Here is a set of notes by Derek, Ryan and myself regarding the showcase storyline workflow based on our work on Friday and Saturday at the Connectathon. We were able to run through an end-to-end test of the system there and go through the story (minus the RapidSMS component). This allowed us to get some practical insights on how the presentation will play out. Please let us know what you think and if you've got any suggestions for improvement.
SETUP: describe the story… talk about how we will move time forward… give the phone and the RapidSMS “cheat sheet” (or just a version of the sheet with instructions on how to do our one RISK transaction?) to one of the attendees and explain that that person is “Grace”, the CHW in Mosa’s village.
We need two OpenMRS instances, each with a clinician login (not super user); the “clinic” and the “hospital” need to be different colours. It would be useful to display these two OpenMRS instances on two different screens.
We need an NTP server with a big, easy to see UI that lets us add weeks and/or days to the current time. E.g. Displays “current” time; has two fields and one button: +/- WEEKS, +/- DAYS, SUBMIT. All of our services need to be getting their time (CT) from this NTP server. This allows us to advance the system time throughout the story for more realistic data capture.
Present date: e.g. March 4th, 2013
Upon registering Mosa (retrieve her record)…
· Fill in her history (Obs and past medical history form) | we need to ensure that default values are entered into the field for number of pregnancies (zero) and for outcomes from those (all zero or blank). Mosa did not come in with a partner. Mosa’s last menstrual cycle should be Jan 4, 2013 (she is 2 months along when she comes to the clinic). Her height is 150cm and she has not had a previous HIV test.
· Capture her clinical readings (Physical form) | Her beginning weight should be 51 kg. Her BP should be 125 / 85, her fundal height should be 8cm and the fetal heart rate is 150. Mosa has no danger signs.
· Log Mosa’s HIV test results (Testing form) | Mosa’s test results indicate she is HIV positive. We will need to find out what are the particulars of this test. It is a quick test… is it repeated twice? Is blood drawn and a confirmation lab test also ordered? Is she put on PMTCT – and if yes, is the fact that she’s on PMTCT recorded anywhere and is there anything that is recorded regarding her orders for ARVs?
Roll the NTP server forward by 5 weeks… (April 8th, 2013)
CHW visits Mosa at her home in her village…
· Identify Mosa | on a low-tech phone the CHW enters a coded SMS containing Mosa's NID and a RISK code indicating "spotting"
· During the showcase this SMS will be sent by an audience member using a RapidSMS “cheat sheet”. We need to try this a couple of times with the Africa phone so we know how to do it… and if it is easy enough we could expect an audience member to do it.
Roll the NTP server forward by a day… (April 9th, 2013)
Mosa at the clinic (retrieve her record)…
· We will pull up her summary screen (maternal summary) and manually refresh her record which pulls in encounters from the XDS repository. These are then displayed within the maternal summary.
· Capture her clinical readings (Physical form) | Her weight should be 57 kg. Her BP should be 120 / 75 and her fundal height should be 13cm. Mosa has a danger sign: she is anemic.
· Create a referral for Mosa (Referral form) | refer her to hospital “urgently”; enter text information that she is a pregnant HIV patient with anemia.
Roll the NTP server forward by 3 days… (April 12th, 2013)
CHW receives SMS message indicating Mosa has not attended at hospital for her urgent referral.
· Questions: What is the exact text of this message? Is Mosa’s name in the message, or only her NID? What does it say? If an audience member receives this message will it be clear what it is indicating?
· The “story” is: the CHW (Grace) goes to Mosa’s home and finds her in bed with a fever. Grace arranges Mosa to be taken to hospital by a neighbour.
Mosa at the hospital (retrieve her record)…
· Display the “summary” screen (after manually refreshing her record): Mosa’s information is there with the “arc” of her pregnancy displayed
At the summary screen, we talk through the implications of what we’ve demo’d:
1. Mosa is able to be enrolled in a guideline-based maternal care programme at her local clinic.
2. We are able to capture information about Mosa to her shared health record; this information supports continuity of care over time and across multiple sites of care.
3. We leverage mHealth to provide care to Mosa in the community.
4. Because we are operating according to care guidelines, we can tell when something that should have happened, didn’t happen. We can treat the absence of a signal as a signal. The SMS alert to Grace leverages this fundamentally important feedback loop to ensure Mosa and her baby receive the treatment they need.
5. Over time, we will leverage our eHealth transaction logs to conduct M&E on our programme’s success.
6. This is how we expect to materially reduce maternal and infant mortality in Rwanda.
7. We leveraged IHE profiles (PIX and XDS) in order to integrate disparate systems into our HIE and give us the flexibility to utilize multiple tools for these functions
Kind Regards
Hannes
--
Hannes Venter
Software Developer, Jembi Health Systems | SOUTH AFRICA
Mobile: +27 73 276 2848 | Office: +27 21 701 0939 | Skype: venter.johannes
E-mail: han...@jembi.org
