HIV Digital Adaptation Kit: Business Requirements for Implementing WHO Recommendations and Standards in Digital Systems – Global

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Introduction

Background

Digital health – broadly defined as the systematic application of information and communication technologies, computing and data to support informed decision-making by individuals, health workers and health systems , to build resilience to disease and improve health and well-being (1) – is increasingly a critical enabler for health service delivery and accountability. Ministries of health have recognized the value of digital health as articulated in World Health Assembly resolution 71.7 (2) and the Global Strategy on Digital Health (3). Similarly, donors have advocated for the rational use of digital tools as part of efforts to expand service coverage and quality, as well as to promote data use and monitoring (4-6).
Despite the investments and abundance of digital systems, the transparency of health data and the logic of these digital tools or the relationship to evidence-based clinical or public health recommendations is often limited. This limited transparency not only undermines the credibility of these systems, but also hampers the possibilities for interoperability, which undermines the potential for improving continuity of care.

Evidence-based recommendations, such as those in the WHO guidelines, set standards of care and provide a point of reference to inform the content of digital systems countries are adopting. However, guidelines are often only available in a narrative format which requires a resource-intensive process to develop into the specifications needed for digital systems.
This translation of guidelines for digital systems often involves subjective interpretation by implementers and software developers, which can lead to inconsistencies or an inability to verify the content of these systems. Additionally, where digital systems exist, documentation of the underlying data and content may be unavailable or proprietary, requiring governments to start from scratch and expend additional resources each time they intend to deploy. such a system. This lack of health content documentation can lead to vendor lock-in and haphazard deployments that are not scalable or difficult to replicate in different settings.

To ensure that countries can effectively benefit from investments in digital health, “Digital Adaptation Kits” (DAKs) are designed to facilitate the precise consideration of clinical, public health and data use guidelines from the WHO in the digital systems that countries are adopting. DAKs are operational, software-independent, standards-based documentation that distills clinical, public health, and data use guidance into a format that can be seamlessly integrated into digital systems. While digital implementations include multiple factors – including (i) the health domain data and content, (ii) the digital intervention or functionality, and (iii) the digital application or communication channel to deliver digital intervention – DAKs focus primarily on ensuring the validity of health content (Fig. 1) (1, 7). Accordingly, DAKs provide the generic content required in digital systems, independent of a specific software application and with the intention that countries can customize them to meet local needs.

For this particular DAK, the requirements are based on systems that provide the digital tracking and decision support functionalities (Box 1) and include components such as personas, workflows, master data elements , decision support algorithms, planning logic and reporting indicators.
Operational outputs, such as data dictionary worksheets and detailed decision-support algorithms, are included as practical resources that implementers can use as starting points when developing digital systems.
Additionally, DAK data components are mapped to standardized terminology, such as the International Classification of Diseases (ICD), to facilitate interoperability.

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