthening adherence to evidence-based assessment, diagnosis and management and generating high-quality data, CDSS can improve quality care - care that is effective, safe, people-centred, timely, equitable, integrated and efficient,” wrote the scientists in their paper published in the Revue Medicale Suisse journal.

With advances in digital technologies, there is growing interest in the potential of digital health to strengthen health systems. CDSS is one of the 28 different types of digital health interventions that the WHO has identified as having the potential to significantly improve the quality of care.

The digital tool generates and presents recommendations based on patient-specific information; ranging from simple information windows to complex and comprehensive decision aids that guide healthcare providers in the assessment, diagnosis and management of their patients.

Tools should reflect the evidence
While the CDSS can act on many aspects, the digital tool must accurately reflect evidence-based recommendations and meet the needs of users and the health system, the scientists said while also suggesting iterative development and evaluation of CDSS.

“In order to maximize the effectiveness of CDSSs, solutions must be designed and implemented in accordance with the principles for digital development. More than 500 people, representing more than 100 organizations, shared their thoughts on how to implement these principles, reflecting the ever-evolving nature of digital health.”

The principles for digital development include; user-centred design, understanding the existing ecosystem, designing for scale, building for sustainability, being data-driven, using an open approach (open standards, open data, open source, and open innovation), reusing and improving (adapt and enhance existing products, resources and approaches), addressing privacy and security in digital development and collaboration.

Improving care quality, collaboration is key 
“To have a lasting impact on quality of care at scale, CDSSs need to operate consistently, meet the needs of providers and health systems, and result in improvements. This involves an iterative, user-centred approach to development, including engagement, feedback, monitoring and evaluation, with goals and methods appropriate to the stage of maturity of the tool.”

The scientists also called for collaboration among Communities of Practice (CoP), such as the SADC CoP of the Geneva Digital Health Hub, the Global Digital Health Network, WHO initiatives and the coordination of digital health groups within countries and regions.

“CDSS communities need to work together to address data gaps, particularly with respect to effectiveness and cost-effectiveness at scale, while recognizing that CDSSs are only a small piece of the puzzle on the road to universal health coverage and quality of care.”

The scientists involved in the study include Fenella Beynon, Talia Salzmann, Rainer Tan and Montolnan Alladiguimbai from the Swiss TPH; Papa Faye, Aliou Thiongane and Ousmane Ndiaye from Cheikh Anta Diop University of Dakar (UCAD); Lameck Luwanda from Ifakara Health Institute; Florian Triclin from Terre des Hommes; Melissa Harper from Médecins sans frontiers (MSF); Javier Amos Elkin from International Committee of the Red Cross (ICRC); and Sophie Delaigue from Geneva Digital Health Hub.

Read the publication: https://pubmed.ncbi.nlm.nih.gov/37493115/