Expert 24 with Stellenbosch University

Better management of childhood illness in Africa through the mobilization of mobile decision support applications based on complex WHO guidelines

A social enterprise was established by Expert 24 to allow developing countries to leapfrog across the knowledge gap between doctors, health workers and patients. It is based on the Expert 24 technology platform and the Integrated Management of Childhood Illness guidelines by the World Health Organization/Unicef. Decision support of this level of sophistication is currently unavailable anywhere else in the world.

These IMCI guidelines have never before been put into a decision support system due to their scale, the fact that they are revised each year and that each country has their own version. What would have taken many man years of traditional programming took approximately six months of time by one doctor using the Expert 24 platform. The resulting system was a faithful representation of the IMCI Handbook and of the Technical Updates from the WHO/Unicef. The system was launched in South Africa through the Department of Family Medicine and Primary Care at Stellenbosch University.

The application is easy to use, as the intelligent assessment asks only what is needed and operates with a touch-screen stylus entry to answer all questions. A keypad or notepad pops up automatically for relevant questions and answers can be reviewed and changed at any point. A complete and accurate plan of care is reached, with detailed dosing and instructions. The visit record can then be printed with all notes visible. Data can be shared and updated when an internet connection is available, usually with a 3G card. The assessments, treatment and prescribing were done entirely by nurses in remote locations and the outcomes compared to a control group still using the paper assessment.

The results have shown that the new system shortened training time but also provided:

  • Excellent agreement with recommendations
  • Faster assessments with mean time reducing from 10 minutes on paper to 8 minutes 30 seconds using the Expert 24 solution
  • Helped to avoid errors and comply with guidelines
  • Ease of use and was a good active learning tool.

Allowing the rapid development of the most complex care guidelines, the Expert 24 system demonstrated a glimpse of the future in developing cost-effective, high quality, consistent healthcare with nurses and health workers taking on those tasks historically done by doctors. This project was in response to the WHO’s belief that there are 2.4 million too few physicians, nurses and midwives in the world and demonstrated the significant efficiencies and quality improvements that can be made with smart decision support. These lessons are not just relevant to the developing world and can shorten clinical encounters while improving quality and consistency of care in any health delivery system.