Post on 13-Jan-2016
MICRO HEALTH FRANCHISE SYSTEM
Micro Health Franchise System provides high quality care to mother and child of reproductive age.
www.umeedsey.org
Introduction FINCON Services Inc.
Management Consulting Firm Worked Internationally with ADB
Poverty Eradication Initiative CSR: Raise resources worth $70
million
Project: UmeedSey Grand Challenge:
Saving Lives at Birthwww.umeedsey.org
What are we Trying to Achieve with UmeedSey Project Quality MNCH Services in remotest part of the
country in a financially sustainably and commercially viable model.
Reform of Public health system and availability of real time accurate data for policy formulation.
BIO Surveillance System at policy/ decision level. Reduced financial burden on the Public ex-
checker Micro Health Insurance
Publication:
Clinical Decision Support System for Mother and Child HealthThe purpose of the CDSS is to
improve diagnosis process and to provide assistance to healthcare professionals via investigation or examination of patient’s data.
In this paper we are going to present a Clinical DecisionSupport System (CDSS) that eliminate delays faced bycommunity midwives/ lady health visitors in providingstandardized/ cost effective healthcare services tomother and child in remote areas of the country.
Challenges: While designing complete m-health software for midwifes; we
had a number of challenges ahead of us. 1. How to ensure early diagnosis? (Decrease Cost per
pregnancy)2. Triage a normal delivery case than a complicated and
emergency case?3. Monitor CMWs/LHVs activity? (Quality of Service)4. Share patient profile with expert doctor via Electronic
Medical Record; that provides detail and concise summary of a pregnancy case? (Referral Doctor)
5. Link Supply Chain Processes with CMWs/ LHVs activities. (Internal Audit)
How does CDSS Keeps the track of Patient Status?
Flow of Antenatal:
First Trimester (13 Weeks)
Second Trimester (13 Weeks)
Third Trimester (13 Weeks)
16 appointments for nulliparous women (primigravida) 14 for parous women.(multigravida)
T1 Visit 1Contact CMW
T1 Visit 2Confirmation of Pregnancy
T1 Visit 3CMW Collect Information
xt1v2
State 3xt1v3
T1 Visit 4Booked
Appointment(10-12 Week)
xt1v4State 4
Post Natal (06 Weeks)
State 2
T2 Visit 5(14 – 16 Week)
T2 Visit 6(18 – 20 Week)
T2 Visit 7(22 – 24 Week)
T2 Visit a(25 Week) For
nulliparous women
xt2v5
xt2v6
xt2v7
State 6
State 7
State a
T3 Visit 8(28 Week)
T3 Visit b(31 Week)For
nulliparous women
T3 Visit 9(32 – 34 Week)
T3 Visit 10(36 Week)
T3 Visit 11(38 Week)
T3 Visit 12(40 Week)
T3 Visit c(41 Week)
P1 Visit 13(24-48 hrs
After Birth)
P1 Visit 14(6-7 Days)
P1 Visit d(6th Week)
xt3v8
xt3vb
xt3v9
xt3v10
xt3v11
xt3v12
xt3vc
State b
State 9
State 10
State 11
State 12
State c
xpv13
xpv14
xpv15
State 14
State 15
State 1
State 5 State 8
xt2va
State 13
Step 1: Defining the Complete Antenatal Care States40 STATES
How does CDSS Keeps the track of Patient Status? Step 2: Defining the Sequence of States (ACTIONS)
10-12 weeks
14 – 16 Week 18 - 20 weeks 22-24 week
For nulliparous women 25 weeks
Visit a
Measurement of blood pressure
Contact Care professional
Register Patient
Confirmation of Pregnancy
Get history(pervious)
28 weeks
For nulliparous women 31 weeks
Visit b 32-34 weeks 36 weeks 38 weeks 40 weeks41 weeks
Visit c
CBC( hemoglobin)
Blood typing(RH +ive,-ive)
Hepatitis B
Rubella titer
Screen genetic diseases(If any)
Measure height of uterus
First dose of tetanus toxoid
Anomly ultrasound scan
Second dose of Tetanus toxoid
Look for Edema
Measure height of fundus
CBC (hemoglobin review)
Measure height of fundus
Ask for fetal movements
Oral glucose tolerance test(if needed)
Offer anti-D prophylaxis(If needed) second dose of anti-D prophylaxis
Check the position of the baby
offer a membrane sweep
offer induction of labor
Measure height of fundus Measure height of fundus Measure height of fundus Measure height of fundus Measure height of fundus Measure height of fundus
Look for Edema Look for EdemaLook for EdemaLook for Edema Look for EdemaLook for Edema Look for Edema
CBC (hemoglobin review)
Measurement of Weight\height
Test urine for protein, sugar and bacteria
Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS)
Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of WeightMeasurement of Weight
Measurement of blood pressure: Measurement of blood pressure Measurement of blood pressureMeasurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure:
Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar
41 weeks End Visit c
Check fetal hearts(FHS)
Look for Edema
Measure height of fundus
Measurement of Weight
Measurement of blood pressure:
Test urine for protein and sugar
P1 Visit 13 P1 Visit 14
(24-48 hrs After Birth)
P1 Visit d
(6-7 Days) (6th Week)
Post Nata End
Ultrasound scan(Dating)
ComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaints Complaints
