Em Care Newsletter 4 - December 2022

Overview

Project update 

• As we noted in a smaller update in September, we unfortunately had to postpone a planned pilot of Em Care in Iraq. This was scheduled for October but has been delayed until early next year.
• We made good progress towards both finalizing our global Digital Adaptation Kit (L2) and adapting this content to the national IMCI protocols in Iraq.
• However, we have faced some significant challenges in authoring this content as machine readable code in our FHIR Implementation Guide (L3) and in executing the content in our Em Care refence app (L4).
• The key challenges have been:
  • At the L3 level, we needed support from the FHIR community to troubleshoot and debug errors, particularly in the code which represents our decision logic (Clinical Quality Language, or CQL). The tooling available to help catch and debug errors is still maturing, and this stage has taken significantly longer than we expected.
  • At the L4 level, we also found that the Google FHIR SDK (Software Developer Kit) (on which the L4 reference app runs on Android phones) didn’t yet support key expressions within our L3 code (for example, enabling automatic calculations of age to be made from a date of birth). The Google team were very responsive, and these issues are now largely solved.  

Operational update 

• We are very close to supporting the end-to-end clinical workflow – from registration to treatment – within our L4 reference app based on the Iraq content. Once this is ready and has undergone thorough testing, we will be scheduling new dates for the pilot in Iraq.
• The work to adapt Em Care content to Cameroon, our second pilot country, started in October with desktop reviews of their national guidelines.
• A joint WHO-Swiss TPH workshop will be held from 9-14 December in Kribi, Cameroon. The objectives are to document all required adaptations to the Em Care DAK, and to ensure it is aligned with national protocols and ready for use at country level.
• The tentative dates for finalization of our L2 and L3 – at both global and country levels – and for the L4 pilots in Cameroon and Iraq, are shown in the table below

Table - Em Care key 2023 dates

* adaptations will be documented during workshop 9-14 December

Featured Story In-Focus - Interview with Dr Gillian Levine, SwissTPH

Dr Gillian Levine, Postdoctoral fellow at SwissTPH whose primary area of work is in research for new-born and young infants in low- and middle-income countries shares her perspective on clinical decision support tools. At SwissTPH she conducts research on child health to develop clinical algorithms for improving the outcomes in primary care using clinical decision support tools.

With Em Care, Dr Gillian is engaged in developing the clinical content for the app. She stated “I have worked with four different clinical decision support apps, but this is the first for emergency settings. It is exciting!”

Dr. Gillian has conducted research on clinical decision support tools in four countries—Kenya, India, Senegal and United Republic of Tanzania. Speaking about the challenges she’s faced, she explained “young infants are a small, but very important population. Collecting information is difficult because health care workers do not have experience dealing with young infants and only a relatively small number of consultations take place compared with older children.” She added “Although Ministries of Health and health care workers are receptive of different clinical decision tools, they are scared to get their information wrong.” She also mentioned that the Ministries of Health and health care workers are generally welcoming to apps like these since it adds value to their advancement in the health care field.

Speaking about Em Care, she described “The content is based on global WHO guidelines, and I’ve been working with the Ministries of Health in Iraq and Cameroon for the adaptations of IMCI in their countries.”  She hopes that Em Care’s use of IMCI guidelines will contribute to reduce mortality in every setting in the world and improve evidence based implementation of such apps in the future.

Upcoming events

• We are planning a webinar in mid to late January 2023, to share more updates on progress and provide a demo of the L4 app to those who are interested. Please keep an eye out for an invitation in the coming week or so.
• Thank you once again for all your support throughout 2022. We look forward to working together in 2023 to bring Em Care into the hands of our frontline health care workers!

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