SMART Guideline Implementation: ANC DAK
Summary of the Problem
WHO expert groups want to get best-practice guidelines out into the real world, fast, and update those guidelines as medical knowledge changes. This currently takes years.
2 Central Hypotheses:
1) The OpenMRS 3 framework allows content like that in the ANC DAK to be quickly created into a new sample "ANC package"; and,
2) Understanding In-Country Content Decision Makers' needs and workflows is mission-critical for successful DAK & O3 package adoption even beyond ANC.
OpenMRS, AMPATH, Mekom, and PIH are being supported by Digital Square's Notice F Award to coordinate design of a DAK-Based OpenMRS 3.x ANC Package that:
meets ANC DAK core dictionary, functional, and non-functional requirements
has the decision support component of the ANC DAK
has program indicators
Design: Design related deliverables include published results from user research/assessment and designs for whatever we prioritise.
Links to Know
Key Contacts: @suruchi dhungana (Product Manager) & Paul Adams (UX Designer)
Communication: Slack channel #anc (most discussion and updates are happening in slack)
Issue Tracker: Jira Board here (all issues with label "ANCDAK")
Designs: Pending
Timeline: June 2022-June 2023
The ANC DAK contains the content needed to execute WHO-recommended ANC care guidelines, such as: workflows, medical codes, decision support rules, metrics, and functional requirements.
Our 3-Prong Approach
Image source file here.
Open Questions
How do we expect the ANC DAK content to be used in the real world?
How does content decision making happen in countries: In Ministries? In Implementations? (i.e. how people decide what content/care pathways should be applied at their sites)
Detail ANC UX Design Activities timeline
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User Contact Champions
These contact points are the ones our UX+PM team can reach out to in order to organize user research/interviews etc with ideal users.
Sierra Leone: PIH (Maternal Centre of Excellence) - @Ellen Ball
TBD - Haiti or Cambodia: (Hospital/NGO with ++deliveries) - @Dimitri R
Ethiopia: Jen to f/u w/ UCSF/ICAP contacts
Actions & Decisions Log
Date | Action or Decision or Request for Information | Notes (Links, Comments, etc) |
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2022.07.27 | 2 key findings so far: (1) content not meeting minimum expectations (PIH) eg clear fetal outcome; (2) FHIR IG confusing w/ ++ broken links. Considering focusing on creating tools that would ingest L3 (FHIR IG) content automatically into OMRS. UX Proposal submitted by Sonder here, proposing OOUX approach to research. Reviewed types of Decision Support content: different information types & urgency types. Id'd gaps in existing UI Patterns in O3 to support ANC CarePlan outputs - these red gaps will be a focii for UX research, so output will be a complete toolkit. | Meeting: ANC DAK Product Vision & Roadmap Whiteboarding - All Whiteboard: https://metroretro.io/board/LBUYIYVOLJML |
2022.08.18 | After a ++helpful deep dive w/ Bryn Rhodes on the ANC FHIR IG: Decided we will not pursue a FHIR IG-based approach at this time. 2 main findings: Decision Support Engine: Learned that Bryn’s team has created an opensource Decision Support Engine, now maintaining this, Google Android SDK group is their user at the moment. We could leverage this engine for our Decision Support needs (and OMRS could then bypass need for bespoke data model update for careplan support, b/c you don't actually need careplan support to make use of the engine). Gap in Content Decision Maker Persona/Research: Seems that ANC DAK has missed a key persona: country-level content decision makers. Eg the massive lift for them to consider all this content and reconcile it with their regional requirements, funder requirements, and current data collected. Decision: this will be a critical user for us to involve in user research. | FHIR IG review with Bryn Rhodes - All Explored existing L3 resources and whether automating intake of a FHIR IG might be valuable approach. (Notes) |
2022.08.19 | Identified 9 names who informed the ANC DAK who could be starters for interviews re. "real world use" of guideline content, developing understanding of market demand/market pain points. Need follow up plan for Sept. | List here - 9 of 70 listed as informants for ANC DAK are from implementer groups |
