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.
Implementation Cont.
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Implementation Cont.
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
Implementation Cont.
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.
Implementation Cont.
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