Mobile based decision support system for iccm program
1. Mobile Based Decision Support System to
Improve Child Health Care (mobile e-Health System)
Andualem Workneh,
andufree@gmail.com
June â 15, 2013
For Creatic4Africa research scholarship program
organized by
CTIC Foundation
2. 2
Outline
1. Introduction
2. Statement of the problem
3. Objective
4. Related Work
5. Proposed System
6. Implementation
7. Next phase â in the target environment
8. Conclusion
3. 3
1. Introduction
ïź In Ethiopia, a primary health care unit consist of Health centers and
Health posts (HPs).
ï± In each health post, Health extension workers (HEWs) are assigned to
give health service to the community.
ïź Responsible to execute different health packages including
Integrated Community Case Management (ICCM) program âŠ
4. Introduction âŠ
ïź ICCM program is an integrated management of childhood and
newborn illness at the health post level.
ïź The main objective of ICCM program is to reduce child mortality and
morbidity by giving better health service to children and newborns.
ï± Focuses on addressing leading causes of child mortality: pneumonia,
diarrhea and malaria
ï± And also other medical cases (malnutrition, immunization ....)
ïź ICCM medical guideline is used for ICCM service provision
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2. Statement of the problem
ïź 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.
ï± Performing diagnosis and treatment without using the guideline has a
risk of committing clinical error
ï± Medical procedures are not easy to remember (especially for less
experienced HEW)
ïź But in the current practice, less adherence to guideline usage is
observed
6. Statement of. Cont.
ïź Poor medical data reporting
and documentation were also
observed
ï± Childâs medical case is
recorded in a paper-based
form
ï± Incompleteness and
inconsistency in the medical
records were observed.
ïź Giving continuous supportive
supervision to HEWs is also a
challenge
ï± Supervisors can not reach all
HEWs regularly
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Statement of. Cont.
ïź 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
ïź General Objective:
ï± It is to design and develop mobile based decision support system
to help HEW to give better service in ICCM program
ïź Specific Objective:
ï± Conduct requirement gathering (interview and field observation)
ï± Model the ICCM guideline to electronic form with a selected
modeling tools/language
ï± Design the proposed system based on the requirement
ï± Develop a prototype and
ï± Pilot test the prototype in the field
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4. Related work
ïź e-IMCI:
ï± e-IMCI is a PDA based decision support system that guide
clinicians through a series of preprogrammed algorithms based
on IMCI protocol.
ï± Help to achieve
ïź High adherence to the protocol
ïź Reduce skipped steps and branching errors
ï± It is pilot tested in Tanzania
ïź Electronic Decision Support in the treatment of AIDS
patients in South Africa:
ï± It is to support screening of HIV+ patients to determine where
they can get treatment and follow-up
ï± An electronic HIV treatment guideline is used
ï± This system is pilot tested in South Africa
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5. Proposed System
ïź Mobile based DSS system
is proposed.
ïź It has a client-server
architecture with decision
support, data collection
and data reporting
modules
ïź The system has the
following hardware-
software mapping
Figure 2: Hardware-software deployment diagram for the proposed system
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6. Implementation
ïź The ICCM guideline is modeled with an open
source business process management suite called
jBPM.
ï± 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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ïź For the client-side, Android based smart phone was
selected. Android is chosen because
ï± It is based on an open-source platform and has better
localization capability,
ï± Availability of tools like ODKCollect, a mobile based data
collection framework, and an Amharic virtual keyboard for
data entry.
ïź For the server-side, Django web framework were
used to develop the web-based application.
Implementation Cont.
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Implementation Cont.
ïź Client-Side system
ï± Assessment â Classification â
Treatment (based on the
electronic guideline)
ï± Edit filled medical records
ï± Send filled medical record to
server
ï± Download new rule, forms, and
feedbacks given from server
ï± Delete existing medical records
Figure 5: Client side system which is running on a mobile phone. List of client-side
functionalities
15. Implementation Cont.
ïź Assessment:
ï± Questions for
assessing medical
case of the child is
displayed one by one.
ï± 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.
16. Implementation Cont.
ïź Suggested medical
case classifications
and treatment
procedures:
ï± 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.
ïź Server-side system:
ï± 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
ïź Involving participating stakeholders to pilot test the
system in selected HPs
ï± Training HEWs on how to work with the system, and
ï± Run the system for specific period
ï± Perform usability testing with HEWs
ïź Evaluating the system and make adjustments based on
the experience gained
ïź And proceed with system deployment to other HPs
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9. Conclusion
ïź With the system proposed, it is expected to achieve
ï± High adherence to usage of ICCM guideline
ï± Better medical record reporting, storage and documentation
ï± Better means to give supportive supervision to HEWs from
remote by sending feedback to HEWs
ïź For the future, the system can be customized or
extended
ï± to run on other mobile platforms;
ï± to support other regional languages; and
ï± to support other related health programs.