Digital Adaptation Kit for Immunizations: Operational Requirements for Implementing WHO Recommendations in Digital Systems

"...focuses on providing the content requirements for person-centred point-of-service systems used in primary health care settings by health workers for the provision of immunization services."

Digital Adaptation Kits (DAKs) are part of the World Health Organization (WHO)'s SMART [Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable] guidelines initiative. This initiative aims to ensure that the content of WHO's evidence-based guidelines is accurately reflected in the digital systems being used at country level. For this DAK, the requirements are based on systems that provide the functionalities of person-centred point-of-service systems (PCPOSS) used in primary healthcare settings by health workers for provision of immunisation services. Operational outputs, such as detailed decision-support algorithms, are included as part of the DAK as practical resources that implementers can use as starting points when developing digital systems.

The primary intended audience for this DAK is health programme managers within the health ministries who will be working with their digital or health information systems counterparts in determining the health content and programme requirements for a PCPOSS or electronic immunisation registry (EIR).

Digital in nature, a PCPOSS facilitates the provision and delivery of health services to individuals (i.e. persons, clients, patients, health service users) at the point of care. A PCPOSS includes software capabilities that enable healthcare providers to access, record and update individuals' health information, as well as interactively communicate with them. The term PCPOSS encompasses various services and application types, including:
 

• Community-based information systems: Systems that "facilitate data collection and use at the community level. These applications are utilized by community-based workers who provide health promotion and disease prevention activities";
• Decision support systems: Digital "tools that combine medical information databases and algorithms with patient specific data. They are intended to provide health-care professionals and/or users with recommendations for diagnosis, prognosis, monitoring and treatment of individual patients";
• Electronic health record systems: "Secure, online system that holds information about people's health and clinical care and is managed by health workers"; and
• Personal health records: A "record of an individual’s health information in a structured digital format for a set of defined use cases over which the person has agency".

End users of PCPOSS can include all health worker occupational groups operating at all care levels, including those operating outside of formal healthcare facilities (e.g., community health workers and health volunteers).

This DAK comprises 8 interlinked components: (i) health interventions and recommendations; (ii) generic personas; (iii) user scenarios; (iv) generic business processes and workflows; (v) core data elements; (vi) decision-support logic; (vii) indicators and performance metrics; and (viii) functional and non-functional requirements. Table 1 on pages 8-9 of the resource provides an overview of each of the contributing components of the DAK, which the document elaborates. All information within the DAK represents a generic starting point, which can then be adapted according to the specific context.

One scenario for using the DAK would be a country that currently has paper-based systems they would like to digitalise. Users in this scenario may review the DAK as a starting point for streamlining the necessary data elements and decision support that should be in the optimised client-level digital system. Users may then refer to the paper-based tools to determine if there are missing fields or content that should also be included within the digital system.