Mobile based decision support system for iccm program

Mobile Based Decision Support System to

Improve Child Health Care (mobile e-Health System)

Andualem Workneh, [email protected]

June – 15, 2013

For Creatic4Africa research scholarship program

organized by

CTIC Foundation

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Outline

1. Introduction

2. Statement of the problem

3. Objective

4. Related Work

5. Proposed System

6. Implementation

7. Next phase – in the target environment

8. Conclusion

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1. Introduction

In Ethiopia, a primary health care unit consist of Health centers and Health posts (HPs). In each health post, Health extension workers (HEWs) are assigned to

give health service to the community. Responsible to execute different health packages including

Integrated Community Case Management (ICCM) program …

Introduction …

ICCM program is an integrated management of childhood and newborn illness at the health post level.

The main objective of ICCM program is to reduce child mortality and

morbidity by giving better health service to children and newborns. Focuses on addressing leading causes of child mortality: pneumonia,

diarrhea and malaria And also other medical cases (malnutrition, immunization ....)

ICCM medical guideline is used for ICCM service provision

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2. Statement of the problem

While giving ICCM service to children, HEWs are expected to always use ICCM guideline. High adherence to usage of the manual guideline is very much required.

Performing diagnosis and treatment without using the guideline has a

risk of committing clinical error Medical procedures are not easy to remember (especially for less

experienced HEW)

But in the current practice, less adherence to guideline usage is observed

Statement of. Cont.

Poor medical data reporting and documentation were also observed Child’s medical case is

recorded in a paper-based form

Incompleteness and inconsistency in the medical records were observed.

Giving continuous supportive

supervision to HEWs is also a challenge Supervisors can not reach all

HEWs regularly

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Statement of. Cont.

In the current system, paper based clinical guideline is used together with a registration book

Figure 1: Paper based ICCM Clinical guideline, to assess and classify breathing problem

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3. Objective

General Objective: It is to design and develop mobile based decision support system

to help HEW to give better service in ICCM program

Specific Objective: Conduct requirement gathering (interview and field observation)

Model the ICCM guideline to electronic form with a selected modeling tools/language

Design the proposed system based on the requirement

Develop a prototype and

Pilot test the prototype in the field

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4. Related work e-IMCI:

e-IMCI is a PDA based decision support system that guide clinicians through a series of preprogrammed algorithms based on IMCI protocol.

Help to achieve High adherence to the protocol Reduce skipped steps and branching errors

It is pilot tested in Tanzania

Electronic Decision Support in the treatment of AIDS patients in South Africa: It is to support screening of HIV+ patients to determine where

they can get treatment and follow-up An electronic HIV treatment guideline is used This system is pilot tested in South Africa

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5. Proposed System

Mobile based DSS system is proposed.

It has a client-server architecture with decision support, data collection and data reporting modules

The system has the following hardware-software mapping

Figure 2: Hardware-software deployment diagram for the proposed system

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6. Implementation

The ICCM guideline is modeled with an open source business process management suite called jBPM. The electronic ICCM guideline is stored as BPMN 2.0

specification.

Figure 3: Modeled clinical guideline, to assess and classify breathing problem

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Implementation Cont.

<subProcess id="_1" name="የአተነፋፈስ ችግር ምርመራ" >

<startEvent id="_1-1" name="Start" />

<exclusiveGateway id="_1-2" name="Gateway" gatewayDirection="Diverging" />

<scriptTask id="_1-3" name="የአተነፈፍስ ችግር (Birth Asphyxia)" >

<script>kcontext.getKnowledgeRuntime().setGlobal("classification_1", "የአተነፈፍስ ችግር (Birth Asphyxia)");</script>

</scriptTask>

<scriptTask id="_1-4" name="የአተነፈፍስ ችግር የሌለው (No Birth Asphyxia)" >

<script>kcontext.getKnowledgeRuntime().setGlobal("classification_1", "የአተነፈፍስ ችግር የሌለው (No Birth Asphyxia)");</script>

</scriptTask>

<scriptTask id="_1-5" name="የአተነፈፍስ ችግር ህክምና" >

<script>treatment = "<?xml version='1.0' encoding='UTF-8'?><Treatment> <Task> ሪሰሲቴት ማድረግ ጀምሪ ..... </Task> </Treatment>";

kcontext.getKnowledgeRuntime().setGlobal("status", "red");</script>

</scriptTask>

<scriptTask id="_1-6" name="የአተነፈፍስ ችግር የሌለው ህክምና" >

.....

</script>

</scriptTask>

....

<sequenceFlow id="_1-2-_1-3" sourceRef="_1-2" targetRef="_1-3" >

<conditionExpression xsi:type="tFormalExpression" >return isNotBreathing == true || hasDifficultBreathing == true || (breathCountPerMinute < 30);</conditionExpression>

</sequenceFlow>

<sequenceFlow id="_1-2-_1-4" sourceRef="_1-2" targetRef="_1-4" tns:priority="1" >

<conditionExpression xsi:type="tFormalExpression" >return isNotBreathing == false && hasDifficultBreathing == false && (breathCountPerMinute >= 30);</conditionExpression>

</sequenceFlow>

.....

</subProcess>

Modeled ICCM guideline in BPMN 2.0 specification

Figure 4: Modeled Clinical guideline in BPMN 2.0

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For the client-side, Android based smart phone was selected. Android is chosen because

It is based on an open-source platform and has better localization capability,

Availability of tools like ODKCollect, a mobile based data collection framework, and an Amharic virtual keyboard for data entry.

For the server-side, Django web framework were used to develop the web-based application.


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Client-Side system

Assessment – Classification – Treatment (based on the electronic guideline)

Edit filled medical records

Send filled medical record to server

Download new rule, forms, and feedbacks given from server

Delete existing medical records

Figure 5: Client side system which is running on a mobile phone. List of client-side functionalities


Assessment: Questions for

assessing medical case of the child is displayed one by one.

Xform technology is used to develop the form

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Figure 6: Assessment questions (a) open-ended question with Amharic virtual keyboard. (b) Close-ended question

a. b.


Suggested medical case classifications and treatment procedures:

The mobile application classifies the medical case of the child based on assessment made and the electronic medical guideline.

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a. b.

Figure 7: (a) suggested case classifications . (b) suggested treatment procedures for a

particular medical case

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Implementation Cont. Server-side system:

Medical history of the child is compiled at the server side. For this purpose, ID is given to each child to uniquely identify each child and it medical encounter

Figure 8: Web interface for the reported medical case

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7. Next phase - in the target environment

Involving participating stakeholders to pilot test the system in selected HPs

Training HEWs on how to work with the system, and

Run the system for specific period

Perform usability testing with HEWs

Evaluating the system and make adjustments based on the experience gained

And proceed with system deployment to other HPs

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9. Conclusion

With the system proposed, it is expected to achieve

High adherence to usage of ICCM guideline

Better medical record reporting, storage and documentation

Better means to give supportive supervision to HEWs from remote by sending feedback to HEWs

For the future, the system can be customized or extended

to run on other mobile platforms;

to support other regional languages; and

to support other related health programs.

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Thank you

Technology

Mobile based decision support system for iccm program