Team 7

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Making an electronic version of the IMCI to help diagnose common childhood illnesses.

Team members:

Project Proposal

eIMCI - Electronic Integrated Management of Childhood Illnesses

Users and tasks

Users:

  • Our primary users will be mostly young women nurses in developing countries trying to use the established IMCI tool to diagnose common childhood illnesses.

Tasks:

  • Our project will make navigating the IMCI charts easier, by putting them in an electronic format.
  • The program will have an electronic update feature, to keep it up to date with the latest medical discoveries.
  • It will aid healthcare workers in finding out the correct diagnosis by providing text, image and video results.

Existing solutions and their limitations

Today, while the IMCI is accurate it is not very efficient to use. It is distributed as a print copy, and there are multiple pages of flowcharts that uneducated healthcare workers must flip through. It is very easy to skip important steps, get lost in the pages/charts and also is hard to update in case new medical advances come out.

A new web application would be advantageous over the existing print alternative for many reasons. For one, by using a proper electronic UI, it will be harder to skip steps and misdiagnose patients. Settings could be saved such as location, altitude, malaria risk, etc. so that these basic settings would not need to be a factor in the flowcharts. Patient data could be saved to simple databases to further aid in keeping track of patients health and prior history. Electronic media is easily updateable instead of a print copy as well.

Meeting notes

Some preliminary ideas we had:

  • Language support for different countries.
  • Different UIs for different countries. (For example, Arabic countries read right to left, so they might naturally follow flowcharts right to left as well)
  • Modular design, since medical information might have to be updated.
  • Saved settings (location, altitude, malaria risk in area, etc.)
  • Simple database (maybe Sqllite) to track patient history to see if problems are not isolated.
  • Combination of Text, Images and Videos to help healthcare worker verify problems from symptoms.


User and Task Analysis

Data gathering techniques

Interview people who are knowlegeable about the IMCI - We will arrange a meeting with Prabu Selvam to find out about the current usage of the IMCI and the state of technology available to users. We will ask about the availability of laptops and internet access.

Direct observation of a nurse using the current IMCI - We would observe nurses using the current paper version of the IMCI to diagnose someone and look for pitfalls and problems with the process.

Questionnaire for nurses - Ask nurses who actually use the IMCI in the field: Are there any problems with the current system? Do you have ideas for how to improve it? What technology do you have access to? Do you have internet access on a regular basis? We would send these questions to nurses in the field and to the institutions responsible for basic training.


Interview with Prabu

We met with Prabu Selvam on 2/25 and talked about the general needs of the program, what type of computers would be available to us, and discussed his ideas for design. We also discussed another company who had tried to accomplish the same thing, and the problems with their product. This program would be deployed on low-end netbooks, probably around the $100 price range.


User groups

Nurse

  • Generally Female
  • 16-18 years old
  • Very little formal education
  • Very little computer experience
  • Not highly respected as a medical professional
  • Frequent usage

Technician

  • 16-30 years old
  • Basic computer skills/education
  • Does updates and platform maintenance
  • Occasional usage

Instructors/Doctors

  • 30-60 years old
  • Basic/Advanced computer skills
  • Formal education
  • Good medical skills
  • Semi-frequent usage
  • Demonstrates proper usage of program

Personas

Rupa is a 17 year old nurse working in Bangladesh. She has gone through grade school and has never used a computer. She has no medical knowledge, but is currently in a short traning program run by the WHO. She will be using this program on a daily basis to diagnose and treat children in her village.

Abdul is a 20 year old computer technician who has gone through high school. He has basic computer skills and working as part of an apprenticeship with a group that has been contracted by the government to maintain the computers running eIMCI

John is a 40 year old doctor from the US is volunteering with a group working with the WHO to train and educate nurses in developing countries. He has a solid medical background and computer skills. He uses eIMCI on a regular basis as a teaching tool.


Other stakeholders

  • Children who are being diagnosed and their parents.
  • Organizations who are sponsoring the creation of the IMCI


Tasks

Diagnose kids

  • The goal of this is to figure out what's wrong with a kid.
  • Preconditions
    • A sick patient
    • Updated software
  • Subtasks
    • Log in
    • Pull up patient records
    • Select proper protocol
    • Follow chart:
      • Identify symptoms
      • Chose most probable symptom
    • Treat most probable diagnosis
  • Complexity: Medium
  • Frequency: Often

Update patient records

  • Preconditions
    • Patients in the system
  • Subtasks
    • Identify patient
    • Update basic info (weight, height, etc)
    • Update diagnostic history
    • Update vaccination/treatment history
  • Complexity: Easy
  • Frequency: Often

Update/maintain platform

  • Preconditions
    • Software patch
  • Subtasks
    • Update diagnostic database
    • Update OS
    • Export diagnostic statistics
  • Complexity: Medium
  • Frequency: Not very frequent

