"Case Loads": Differentiate between open and closed cases?

[Christian Neumann]

Hi,

Currently we are implementing our referral app with the most simplistic case sharing approach: Every mobile user is in the same group and therefore feed his/her cases in the District-wide case list (mostly because there are referrals who can be referred outside the 'catchment area' and there require case-visibility above this catchment area).

I'm aware of restrictions in number of cases on a single CommCare device (e.g. as listed under https://confluence.dimagi.com/display/commcarepublic/Case+Loads+on+CommCare). I'm not 100% sure how the case sharing technical works. Therefore: Does the ballpark number of 1000 cases/device is only for active/open cases or are closed cases are also sync'ed (and kept) on every device?

Thanks,

christian

[Simon Kelly]

Hi Christian

Those figures only apply to open cases. We don't sync closed cases to the devices except under specific conditions.

I'm curios to know how you've designed your referrals workflow.

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Simon Kelly

Senior Engineer | Dimagi South Africa

[Christian Neumann]

Thanks Simon!

I’m happy to share the details of our current setup. And I’m also curious to hear your opinion and suggestions on how to improve the process.

Partners In Health in Malawi has an implementation of OpenMRS catching patients District-wide across all facilities (~15). Besides this patient-level data now screening activities happen both at community level (e.g. in a village, or through dedicated events) and at the Outpatient department of every facility. During these screening events (potential) patients can be referred to their nearest health center / hospital providing the required services.

Now unlike the typical (?) use case of CommCare where a frontline health worker has his/her own dedicated phone, we will have tablets that are travelling around the district to the various screening activities. These ‘registration’ devices will be use to open the CommCare case. And then there will be matching tablets at the health centers/hospitals to keep track of who came in when (aka closing the CommCare case).

Now the majority of the referrals will remain within their 'catchment area’. So most people screened at one screening activity will be referred always to the same nearest facility. But there will be cases where either the patient actually lives closer to another facility or where a patient requires special services not available at the nearest facility. And these cases leave the 'default boundary’ and the CommCare cases need to be available not only at the nearest, but in theory at every other facility.

With this the devices are not bound to a specific user, but more to a use case (referral registration or tracking-who-visited-through-a-referral) and to some degree the physical location. Hence I have a hard time dividing the CommCare cases into disjunct user groups.

I don’t have exact numbers, but I would guess that 100 referrals for one screening activity are the upper boundary. But multiple of these activities can happen throughout the district (but I doubt that from the beginning they all will get close to this upper boundary). But the referred (potential) patients will only show up a week or 2 after their referral. Additionally everyone who was referred will actually show up (and then require a potentially lengthy tracking process), so I expect that over time we will have a growing number of open cases.

This is not implemented yet, but I could see that for patients where the tracking-process was started, the CommCare case might also be closed. So that these ones, which might potentially never be resolved due to lost-to-followup, are actually no longer part of the open cases in CommCare.

Hope this makes sense and happy to learn more about other ways to implement it.

christian

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[Simon Kelly]

Thanks for the description of your project Christian. I've got a few questions:

• How do you identify patients when they present themselves at the facility? i.e. how do you find their case on CommCare?
• When you refer the patients do you always know which facility you are referring them to?

Regarding the 'lost to follow up' issue you can automatically close cases after a certain duration of inactivity: https://help.commcarehq.org/display/commcarepublic/Automatically+Close+Cases

[Christian Neumann]

Thanks Simon, 

Please find my comments inline below.

On 27 Jun 2016, at 15:50, Simon Kelly <ske...@dimagi.com> wrote:

Thanks for the description of your project Christian. I've got a few questions:

• How do you identify patients when they present themselves at the facility? i.e. how do you find their case on CommCare?

We will go give out stickers/labels to every referral case. The label also contains a pre-printed QR code which is scanned during CommCare case registration. Later on the patient is supposed to present this sticker with the code at the referral clinic. For community-based screening the chance is higher that a referred patients won’t bring this 'paper-token’ to the clinic, but will work better for health centre to facility referrals as in Malawi patients are used to bring in their personal health passport book.

Ideally some kind of biometrical identification could be used, but this seems to be out of scope for us for now.

• When you refer the patients do you always know which facility you are referring them to?

Yes, during referral (and case registration), then patient is given an appointment date at the for him matching clinic.

Regarding the 'lost to follow up' issue you can automatically close cases after a certain duration of inactivity: https://help.commcarehq.org/display/commcarepublic/Automatically+Close+Cases

And thanks for this link. Didn’t know about the automatic case closing. Need to think a bit about it, as I might want to have a dedicate ‘hook’ to know which cases are closes when. Will get back to you regarding this.

christian

[Simon Kelly]

Hi Christian

Correct me if I've missed something but it seems like the main issue you have with the referral workflow is that you aren't able to 'refer' a patient to a specific CommCare user because the CommCare users aren't fixed to a particular facility.

If that is the case then I don't think there are any ways around having all cases in a single case sharing group.

We have done some work on a feature that allows users to search for cases that they don't own and pull them down to their device. This would allow any user to search for cases that aren't on their phone and then still be able to complete a form for those cases. The searching would require that they have an internet connection though.

If that sound like a feature you'd be interested in we can keep you informed of it's status.

Simon

[Christian Neumann]

Hi Simon,

Yes, your summary is correct. So unlike the ‘typical’ use case for CommCare where you have many frontline health workers, we have more of an event / activity view here. Maybe I’m also (too much?) influenced by my OpenMRS background. Will need to rethink if I’m thinking too much inside-of-my-box.

The feature you are describing sounds interesting, although some of our referral clinics currently don’t have Internet connectivity all the time. Still it could be helpful if I can divide my cases into multiple case sharing groups (I expect the majority of cases belong to the relevant & disjunct catchment areas). And only for cases that leave these boundaries your 'search-for-cases-they-dont-own feature’ will be used.

So in short: yes, if you have more information about this or once you have additional updates, please let me know.

Thanks,

christian

[Simon Kelly]

Great, we'll let you know once that feature gets past the development stage.