Design of a phone-based clinical decision support system for resource-limited settings

While previous work has shown that clinical decision support systems (CDSS) improve patient care in resource-limited settings, there is little access to such systems at the point of care. Moreover, even when CDSS are available, compliance with care suggestions remain low. In this paper, we use a multi-method approach to document four failure modes that can affect CDSS implementations. Building from six iteratively derived design principles, we describe a phone-based system designed to address these failure modes. Through a formal usability evaluation, we discover six core findings that are important for implementers of mobile systems for health care providers in resource-limited settings.

[1]  C Safran,et al.  Guidelines for management of HIV infection with computer-based patient's record , 1995, The Lancet.

[2]  D D Nicholas,et al.  The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries. , 1991, Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care.

[3]  H. Lucas Information and communications technology for future health systems in developing countries. , 2008, Social science & medicine.

[4]  Paul G. Biondich,et al.  The AMPATH Medical Record System: Creating, Implementing, and Sustaining an Electronic Medical Record System to Support Hiv/AIDS Care in Western Kenya , 2007, MedInfo.

[5]  Paul G. Biondich,et al.  The OpenMRS Implementers Network , 2009, Int. J. Medical Informatics.

[6]  John F. Canny,et al.  Mobile-izing health workers in rural India , 2010, CHI.

[7]  Bradley N Doebbeling,et al.  Variation in implementation and use of computerized clinical reminders in an integrated healthcare system. , 2004, The American journal of managed care.

[8]  Paul G. Biondich,et al.  Concept Dictionary Creation and Maintenance Under Resource Constraints: Lessons from the AMPATH Medical Record System , 2007, AMIA.

[9]  M. Jacobs,et al.  Human resources for health: overcoming the crisis , 2004, The Lancet.

[10]  Mark Dybul,et al.  Rapid expansion of the health workforce in response to the HIV epidemic. , 2007, The New England journal of medicine.

[11]  Gunnar H. Nilsson,et al.  Clinical effect of computer generated physician reminders in health screening in primary health care - a controlled clinical trial of preventive services among the elderly , 2004, Int. J. Medical Informatics.

[12]  C. McDonald Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[13]  Thomas N. Smyth,et al.  Notes from the Field Stories from the Field : Reflections on HCI 4 D Experiences , 2009 .

[14]  Neal Lesh,et al.  Using Mobile Applications for Community-based Social Support for Chronic Patients , 2009 .

[15]  William DuMouchel,et al.  A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. , 1996, Journal of the American Medical Informatics Association : JAMIA.

[16]  Gaetano Borriello,et al.  Optimizing high latency links in the developing world , 2008, WiNS-DR '08.

[17]  Hamish S. F. Fraser,et al.  Informatics tools to monitor progress and outcomes of patients with drug resistant tuberculosis in Peru , 2002, AMIA.

[18]  Gaetano Borriello,et al.  E-imci: improving pediatric health care in low-income countries , 2008, CHI.

[19]  Paul G. Biondich,et al.  Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa: a prospective comparative study , 2011, J. Am. Medical Informatics Assoc..

[20]  Emily S. Patterson,et al.  Identifying barriers to the effective use of clinical reminders: Bootstrapping multiple methods , 2005, J. Biomed. Informatics.

[21]  Luiz Augusto Facchini,et al.  Health information technology in primary health care in developing countries: a literature review. , 2004, Bulletin of the World Health Organization.

[22]  Gaetano Borriello,et al.  Open data kit: tools to build information services for developing regions , 2010, ICTD.

[23]  Paul G. Biondich,et al.  Cooking Up An Open Source EMR For Developing Countries: OpenMRS - A Recipe For Successful Collaboration , 2006, AMIA.

[24]  Eva Harris,et al.  Quantitative assessment of the benefits of specific information technologies applied to clinical studies in developing countries. , 2008, The American journal of tropical medicine and hygiene.

[25]  Lakshminarayanan Subramanian,et al.  TCP behavior in sub packet regimes , 2011, PERV.

[26]  Suzanne Austin Boren,et al.  The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. , 2008, Informatics in primary care.

[27]  Ronald Rosenfeld,et al.  HealthLine: Speech-based access to health information by low-literate users , 2007, 2007 International Conference on Information and Communication Technologies and Development.

[28]  Emily S. Patterson,et al.  Research Paper: Human Factors Barriers to the Effective Use of Ten HIV Clinical Reminders , 2004, J. Am. Medical Informatics Assoc..

[29]  S. Boren,et al.  The use and effectiveness of electronic clinical decision support tools in the ambulatory/primary care setting: a systematic review of the literature. , 2008, Informatics in primary care.

[30]  B. Castelnuovo,et al.  Improvement of the patient flow in a large urban clinic with high HIV seroprevalence in Kampala, Uganda , 2009, International journal of STD & AIDS.

[31]  Paul G. Biondich,et al.  Changing course to make clinical decision support work in an HIV clinic in Kenya , 2010, Int. J. Medical Informatics.

[32]  John Canny,et al.  Research and reality: using mobile messages to promote maternal health in rural India , 2010, ICTD.

[33]  Pooja Kumar,et al.  Providing the providers - remedying Africa's shortage of health care workers. , 2007, The New England journal of medicine.

[34]  Gerald P. Douglas,et al.  The Lilongwe Central Hospital Patient Management Information System: A Success in Computer-Based Order Entry Where One Might Least Expect It , 2003, AMIA.

[35]  R. Haynes,et al.  Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. , 1998, JAMA.

[36]  D. Chadwick,et al.  Using the internet to access confidential patient records: a case study , 2000, BMJ : British Medical Journal.

[37]  Hilary Brown,et al.  Responding to the global human resources crisis , 2004, The Lancet.

[38]  D Coulombier,et al.  Use of a computerized tuberculosis register for automated generation of case finding, sputum conversion, and treatment outcome reports. , 2002, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[39]  Christopher Bailey,et al.  Information Systems for Patient Follow-Up and Chronic Management of HIV and Tuberculosis: A Life-Saving Technology in Resource-Poor Areas , 2007, Journal of medical Internet research.

[40]  A D Oxman,et al.  Changing physician performance. A systematic review of the effect of continuing medical education strategies. , 1995, JAMA.

[41]  Katharina Kober,et al.  Scaling up access to antiretroviral treatment in southern Africa: who will do the job? , 2004, The Lancet.

[42]  Kamran Siddiqi,et al.  Getting evidence into practice: what works in developing countries? , 2005, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[43]  Paul M. Aoki,et al.  Asynchronous remote medical consultation for Ghana , 2008, CHI.

[44]  D. Vassallo,et al.  Experience with a Low-Cost Telemedicine System in Three Developing Countries , 2001, Journal of telemedicine and telecare.

[45]  C. McDonald,et al.  A computerized reminder system to increase the use of preventive care for hospitalized patients. , 2001, The New England journal of medicine.

[46]  Yaw Anokwa Deploying a Medical Record System in Rural Rwanda , 2007 .

[47]  William M. Tierney,et al.  Creation and evaluation of EMR-based paper clinical summaries to support HIV-care in Uganda, Africa , 2010, Int. J. Medical Informatics.

[48]  R. Haynes,et al.  Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes , 1998 .

[49]  R. Morrow,et al.  Improving physicians' preventive health care behavior through peer review and financial incentives. , 1995, Archives of family medicine.