Design Sketches

Scenarios

  • Diagnose Children- Jane is a trained eMCI user in a 3rd world country. Her job is to over see the health of the children in her local village. On this particular day Jane is approached by patient Molly. Molly has been feeling sick and wants to get better. Jane pulls up her eIMCI program on her laptop finds her record for Molly and then begins to ask her questions concerning her condition. Due to the altitude and Molly's fever eIMCI determins that Molly probably has malaria. eIMCI then tells Jane how to treat Molly s condition and explains what there is to expect in the future.
  • Update/Maintain platform - Abdul has been contracted by the government to maintain the computers running eIMCI. He has been assigned a particular region for his job. The region he looks over has a couple of villages that utilize eIMCI to diagnose and help sick children. Abdul is dispatched from headquarters once a week to visit each of the villages to maintain and update the platforms for optimal performance. Abdul takes with him a flash drive with some with updates, and an external harddrive that he uses to store statistics and diagnostics that eIMCI has tracked. When Abdul arrives at each location, he updates and exports the necessary data.
  • Update patient records - Rupa is a nurse who utilizes the eIMCI at a small village in Bangladesh. As the WHO is collecting statistics on common childhood diseases, the eIMCI is outfitted with a database to hold patient records for future analysis. When a patient comes in for treatment, Raina checks if the patient is new or a recurring patient, and adds the patient to the database respectively. Information that might be taken from the patient include name, age, picture, and parents. Raina also has the clearance to go and edit patient records, in case a mistake was made recording them at first. She does this by logging into administrator mode on the login screen and merely changing the text entries.


Conceptual Storyboard

UI Storyboard

Paper Prototype

  • Risk assessment: After meeting with users in class during the prototype phase, there are some risky parts of our program that are evident. One is the option we give our users to select unknown instead of yes/no to a symptom list. This gives the chance that a nurse might check too many unknowns for the program to make an educated diagnosis. Another risk is the nurse not bothering to login to diagnose the patient which would require putting in patient information but instead just using the emergency mode all the time. There might also be a problem in the admin panel where if the admin forgets to logout, the nurse who uses the computer afterwards has access to the admin panel and might inadvertently mess the program up. A particularly dangerous risk might occur when the possible diagnosis are presented to the nurse, with the most probable one on top. The nurse might not understand what is presented to her and might select a diagnosis which is not the best diagnosis for the patient, and administer the wrong treatment. These risks happen in both the diagnosis and administrator program update/export/import scenarios.
  • Briefing: Given the nature of eIMCI, we wanted users to test a multitude of features available on our prototype. In order to effectively achieve this goal, we had two different briefings that we tried out. They were as follows:
    • 1. The first briefing was that they were a nurse in Bangladesh, with little to no formal education. They have been given eIMCI as a tool to help them diagnose young children. One day, a child is brought to them, and the patient's parent explains that their child has been showing signs of diarrhea.
    • 2. The second briefing was that they were a technician that travels to locations where eIMCI has been distributed, and does various technical tasks to maintain and support the software.
  • Scenario Tasks:
    • 1. The first task was for the nurse in the first briefing. The objective was to locate the patient in the database, if they existed, and update any relevant information. If they did not exist, then it was their responsibility to create a profile for the child.
    • 2. The second task was also for the nurse in the first briefing. The objective was to diagnose the child based on the list of determinable symptoms, and then to follow the appropriate treatment instructions given.
    • 3. The third task was for the technician in the second briefing. The objective was to export the database of user/patient information gathered by the program, to bring it back to their headquarters. The information will help document and keep track of particular statistics and illnesses in that region, which is essential to developing more efficient and educated administrative decisions to help sick children. While the technician is exporting the database, he is also advised to check up on the various eIMCI terminals he visits, and make sure that they're all up to date and functioning properly.
  • Observations from Testing: Testing of our paper prototypes went significantly well, most users had no problem following the prompts to diagnose a child. When it came to the Technician scenario tasks, most users knew what to do, however we noticed that our prototype was missing some core buttons to help with navigation. Some users did not understand how to get rid of the Version Dialog Box, while other users complained that after a file was imported, they received no on screen confirmation that the file was imported correctly. Also, as a group we realized that it would be a good idea to have a button to be able to start the whole diagnostic procedure from the beginning, or possibly have a navigation tree to be able to go back to an earlier step. Finally when the program determines the possible illness that the person is experiencing, the window was not labeled much differently then the previous question prompts, so some users thought the program was asking them if they had these illnesses rather than telling them that these were "Possible Illnesses".

Prototype Photos

Computer Prototype

Experimental Design

Implementation

User Testing and Analysis