Journal Article

medAL-suite: A software solution for creating and deploying complex clinical decision support algorithms

Tan, Rainer, Beynon, Fenella, Levine, Gillian A., Keitel, Kristina, Cleveley, Lisa, Cobuccio, Ludovico Gennaro, D’Acremont, Valérie, Kulinkina, Alexandra V., Ucak, Sinan, Kalisa, Emmanuel, Fresco, Alain, Vonlanthen, Alan, Barchichat, Emmanuel, Miauton, Alix, Faivre, Vincent, Mtebene, Ibrahim Evans, Girard, Quentin, Agrea, Peter, Norris, Martin, Renggli, Sabine, Schaufelberger, Sylvain, Thabard, Julien

2025

Overview

Background Sub-optimal healthcare quality in low-resource settings is attributed in part to poor adherence to clinical guidelines. Clinical decision support systems (CDSS) help to integrate guideline-based algorithms into logical workflows and improve adherence to evidence-based recommendations, and hence quality of care. However, the process of translating paper-based guidelines into electronic algorithmic formats is often complex, inefficient, expensive, and error-prone due to reliance on advanced software development skills and clinical knowledge. Methods In response to these challenges, we developed open-source software called the Medical Algorithm Suite (medAL- suite ), consisting of four components, with a primary goal of increasing efficiency, accuracy, and transparency of CDSS creation by giving experienced clinicians, rather than software developers, greater control over the process. At the heart of the software suite is the medAL- creator that allows clinicians to design algorithms using a code-free drag-and-drop interface. Algorithms are subsequently automatically deployed in medAL-reader to service level clinicians in health facilities. CDSS implementers use medAL- data and medAL- hub to manage configuration, versioning, and deployment. Results Since its development, the medAL- suite has been used to digitalize complex primary care guidelines and deployed in large-scale clinical studies in Tanzania, Rwanda, Kenya, Senegal, and India, leading to notable outcomes such as the reduction of inappropriate antibiotic prescriptions and improvement in care quality. Over 300,000 pediatric outpatient consultations have been completed in Rwanda and Tanzania to date using the digital algorithm. Discussion The medAL- suite focused on democratized development, process-centric design, point-of-care utility, touch-screen interface, low cost, and low power consumption to contribute to sustainable digital systems in low-resource settings. Important future developments and adaptations as the software evolves should emphasize interoperability and scalability, primarily via integrating CDSS functionality into electronic medical records for a streamlined user experience that supports improved service quality at the point-of-care. Clinical trial number Not applicable.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Algorithm / Algorithms / Authorship / CDSS / Chronic illnesses / Clinical decision making / Clinical decision support / Clinical guidelines / Clinical medicine / Clinical practice guidelines / Configuration management / Decision support systems / Decision Support Systems, Clinical - standards / Decision trees / Design / Digital health / Digital systems / Electronic health records / Electronic medical records / Guidelines / Health care facilities / Health facilities / Health Informatics / Healthcare industry software / Humans / Information Systems and Communication Service / Logic / Management of Computing and Information Systems / Medicine / Medicine & Public Health / Open source software / Pediatrics / Power consumption / Primary care / Public software / Software / Software development / Software packages / Software upgrading / Touch screens / User experience / Variables