Mobile Based Decision Support System toImprove Child Health Care (mobile e-Health System)Andualem Workneh,andufree@gmail.c...
2Outline1. Introduction2. Statement of the problem3. Objective4. Related Work5. Proposed System6. Implementation7. Next ph...
31. Introduction In Ethiopia, a primary health care unit consist of Health centers andHealth posts (HPs). In each health...
Introduction … ICCM program is an integrated management of childhood andnewborn illness at the health post level. The ma...
52. Statement of the problem While giving ICCM service to children, HEWs are expected to alwaysuse ICCM guideline. High a...
Statement of. Cont. Poor medical data reportingand documentation were alsoobserved Child’s medical case isrecorded in a ...
7Statement of. Cont. In the current system, paper based clinical guideline isused together with a registration bookFigure...
83. Objective General Objective: It is to design and develop mobile based decision support systemto help HEW to give bet...
94. Related work e-IMCI: e-IMCI is a PDA based decision support system that guideclinicians through a series of preprogr...
105. Proposed System Mobile based DSS systemis proposed. It has a client-serverarchitecture with decisionsupport, data c...
116. Implementation The ICCM guideline is modeled with an opensource business process management suite calledjBPM. The e...
12Implementation Cont.<subProcess id="_1" name="የአተነፋፈስ ችግር ምርመራ" ><startEvent id="_1-1" name="Start" /><exclusiveGateway ...
13 For the client-side, Android based smart phone wasselected. Android is chosen because It is based on an open-source p...
14Implementation Cont. Client-Side system Assessment – Classification –Treatment (based on theelectronic guideline) Edi...
Implementation Cont. Assessment: Questions forassessing medicalcase of the child isdisplayed one by one. Xform technolo...
Implementation Cont. Suggested medicalcase classificationsand treatmentprocedures: The mobile applicationclassifies the ...
17Implementation Cont. Server-side system: Medical history of the child is compiled at the server side. For this purpose...
187. Next phase - in the target environment Involving participating stakeholders to pilot test thesystem in selected HPs...
199. Conclusion With the system proposed, it is expected to achieve High adherence to usage of ICCM guideline Better me...
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Mobile based decision support system for iccm program

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Mobile based decision support system to help the implementation of integrated community case management in Ethiopia.

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Mobile based decision support system for iccm program

  1. 1. Mobile Based Decision Support System toImprove Child Health Care (mobile e-Health System)Andualem Workneh,andufree@gmail.comJune – 15, 2013For Creatic4Africa research scholarship programorganized byCTIC Foundation
  2. 2. 2Outline1. Introduction2. Statement of the problem3. Objective4. Related Work5. Proposed System6. Implementation7. Next phase – in the target environment8. Conclusion
  3. 3. 31. Introduction In Ethiopia, a primary health care unit consist of Health centers andHealth posts (HPs). In each health post, Health extension workers (HEWs) are assigned togive health service to the community. Responsible to execute different health packages includingIntegrated Community Case Management (ICCM) program …
  4. 4. Introduction … ICCM program is an integrated management of childhood andnewborn illness at the health post level. The main objective of ICCM program is to reduce child mortality andmorbidity 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 provision4
  5. 5. 52. Statement of the problem While giving ICCM service to children, HEWs are expected to alwaysuse ICCM guideline. High adherence to usage of the manual guidelineis very much required. Performing diagnosis and treatment without using the guideline has arisk of committing clinical error Medical procedures are not easy to remember (especially for lessexperienced HEW) But in the current practice, less adherence to guideline usage isobserved
  6. 6. Statement of. Cont. Poor medical data reportingand documentation were alsoobserved Child’s medical case isrecorded in a paper-basedform Incompleteness andinconsistency in the medicalrecords were observed. Giving continuous supportivesupervision to HEWs is also achallenge Supervisors can not reach allHEWs regularly6
  7. 7. 7Statement of. Cont. In the current system, paper based clinical guideline isused together with a registration bookFigure 1: Paper based ICCM Clinical guideline, to assess and classifybreathing problem
  8. 8. 83. Objective General Objective: It is to design and develop mobile based decision support systemto 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 selectedmodeling tools/language Design the proposed system based on the requirement Develop a prototype and Pilot test the prototype in the field
  9. 9. 94. Related work e-IMCI: e-IMCI is a PDA based decision support system that guideclinicians through a series of preprogrammed algorithms basedon 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 AIDSpatients in South Africa: It is to support screening of HIV+ patients to determine wherethey can get treatment and follow-up An electronic HIV treatment guideline is used This system is pilot tested in South Africa
  10. 10. 105. Proposed System Mobile based DSS systemis proposed. It has a client-serverarchitecture with decisionsupport, data collectionand data reportingmodules The system has thefollowing hardware-software mappingFigure 2: Hardware-software deployment diagram for the proposed system
  11. 11. 116. Implementation The ICCM guideline is modeled with an opensource business process management suite calledjBPM. The electronic ICCM guideline is stored as BPMN 2.0specification.Figure 3: Modeled clinical guideline, to assess and classifybreathing problem
  12. 12. 12Implementation 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 = "&lt;?xml version=1.0 encoding=UTF-8?&gt;&lt;Treatment&gt; &lt;Task&gt; ሪሰሲቴት ማድረግ ጀምሪ .....&lt;/Task&gt; &lt;/Treatment&gt;";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 &lt; 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 &amp;&amp; hasDifficultBreathing == false&amp;&amp; (breathCountPerMinute &gt;= 30);</conditionExpression></sequenceFlow>.....</subProcess> Modeled ICCM guideline in BPMN 2.0 specificationFigure 4: Modeled Clinical guideline in BPMN 2.0
  13. 13. 13 For the client-side, Android based smart phone wasselected. Android is chosen because It is based on an open-source platform and has betterlocalization capability, Availability of tools like ODKCollect, a mobile based datacollection framework, and an Amharic virtual keyboard fordata entry. For the server-side, Django web framework wereused to develop the web-based application.Implementation Cont.
  14. 14. 14Implementation Cont. Client-Side system Assessment – Classification –Treatment (based on theelectronic guideline) Edit filled medical records Send filled medical record toserver Download new rule, forms, andfeedbacks given from server Delete existing medical recordsFigure 5: Client side system which is running on a mobile phone. List of client-sidefunctionalities
  15. 15. Implementation Cont. Assessment: Questions forassessing medicalcase of the child isdisplayed one by one. Xform technology isused to develop theform15Figure 6: Assessment questions (a) open-ended question with Amharic virtualkeyboard. (b) Close-ended questiona. b.
  16. 16. Implementation Cont. Suggested medicalcase classificationsand treatmentprocedures: The mobile applicationclassifies the medicalcase of the child basedon assessment madeand the electronicmedical guideline.16a. b.Figure 7: (a) suggested case classifications . (b) suggested treatment procedures for aparticular medical case
  17. 17. 17Implementation Cont. Server-side system: Medical history of the child is compiled at the server side. For this purpose, ID is given toeach child to uniquely identify each child and it medical encounterFigure 8: Web interface for the reported medical case
  18. 18. 187. Next phase - in the target environment Involving participating stakeholders to pilot test thesystem 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 onthe experience gained And proceed with system deployment to other HPs
  19. 19. 199. 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 fromremote by sending feedback to HEWs For the future, the system can be customized orextended to run on other mobile platforms; to support other regional languages; and to support other related health programs.
  20. 20. 20Thank you

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