SMART Guidelines Starter Kit, published by WHO. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-ig-starter-kit/ and changes regularly. See the Directory of published versions

L2 Authoring Overview

Abbreviations

Abbreviation	Abbreviated term
ANC	antenatal care
BPMN	Business Process Model and Notation
DAK	digital adaptation kit
DHI	digital health and innovations
DMN	Decision Model Notation
HMIS	health management information systems
PCPOSS	person-centred point of service system
SMART	standards-based, machine-readable, adaptive, requirements-based and testable
SME	subject matter expert
SOP	standard operating procedure
TB	tuberculosis
TPT	tuberculosis preventive treatment
UHC	universal health coverage

Objective of this SOP

The standard operating procedure (SOP) is intended to guide WHO staff and technical partners who have been engaged to create a Digital Adaptation Kit (DAK) for specific health program areas (e.g., consultants, business analysts, contracted vendors). This SOP aims to establish a standardized DAK development process so that all DAKs are presented consistently.

What is a DAK?

DAKs are operational, software-neutral, standardized documentation that distil clinical, public health and data use guidance into a format that can be transparently incorporated into digital systems. Information detailed in the DAKs reflect generic workflow processes, data and decision-support algorithms, as derived from specific health interventions and WHO guidelines and other normative products as well as associated publications for specific health areas, including WHO normative guidance, WHO normative products, WHO guidance and their normative statements. For example, among the documents reviewed for TB DAK we have “WHO consolidated guidelines on tuberculosis – Module 1: prevention (tuberculosis preventive treatment)”, “WHO consolidated guidelines on tuberculosis – Module 2: screening (systematic screening for tuberculosis disease)” but also the corresponding operational handbooks “WHO operational handbook on tuberculosis – Module 1: prevention (tuberculosis preventive treatment)” and “WHO operational handbook on tuberculosis – Module 2: screening (systematic screening for tuberculosis disease)” as well as the associated publication “Framework for collaborative action on tuberculosis and comorbidities”.

The outputs of the DAKs are intentionally generic and need to be contextualized to local policies and requirements.

Why is a DAK needed?

Evidence-based recommendations, such as those featured in WHO guidelines and other normative products, are often only available in a narrative format. Trying to adopt these recommendations often results in:

• a resource-intensive process to elaborate the normative statements into specifications needed for digital systems;
• subjective interpretation by technology partners, which can lead to inaccuracies and inconsistencies;
• inability to verify clinical content within these systems, potentially leading to adverse health outcomes and other unintended effects.

A DAK outlines the content contained in WHO guidelines and other normative products into a business requirements document to:

• provide a common language and understanding across various audiences, in particular between health programme managers and technology partners, enabling key stakeholders to have a joint understanding of the health content within the digital system, with a transparent mechanism to review the validity and accuracy of the health content;
• support adherence to evidence-based recommendations with fidelity and facilitate consistent applications and implementation of those recommendations in point-of-service services and applications;
• provide a starting point for the business requirements gathering process to accelerate the development of a person-centred point of service system (PCPOSS), reducing the time and resources needed;
• provide a benchmark of minimum requirements in a software service or application for the specified scope.

Target audience for the DAK?

The primary target audience for a DAK is:

• Health programme managers
  • Use:
    • create roadmaps and plan activities needed for the implementation of the clinical practices and policies for the health programme area;
    • estimate costs;
    • overseeing and monitoring the implementation of the clinical practices and policies for the health programme area.
• Business analysts
  • Use: apply the DAK framework in the process of translation of health-system processes and guidance documents into standards-compliant software requirements for developing PCPOSS.
• Digital health informaticians (software architects, software developers, quality assurance specialists, etc.)
  • Use:
    • estimate effort;
    • implement the DAK in machine-readable, computable format.
• Country Teams to adapt
  • Use: adapt and localize the content as per country program policies

The content therefore should keep these audiences in mind and ensure that all the DAK components offer:

• easy readability for humans;
• clarity in outputs expected, including thoughts/annotations for times when there could be overlaps or ambiguity;
• annotations for country teams and implementation teams that can help with the interpretation of guidance wherever applicable.

Uses of the DAK