Transitioning to Digital Systems: The Role of World Health Organization’s Digital Adaptation Kits in Operationalizing Recommendations and Interoperability Standards

Tigest Tamrat; Natschja Ratanaprayul; Maria Barreix; Özge Tunçalp; David Lowrance; Jenny Thompson; Leona Rosenblum; Nancy Kidula; Ram Chahar; Mary E. Gaffield; Mario Festin; James Kiarie; Brian Taliesin; Carl Leitner; Sylvia Wong; Teodora Wi; Hillary Kipruto; Ayotunde Adegboyega; Derrick Muneene; Lale Say; Garrett Mehl

doi:10.9745/GHSP-D-21-00320

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TABLE.

Components of the World Health Organization Digital Adaptation Kit

Component and Description	Role in the DAKs	DAK Outputs	Basis for Inclusion
1. Health interventions and associated recommendations: Overview of the health interventions and WHO recommendations included within this DAK. The list of health interventions is drawn from the universal health coverage menu of interventions compiled by WHO.	Contextualization: To understand the underlying guidance and interventions.	List of WHO Guidelines and related guidance for the DAK List of included health interventions	WHO Multisite Study
2. Generic personas: Depiction of the end users, supervisors, and related stakeholders who would be interacting with the digital system or involved in the clinical care pathway.	Contextualization: To understand the motivations and constraints of end users.	Description, competencies and essential interventions performed by targeted personas	CRDM
3. User scenarios: Narratives that describe how the different personas may interact with each other.	Contextualization: To understand how different personas interact and their potential engagement with the digital system.	Narrative of how the targeted personas may interact with each other during a workflow	CRDM
4. Generic business processes and workflows: Key processes and workflows for the identified health program area.	Contextualization and system design: To understand how activities are conducted within the health program and anchor the core data elements and decision-support logic.	Overview table presenting the key processes for the health program area Workflows for each of the processes, accompanied by annotations/notes	CRDM
5. Core data elements: Data elements required throughout the different points of the workflows and linked to terminology codes, such as ICD and other content standards.	System design and interoperability: To define the data elements required for clinical decision making or monitoring requirements, with terminology mappings to facilitate interoperability with other standards-based systems.	List of core data elements Annexed data dictionary with complete data specifications in spreadsheet format	WHO multisite study
6. Decision-support logic: Decision-support logic and algorithms in accordance with WHO guidelines.	System design and adherence to recommended clinical practice: To define the underlying algorithms and logic that need to be coded into the system.	Decision tables with inputs, outputs and triggers for each decision logic and scheduling logic for services, as a linked spreadsheet	WHO multisite study
7. Indicators and performance metrics: Core set of indicators that need to be aggregated for decision making, performance metrics, and sub-national and national reporting.	System design and programmatic monitoring: To define the calculations required for populating aggregate indicators for program management and health system monitoring derived from core data elements.	Indicators table with numerator and denominator derived from the data elements	WHO multisite study
8. Functional and nonfunctional requirements: Functions and capabilities the system must have to meet the end users’ (e.g., health workers’) needs (functional requirements).	System design: To know how the system should function to achieve the different business processes.	Illustrative list of functional and nonfunctional requirements linked to the different workflow activities and personas	CRDM

Abbreviations: CRDM, Collaborative Requirements Development Methodology; DAK, digital adaptation kit; ICD, International Classification of Diseases; WHO, World Health Organization.