Digitalizing clinical guidelines: experiences in the development of clinical decision support algorithms for management of childhood illness in resource-constrained settings

Key MessagesClinical decision support systems (CDSSs)-digital tools that support health care providers to improve quality of care-have been developed by various groups to support the management of childhood illness in low- and middle-income countries.CDSSs can differ substantially because of the need for interpretation when translating narrative guidelines into decision logic.Relative to paper-based integrated management of childhood illness (IMCI) guidance, 4 CDSS developers all made adaptations to scope, content, and structure to cover a broader range of conditions, enhance precision, support rationale resource use, expedite care for severely ill children, and improve usability and acceptability.The extent of adaptations highlights the need for guideline developers to provide greater precision in their recommendations to reduce the potential for divergence from evidence-based practice during digitalization.Multistakeholder efforts are needed to build and adhere to standards for CDSS development to ensure transparency and accountability and to maximize impact on health and quality-of-care outcomes.Clinical decision support systems (CDSSs) can strengthen the quality of integrated management of childhood illness (IMCI) in resource-constrained settings. Several IMCI-related CDSSs have been developed and implemented in recent years. Yet, despite having a shared starting point, the IMCI-related CDSSs are markedly varied due to the need for interpretation when translating narrative guidelines into decision logic combined with considerations of context and design choices. Between October 2019 and April 2021, we conducted a comparative analysis of 4 IMCI-related CDSSs. The extent of adaptations to IMCI varied, but common themes emerged. Scope was extended to cover a broader range of conditions. Content was added or modified to enhance precision, align with new evidence, and support rational resource use. Structure was modified to increase efficiency, improve usability, and prioritize care for severely ill children. The multistakeholder development processes involved syntheses of recommendations from existing guidelines and literature; creation and validation of clinical algorithms; and iterative development, implementation, and evaluation. The common themes surrounding adaptations of IMCI guidance highlight the complexities of digitalizing evidence-based recommendations and reinforce the rationale for leveraging standards for CDSS development, such as the World Health Organization's SMART Guidelines. Implementation through multistakeholder dialogue is critical to ensure CDSSs can effectively and equitably improve quality of care for children in resource-constrained settings.