Experiences, challenges and lessons while implementing a clinical decision support system in Botswana.

The use of information and communication technologies in healthcare has given rise to mobile health applications and services. For the developing world, mobile health has been hailed as being valuable for extending access to healthcare to underserved populations. More recently, mobile health applications support clinicians to quickly navigate decision making processes. An exemplar decision support system, VisualDx, was implemented in Botswana to provide reference materials at the point of care to support early diagnosis and management of complex dermatological conditions. This study shares experiences, challenges and lessons learnt while implementing VisualDx in Botswana. An explanatory sequential mixed methods feasibility study was conducted with 28 healthcare providers stationed at 20 clinics and hospital sites across Botswana. Nine recorded training sessions were conducted via Zoom and participants thereafter interacted with VisualDx on varying use cases. Quantitative and qualitative data were collected via surveys and a semi-structured interview per participant. Standard VisualDx App usage data was also collected. Descriptive statistics were generated and analyzed. Thematic analysis of interview transcripts was performed using Delve. Experiences, challenges and lessons learned throughout VisualDx implementation in Botswana cut across; Infrastructure, Data protection compliance, Image data quality, Continuous training support, artificial intelligence regulation, Participants' retention and Sustainable digital health funding. The implementation of VisualDx in Botswana illustrates both the value and the challenges of cross-sector and cross-border collaboration in driving adoption of eHealth tools. The lessons learned may inform future strategy for implementation of other eHealth platforms in Botswana and other similar developing countries.