Update history(If any)
Ultrasound scan
PrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescription
Status Status Status StatusStatus Status Status StatusStatusStatus StatusStatusStatus
Prescription
Medication
Random blood Sugar
Physical Examination
Ask for fetal movements Ask for fetal movements Ask for fetal movements Ask for fetal movements Ask for fetal movements Ask for fetal movementsAsk for fetal movements
Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia
Check for Fetal presentation
P1 Visit 15
28 days
How does CDSS Keeps the track of Patient Status? Step 3: Define Data and Its Relationship to State
Start
Weight gain ABNORMALWeight > 0.5kg/wkkABNORMAL Weight < 0.5kg/wk
NORMAL
0.5kg/wk
check for anemia,
Malnutrition
U/S for IUGR
End
U/S for twin Poly hydro-amino R/O PET
Start
Height
NORMAL
Height > 4ft 8 inch
ABNORMALHeight < 4ft 8 inch
Institutional Delivery
End
How does CDSS Keeps the track of Patient Status? Step 4: Creating a Complete Patient Profile
Start AgePast Medical /
Surgical History
Family history / genetic history
Obstetric history
Physical examination
Antenatal visit record
Lab testsUltrasound
scanEnd
Age <18
Others
Chromosomal problems
Any birth defect
Any one in the family had:
Anemia
Foliate deficiency
anemia
Iron deficiency
anemia
Height > 4ft 8inch
Low HB & high MCV
Low HB & low MCV <= 80
BP
BP < 140/90
BP <= 150/110
BP > 140/90
Weight > 0.5kg
AB
Protein
Leukocyte
HbsAg
Negative
Negative
Abnormal
Abnormal
Positive
0-5hpf
Negative
Current medication
Hepatitis
Obstetric surgery
Diabetes
Renal diseases
Hypertensi-on
Anemia
Cardiac problems
Blood transfusion
Abdomino-pelvic surgery
Hypertension
Cousin marriage
Cardiac
Multiple Preg
Drug abuse
Diabetes
Heamoglobinpathies
Smoking
Porphyria
Inherited Diseases
Allergies Gravida Outcomes
18 > age < 35
Age > 35
Height < 4ft 8inch
Height
Lymph nodes
Jaundice
Oro-dental hygiene
Edema
Nipple
Weight
Goiter
Breast
Varicose veins
Conjunctiva
Weight = 0.5kg
Weight < 0.5kg
Weeks of gestation
Edema
Fundal height
Doctor signature
Weight gain
Next visit
FM
Date
Presentation and engagement
Normal
Positive
Negative
Normal
Positive
RFT
Pap smere
HCV
LFT
Blood group
Blood sugar
HB%(g/dl)
Urine test
Glucose
Anomaly
Dating
FHS
parity
Pregnancy number
Last delivery > 2 yrs
Last delivery < 2 yrs
Abortion
Tubal Pregnancy
Twin Pregnancy
Pre-term pregnancy
Full term pregnancy
Alive
Still birth
Modes of Delivery
NVD
Forcep or Vaccum
LSCS
Patent
Multi-gravida
Primiri-gravida
Hb >10 Hb < 10
Negative
O
B
APositive
RH factor
Negative
How does CDSS Keeps the track of Patient Status? Step 5: Matching Profile against defined patterns.
Start
Anemia Gestational diabetes
Preeclampsia (toxemia)
Eclampsia (severe form of pre-eclampsia)
Hyperemesis gravidarum (HG)
Placenta previa
Feel tired or weak
Placental abruption Preterm labor Multiple
Pregnancies Fetal problems
Feel faint
Shortness of breath
Low number of red blood
cells(Hb<10)
Look pale
Extreme thirst
Screening test shows high blood sugar
levels
Previous child weight
Family Diabetes
Swelling of hands and face
Too much protein in
urine
Stomach pain
Blurred vision
Dizziness
Headache
Seizures
Swelling
Edema
Too much protein in
urine
Nausea
Vomiting
Weight loss
Reduced appetite
Dehydration
Feeling faint or fainting
Painless vaginal
bleeding during second
or third trimester
Vaginal bleeding
Fluid or tissue passing from
the vaginaPelvic pressure
Contractions
uterus is larger than expected for the dates in
pregnancy
increased morning sickness
increased appetite
excessive weight gain, especially in
early pregnancy
fetal movements
felt in different parts of
abdomen at same time
Baby moving less than normal
Baby is smaller than normal
for gestational age
Some problems have no symptoms, but are found with prenatal
test
End
Hunger
Fatigue
Cramping
Abdominal pain
Miscarriage
Uterine tenderness
High blood pressure
High blood pressure
CDSS – Early Diagnosis (Saving Lives) While all of this is happening in
the background; a CMW will see three simple set of instructions.
If the screen is green, the midwife can proceed normally.
Conversely, a red screen will alert the midwife to an emergency situation – transport the patient immediately to EmOC facility.
Finally, a Orange screen – get expert advice from referral doctor.
Electronic Medical Record
Monitoring and Evaluation
Supply Chain Management System
• Once Program Officer and Operational Manager approves this CMW request. Store Keeper dispatches the consignment to franchisee.
• CMW Request tool kit through her mobile app
• Program Officer Receives this request and wait for Operational Manager approval
Innovation in Mother and Child Health Care System
Mobile Application
MNCH Triage (UmeedSey)
CMW Trainings (KhanPur)
CMW Trainings (Chakwal)
Websitehttp://umeedsey.org/
QUESTIONS? THE END