Improving Clinical Decision Support in Low-Income Regions

The combination of lightly trained doctors, under-resourced hospitals, and complex treatment protocols can sometimes result in sub-standard care for HIV patients in low-income regions. While previous work has shown that printed patient summaries with reminders improve the quality of care, reliable access to such decision support is limited. Moreover, even when summaries are available, there are no efficient mechanisms for doctors to correct serious errors found in the summaries. Supervisors of these systems also face challenges, such as depending on unreliable manual processes to monitor summary usage across geographically dispersed clinics. This dissertation describes ODK Clinic, a mobile phone application that makes patient summaries with reminders available at the point of care, enables doctors to correct mistakes in a patient's record, and empowers supervisors with detailed usage data. Informed by the results of a 90-day deployment with over 13,000 patient encounters, I present evidence of how ODK Clinic has improved clinical decision support at one of the largest HIV treatment programs in Sub-Saharan Africa.