PHC eTriage: An application to aid a vital Primary Health Care area

Week 16: mHealth

Driving Question:

How can mobile applications be useful in primary care?

Assignment:

Propose an app idea for a primary health care scenario. Your app idea must not duplicate any app already available in the market.

Definition of Primary Health Care

The WHO defines Primary Health Care an essential health care made universally acceptable to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country and afford at every stage of development.

In the Philippines, key elements of Primary Health Care were identified to better define or isolate the services rendered by the healthcare type.

The following are the eight (8) essential elements of primary health care:

1. Education for Health

This is one of the potent methodologies for information dissemination. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness.

2. Locally Endemic Disease Control

The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Example Malaria control and Schistosomiasis control

3. Expanded Program on Immunization

This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus, diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH

4. Maternal and Child Health and Family Planning

The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. The goal of Family Planning includes spacing of children and responsible parenthood.

5. Environmental Sanitation and Promotion of Safe Water Supply

Environmental Sanitation is defined as the study of all factors in the man’s environment, which exercise or may exercise deleterious effect on his well-being and survival. Water is a basic need for life and one factor in man’s environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health.

6. Nutrition and Promotion of Adequate Food Supply

One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country.

7. Treatment of Communicable Diseases and Common Illness

The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death. Most communicable diseases are also preventable. The Government focuses on the prevention, control and treatment of these illnesses.

8. Supply of Essential Drugs

This focuses on the information campaign on the utilization and acquisition of drugs. In response to this campaign, the GENERIC ACT of the Philippines is enacted. It includes the following drugs: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and Pyrazinamide,Ethambutol, Streptomycin,Albendazole,Quinine

Facilities

The facilities involved in rendering primary care services includes Outpatient, dental and laboratory services that specializes on TB, Malaria, Dengue, etc. Health centres, Primary care hospital, Clinics and provider network Hospitals. Basically these facilities do not have the capacity to perform major activities, such as most of minor and all major surgeries, deliveries of complicated pregnancies and in depth diagnostics such as CT scans and EEG’s.

The Health Centers are the government’s armaments to penetrate and serve every point of the Philippines.  In total there are 2376 Rural Health Units and 101 City Health Offices. These facilities are ready to accommodate every single Filipino who seeks primary care consultations. They are also included on the provider registry network of public and private health facilities with referral or escalation protocols from primary to tertiary level of care.

Working in an Institution that prioritizes the community, I’ve been through many Health Centers that serve as the main health hub of people especially those who are in isolated islands or landlocks. Within these facilities, I’ve encountered health worker runts and problems when it comes to their workflow. For health centers with a large catchment area, the primary issue is patient load. And it does have an impact on processes and management in the area.

Before the deployment of any system, workflow and situational analysis are conducted. We found out that every health center has a standard workflow. What makes them unique is that they make adjustments and revisions to cope up with the number of staff and type of staff.  Here are some of the examples:

Figure 2 RHU 2 General Workflow

Basing on the figures above, we identified the number of personnel manning each station (swim lanes) and identified their tasks. We’ve noticed that the admission section has the heavy load when it comes to consultations. Here are their tasks:

Figure 1 RHU 1 General Workflow

a. Acquire patient’s demographics

b. Search for the patient’s folder if archived; make a new folder in the case of first visits

c. Make an individual treatment plan (ITR)

d. Get anthropometric measurements (Height and Weight) then write down in ITR

e. Get vital signs then write down in the ITR

f. Gather complaints then write down in the ITR

g. Give number to patient for queuing

h. Triage patients to services 

The Problem

Usually the staffs assigned to this area are encoders, nurse casuals, midwives or NDP’s (Nurse Deployment Program). In some RHU’s, they have a rotation to prevent personnel burnout, some assign 2 or more people to cater the influx of patients, some permanently designate HW’s in the area because of understaffing problems.

The admission area sometimes causes the bottleneck of an RHU workflow. The other stations are not fully maximized in the sense that few are served, however pooling of patients in the area is evident. The quality of service declines as the other service stations (Physicians, Midwives, etc.) adjust to accommodate the influx of patients. The peak of this problem is customer discontentment. The cumbersome waiting time and the low quality service give toll to patient’s satisfaction. As a result some patients have decreased trust and confidence on Health Center workers.         

Even though the admission section is a minor section of the facility in terms of depth of service (not totally medical), it is the most important part of the facility. It supposed to act as the reception or secretariat. It has vital duties and roles when it comes to keeping the workflow intact.

The Solution

The problem could be resolved easier by integrating an electronic process in the workflow. An application similar to the standard workflow of health center can be an answer to efficiency problems of the admission processes. The use of the present mobile technology is a perfect environment for this application. Here are some of the reasons:

a. It is portable and light

b. It is not direct power dependent

c. It has features that can be harnessed for other things such as video conferencing, email, etc.

d. It has developer options (Android)

e. Mobile applications are light

f. Its expandable memory provides multiple applications in just one device

g. It can be updated from time to time (via Playstore for example)

h. It can be integrated to a personal PC application

i. Technology adoption is not an issue (most health workers use smartphones)

Introducing the PHC eTriage (Primary Health Care eTriage)

It is designed to improve the admission triaging processes. The manual based operations of RHU admission were converted to electronic to improve time management and efficiency of the area.        

1. Users

a. Admission area

b. Dentist

c. Physician

d. Nurse

e. Midwives

2. Proposed Network layout

Layout 1

Narrative:

Standalone mode

A gateway is installed in a laptop or desktop. This will serve as the consolidator of data taken from PHC eTriage peripherals. The gateway is connected to a wireless router to broadcast an access for the peripherals to use. The users will manually save the IP address of the gateway before using the application.

Integrate to EMR

Integration to EMR is also possible given that the identifiers, registry type, dictionaries and functionalities are similar to the application. The consolidated data of the gateway can be synched to the EMR server via cloud or local server. Or in the future, it can be the portable admission application of the EMR.

Layout 2

Narrative:

The mother app will be installed on a administrator smartphone, this will be held by the staff in the admission area as he/she will be the moderator. The admin will set up a hotspot on her device so that other users can connect. The application will use the hotspot or wireless access emitted by the mother application to exchange data and communicate.  

Key features:
1. The application is made in accordance to Philippines' health center settings and workflow.
2. The application has a dashboard isolated per service to monitor the patient queue of health center specific areas effortlessly.
3. The application can save patient demographics for admission and service references.
4. Can be integrated to an EMR

For full specifications, you may check this link:
https://www.slideshare.net/secret/iFpoXeehBKb4IO

References:

• http://www.wpro.who.int/health_services/service_delivery_profile_philippines.pdf
• http://nurseslabs.com/primary-health-care/
• http://nhfr.doh.gov.ph/Philippine_health_facility_statuslist.php
• http://www.who.int/publications/almaata_declaration_en.pdf