2022.08.29 | Knowledge base amidst WHO SMART working group on content management processes at Ministry or Implementer is unclear - still a grey-area. We should proceed with plan to understand this as it has huge implications for ANC Guidelines + any other future SMART guidelines. | Joined WHO SMART Implementers' call group - Suruchi, Grace Raise awareness among the WHO working group of our work on this project, and address early questions about materials available and what user research had already been done. (Notes) |
2022.09.29 | Ellen & Wamz pick 1-2 ANC care plans from DAK as our first ones to prototype in O3 with codes, forms, and widgets (Ideal: both valuable for end users to see in testing, and relatively low effort) Current top candidates: Danger signs (1), Pre-eclampsia and HTN (17), HIV testing (8) | Need: would be helpful for our ANC grant group to do a small prototype to see the lift required to implement one of these ANC DAK Qnrs + Codes. Could also be a helpful asset for Suruchi & Paul Adams during user interviews. https://openmrs.slack.com/archives/C03GWFC9ZKQ/p1662577762775669 |
TODO | Contacted WHO - Nat to confirm no updated spreadsheet w/ more CIEL code mappings | Currently ~40 needed medical codes have mappings to CIEL in "ANC.End"; all others have no reference to CIEL in the spreadsheet resource (Web annex A: Core data dictionary). @Andrew Kanter has a version with CIEL maps (not 100% complete) |
TODO | Assign champion per country to i.d. people to interview/test |
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TODO | Review together the OHRI MCH Mindmap (to understand OHRI MCH goals & needs) |
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2022.09.13 |
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2022.09.23 | Grace met in person w/ Jembi, Regenstrief, and CDC-HQ officers in S. Africa - discussed SMART Guidelines ++. Much interest in and alignment with our 3-prong strategy (staff research, content research, engine prototype). Intellisoft Botswana interested in supporting w/ Content Decision Makers for user research → followed up. | There is growing interest by PEPFAR in wanting to fund HIV SMART L2 implementation - all very interested in this OMRS grant's work. All folks talked with agreed big need to understand in-country content reconciliation workflows, concern that alert UI to end users needs to not overwhelm esp. when ANC+HIV+NCD etc get combined, and all are +++ interested in technical findings re using the CQL engine. |
2022.09.23 | Suruchi has begun work to implement the O3 Qnrs and Codes in OCL for the Preeclampsia Care Plan. |
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2022.09.27 | Shared update on 3-fold plan (staff research, content decision maker research, and CQL engine prototype plan) with the Implementing Smart Guidelines working group with multiple WHO and DPG representatives present. | Learned: Ona seems to be implementing now as well. Google Android SDK increasingly leveraging too. A member Kashya has possibly found a way to bypass needing to "save" a FHIR Qnr - notes and screenshots here. |
2022.09.27 | Emailed Jose & Bryn about contact for support re. trialing the CQL engine. |
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2022.09.27 | Design Roadmap discussion - Jen Grace Ciaran Paul. |
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2022.09.28 | Team meeting. Picked a Decision Support set for prototyping: High risk & educational: Pre-ecclampsia Could re-use some parts from the PLIR project that were sending data from OMRS to other server (packaging to send fhir resource from OMRS to a different FHIR server); also triggered a measure written in CQL on that FHIR server. | Followed up on support from Mozzy re recent OMRS cmty work on something involving CQL: Later versions of the Hapi FHIR JPA Server (5.3.0 +) come with an embedded CQL engine . https://talk.openmrs.org/t/anc-dak-setting-up-a-prototype-with-the-cql-decision-support-engine/37630/4
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2022.09.30 | Intro interview w/ Dr. Astrid | |
2022.10.07 | Discussion w/ Derek Ritz |
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2022.10.11 |
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2022.10.12 | Digital Square Check-in |
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2022.10.14 | Interview w/ Dr Astrid | |
2022.10.26 | ANC DAK SMART call | |
2022.11.08 | ANC Squad call with WHO Reps |
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2022.11._ | Meeting with Alex Goel (company & CDS builder tools using Encender) |
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2022.11.10 | Meeting with Google Health - FHIR SDK team | |
2022.11.__ | Debrief w/ Derrick Ritz |
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2022.11.10 |