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.
Thanks Simon,
Please find my comments inline below.
On 27 Jun 2016, at 15:50, Simon Kelly skelly@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
On 24 June 2016 at 15:30, Christian Neumann christian.neumann@gmail.com wrote:
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
On 24 Jun 2016, at 13:43, Simon Kelly skelly@dimagi.com wrote:
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.
On 24 June 2016 at 12:19, Christian Neumann <christian.neumann@gmail.com wrote:
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
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