Logiak in Digital Health

Logiak has been used extensively in digital health, but here we are not talking about anything like fitness apps: rather, we are talking about efforts to use digitalisation to improve health systems around the world. As the WHO puts it, we are talking about digital interventions for health system strengthening.

Logiak has been used in various different kinds of projects, from helping health workers provide family planning counselling in northern Tanzania, to tracking migrant workers along the Thailand/Myanmar border to ensure they get their TB treatment, to showing how the Liberian government could engage the services on private clinics in the provision of care of women through pregnancy.

There is one very central activity though for which Logiak is regarded as one of the foremost systems available and that is in the provision of clinical decision support.

MSF's eCARE

The humanitarian healthcare organisation MSF works in some of the most challenging environments in the world, including war zones and refugee camps, so that people caught up in the most appalling circumstances may nevertheless have a chance of obtaining decent healthcare.

MSF appreciates that digital technology can play a role here in augmenting and supporting the work of clinicians. Specifically, clinician decision support tools can help lead clinicians to the right evidence-based conclusions about what treatment is appropriate in any specific case.

Since 2014 pediatricians in MSF Suisse in Geneva have been using Logiak for exactly this aim: to define, deploy and maintain mobile systems for clinicians in their projects mostly in Africa initially, which embody good practice diagnosis and treatment algorithms. The overall project is called "eCARE" and is acknowledged as transformatory by MSF, receiving internal TIC funding.

The first project "eCARE Ped" (pediatric care) improves the quality of care provided for sick children, and has been shown to help reduce the prescription of antibiotics to only those circumstances where they are needed (to help combat the potentially catastrophic anti-microbial resistance).

To create eCARE Ped MSF pediatricians worked together to determine the logic of a step-by-step procedure, embodying good and realistically achievable practice, in treating a sick child. They refer to this the "eCARE Algorithm" and it is embodied in an internal reference booklet, illustrated here.

To use this algorithm in a mobile application, MSF did not engage programmers, but the clinicians themselves were able to Logiak to encode their logic and produce (and, importantly, maintain) a mobile application for clinicians.

DelphiCare in Zambia

DelphiCare is an ambitious project developed using Logiak by the University of Maryland Institute of Human Virology, supported by the U.S. Centers for Disease Control (CDC), for deployment in Zambia.

DelphiCare addresses the problem of care and treatment of children infected with HIV. The logic of this treatment is demanding and involves determining the appropriate ART (anti-retroviral therapy) for each child given the  information contained in viral load and CD4 tests, and looking longitudinally at how each child fares on the specific drug regimens.

DelphiCare incorporates clinical decision support algorithms in a system geared for the longitudinal tracking of patients. This means that not only do clinicians get support for determining which is the best treatment and how to handle HIV patients who also contract TB, but the decision support is based in part on information stored in patient record.

The following system diagram, by Dr. Douglas Watson, illustrates the various components of the system and how they work in concert to provide a solid undergirding for the diagnosis and treatment decisions of clinicians when faced with the complexity of an HIV-infected child.

As with MSF eCARE, the clinical processes are authored by University of Maryland physicians themselves. The logic of the clinical processes remains transparent and modifiable to them.