Dynamic Clinical Algorithms: Digital Technology Can Transform Health Care Decision-Making.

David Bell,Noni Gachuhi,Nassim Assefi

doi:10.4269/ajtmh.17-0477

Abstract

.Most health care in low-income countries is delivered at a primary care level by health workers who lack quality training and supervision, often distant from more experienced support. Lack of knowledge and poor communication result in a poor quality of care and inefficient delivery of health services. Although bringing great benefits in sectors such as finance and telecommunication in recent years, the Digital Revolution has lightly and inconsistently affected the health sector. These advances offer an opportunity to dramatically transform health care by increasing the availability and timeliness of information to augment clinical decision-making, based on improved access to patient histories, current information on disease epidemiology, and improved incorporation of data from point-of-care and centralized diagnostic testing. A comprehensive approach is needed to more effectively incorporate current digital technologies into health systems, bringing external and patient-derived data into the clinical decision-making process in real time, irrespective of health worker training or location. Such dynamic clinical algorithms could provide a more effective framework within which to design and integrate new digital health technologies and deliver improved patient care by primary care health workers.

Highlights

Two of the greatest obstacles to high-quality primary health care in low-income countries are a lack of skilled health workers and the limited access to reliable, actionable health information
Most health care in low-income countries is delivered at a primary care level by health workers who lack quality training and supervision, often distant from more experienced support
To help counteract the deficiency of physicians, in rural and remote areas, community health workers (CHWs) and mid-level providers are often deployed as physician extenders

Summary

A CONCEPTUAL FRAMEWORK FOR DATA DRIVEN CASE MANAGEMENT

To transform medical care in low-income countries into a data-driven, logical, and optimized decision-making process, a DCA system will require, at minimum, an accurate means of patient identification, digitized health care information, and a connection with referral, specialized and supervisory levels of the health care system. All the mechanisms guiding DCAs will need to be developed in close collaboration with clinicians and clinical policy makers They require integration with technology improvements and adaptions in biometric recognition, connectivity, data retrieval, together with neural network or machine-learning algorithms that can adapt clinical decision-making within parameters considered clinically safe and appropriate to the clinical and cultural context.[17] In particular, they will require a willingness to shift and accelerate decision-making processes within health systems—a process that will require political will and regulatory change. Must not impede clinic workflows.[27] biometric recognition and linking of personal data is a rapidly evolving field and opens a path for low-resource health systems to use digital technology to rapidly build the framework that is necessary to achieve more patient-centered care

CONCLUSION

Findings

SUMMARY