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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.

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

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  • 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. 2Outline1. Introduction2. Statement of the problem3. Objective4. Related Work5. Proposed System6. Implementation7. Next phase – in the target environment8. Conclusion
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 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. 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. 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. 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. 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. 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. 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. 20Thank you