The main features of the Simple web-based Dashboard, which is used by health officials, surveillance officers, and system administrators
Reviewing a dashboard in a hospital in India
The key reports in Simple are based on the WHO's HEARTS Technical Package for managing a large-scale hypetension control program and most indicators closely match the HEARTS indicators.
The primary function of the dashboard is to drive feedback loops for people who oversee health programs. The primary indicator of the success of a hypertension control program is:
How many registered hypertension patients returned to care in the last 3 months and their blood pressure was under control (<140 systolic and <90 diastolic)?
Fundamentally, many of the report graphs and tables in Simple explain why more patients aren't controlled. The reports and trends help health officials to identify questions like:
- 1.Are patients returning to care?
- If patients aren't returning to care, are healthcare workers calling them?
- Are we delivering text messages successfully to return patients to care?
- How many patients are "lost to follow-up", haven't visited in >1 year?
- Are patients being registered in large facilities and reassigned to smaller, more convenient facilities?
- 2.Are enough patients being registered?
- Which facilities are registering patients?
- What is the population of a region and how close are we to identifying and registering a realistic percentage of patients there?
- 3.Are patients returning to care but they aren't controlled?
- If patients aren't controlled, are their medications intensified per protocol?
- At what point of the hypertension protocol are the most patients being controlled?
- 4.Are hospitals well-stocked with essential medicines?
- Are patients being given enough medications so they aren't forced to return to the pharmacy at the hospital too often?
- 5.Is Simple being well-used?
- Are we seeing an expected number of follow-up visits recorded?
- Which users are doing the most activity?
- Are BPs being recorded accurately?
The key reports shown at the national, regional, and facility levels track how many patients visit with controlled BP, visit with uncontrolled BP, miss visits, and are registered into the program.
An example quarterly cohort report
Cohort reports are used to track the early progress of newly registered patients. The idea is that patients that start well in the program will succeed long term.
Another key function of the Simple Reports is to enable health officials and epidemiologists to download key data and patient lists for surveillance and analysis. Several different
CSVfiles are available to download for further analysis.
In several countries we integrate a business intelligence tool called Metabase, so authorized users can query the Simple "Data Pipeline" data to create custom reports. This is a powerful way for epidemiologists to find trends and ask questions of the data.
Many surveillance officers meet with the local officials to share progress and advocate for changes within the health system. They often use Microsoft Excel to generate custom reports to illustrate their points. The Simple team has created an Excel template that can be auto-populated with downloaded data from the Dashboard. See example below:
Surveillance officers can download the template, then download a specially formatted data dump from the dashboard, fill out a few fields (e.g. "Recommendations for action in the field") and then use the report for their work.
Simple also generates little mini Reports as graphics that can be shared monthly with health officials over Whatsapp or email, which show a snapshot of a facility's or district's performance.
Another section of the Dashboard is used my surveillance officers to compare all of their facilities to see which are high performing and which need assistance.
Simple can also be used to track anti-hypertensive and diabetes drug stock. See Simple app features for a description of how healthcare workers submit data. In the Dashboard, officials can view the current
Patient daysof drug stock based on a simple algorithm, which calculates based on a facility's registered patients.
Officials can also enter the drug stock numbers through the Dashboard for facilities that submit data using Excel, Whatsapp, or other means.
The Dashboard has an entire section to display the overdue patients within a region or at a specific facility. The dashboard could hypothetically be used to run a centralized call center to contact patinets, but we haven't yet had the opportunity to try this anywhere at any real scale.
Note: Patients in the screenshot below are all fake.
Screenshot of the Overdue section (from the Sandbox testing version of Simple)
Inevitably, some patients get registered twice. With an offline-first app and with millions of patients enrolled, this is impossible to avoid. Simple has a rudimentary deduplication service that identifies very likely matches based on
Phone numbers, and similar
Addresses. Dashboard admins can merge patient records, into a single record.
The Dashboard is a convenient one-stop-shop for program managers. We include common materials such as:
- Training videos
- Training presentations
- Deployment checklists
Simple has an unusual method of enrolling new Simple Android app users. Android app users self-enroll by doing the following :
- 1.Download the app from the Play Store
- 2.Enter their own name, mobile, and choose a PIN
- 3.Choose their work facility from a list of all Simple facilities
- 4.User is now in a
- 5.A Dashboard admin needs to call the user, verify they're permitted to manage patients, then they are approved.
- 6.Once approved, the user is in
approved statusand Simple starts syncing data to-and-from the cloud.
This system makes training large groups much faster, since a trainer doesn't need to pre-approve users. It also means that a busy clinician can start recording patients at her facility even before being approved — but she can't see any previous patient data nor sync to the cloud before she's approved.
Admins can select which Android users are qualified medical officers who can be linked to telemedicine sites.
The pick list of medications in the Simple app is different in every region (each region has a different set of commonly prescribed medications). This list is managed through the Dashboard and synced to the device based on the facility's region.
Typically follow-up appointments are 28 days. This time period can be easily managed from the Dashboard per region.
Facilities can be added through the Dashboard.
Regions are important both for reporting and for data sync to Android devices.
Allows Admins to upload a spreadsheet and add many facilities at once.
Organizations are the top level structure for facilities — and are rarely used. All facilities in India are currently under the IHCI (India Hypertension Control Initiative) organization. In the future, a private hospital chain could theoretically use Simple on the same infrastructure but as a separate organization.
Dashboard admins can have different levels of permissions. Admins can add new admins. New admins are given permission to view or manage a set of facilities and can have permissions such as:
- Manager. Can manage regions, facilities, admins, users, and view everything
- View: Reports only. Can only view reports
- View: Everything. Can view patient data and all facility data.
- