Clinics can be very different, but we will describe some typical workflows for data entry into the Simple Android app for clinicians.
Important: Clinic workflows can be very different. As of April 2022, Simple is used in >7,000 facilities, from small community clinics all the way up to large district hospitals. We do not design for a specific workflow, we design for Simple to be adaptable in many situations.
The line outside an NCD Corner in a district hospital in Bangladesh
A district hospital is the largest public hospital in a region. There is generally only 1 or 2 district hospitals per district.
A typical district hospital will have a large outpatient department (OPD) with long lines of patients queued from 8am in the morning until about 2pm. Most patients did not come to the hospital for hypertension — they likely came for an acute issue — but because of the high footfall at the clinic, it's an excellent place to opportunistically identify many people with hypertension.
A district hospital likely has a dedicated Non-Communicable Diseases Corner (NCD Corner) where patients are tested for blood pressure (BP) and blood sugar readings. The NCD Corner is often located near the OPD intake desk. A NCD Corner might be staffed by a small team of junior nurses and a staff nurse overseeing it. The NCD Corner staff will maintain the hypertension registers and will be the primary users of Simple through the Simple Android app.
A large facility like a district hospital will have many medical officers and will often have specialists on staff. This means that patients can be diagnosed here and medication can be prescribed and supplied.
A district hospital will have a dedicated pharmacy, with hypertension protocol medications and other medications from the "essential drugs list" in stock.
- 1.OPD intake: Patient waits at OPD in-take counter. At the counter, a clerk gives each patient an OPD slip (a single piece of paper) and records their basic demographics into a register. Adult patients are redirected to the NCD Corner.
- 2.NCD Corner: Patients queue at the NCD Corner for 10-30 min. They then have a BP measure and sometimes a blood sugar measure. The patient's BP reading is written on their OPD slip. If the patient has not yet been diagnosed with hypertension and their BP is ≥140/90, they are redirected to a medical officer who is stationed in a room nearby.
- 3.Medical officer's office: Patients queue to enter the medical officer's room. When they reach the front of the queue, the doctor will give them about 2-3 minutes to explain their symptoms, glances at notes on the patient's OPD slip, takes their BP, diagnoses them (if BP is high), and prescribes medications if diagnosed. Any patient who is diagnosed should be redirected to the NCD Corner to be enrolled in the hypertension program. Note: In many large hospitals, medical officers are too busy to use Simple.
- 4.NCD Corner: Diagnosed patients come back to the NCD Corner. Each patient's details are recorded into Simple and the doctor's diagnosis, prescription, and BP reading are entered for this visit. The staff will ask where patients would prefer to receive follow-up care and will change the "assigned facility" to a local facility (see note below). Patients are counselled to return for care in 30 days.
- 5.Pharmacy: Patients are then directed to the pharmacy to pick up ~30 days of medications. In India or Bangladesh, these medicines are free, but in other countries like Ethiopia there is often a fee.
Note! A good hypertension program often dissuades diagnosed patients from taking their follow-up visits at a large hospital. Patients are "assigned" in Simple to a PHC or community facility closer to their home and with shorter waiting times.
The general structure of the public hospital system in India
A typical PHC in India
A primary care hospital can take many forms. A typical PHC might have 2-3 medical officers but they may not always be present. A PHC is the local hosptal where patients can be diagnosed and where new prescriptions can be written. A PHC might have 3 or 4 rooms but usually doesn't have inpatient care.
In some PHCs there will be a specific day of the week for hypertension and diabetes follow-up care, so patients will be encouraged to come on that day. In other PHCs, hypertension patients are treated whenever they come in.
- 1.A small intake desk (often also the pharmacy) will take the patient's demographics and will give them an outpatient paper slip (OPD slip). Patient then queues to see the medical officer.
- 2.Medical officer: The MO will typically take the patient's BP and may diagnose the patient if their BP is ≥140/90. They will write a prescription and counsel the patient to return in 30 days. They may reassign the patient to a local community facility if it's more convenient for the patient for follow-up visits. The medical officer might be the primary user of Simple in this facility — they'll record the patient visit into Simple.
- 3.Patient leaves and picks up medications from the front desk on the way out.
Note: A PHC may be the parent facility for community facilities nearby. They may distribute medications to community facilities, direct activities like following-up with patients, etc. The group of facilities may track their performance as a group.
A simple community clinic (CC) in Bangladesh
A community facility is a local 1-2 room facility in a village and likely does not have a medical officer. A community facility traditionally was focused on maternal and child health, but likely now is treating chronic and simple diseases. If there is no medical officer, the facility can likely only refill medications for patients with controlled BP and refer patients in need of diagnosis or treatment intensification to a PHC or larger hospital.
Some Health & Wellness Centers in India (HWC) have a Community Health Officer (CHO) who is empowered to treat simple conditions. In some instances, they can treat uncomplicated cases of hypertension.
- 1.The CHO, Auxiliary Nurse-midwife (ANM), or next most senior staff will greet and treat patients. Lines are typically short.
- 2.The same person who is treating patients typically records BP measurements, medication refills, and other details into Simple.
Note: A HWC or sub-center is the hub for community health workers who do home visits. HWC staff might print a list of overdue patients or high risk patients and send community health workers to find patients in the community.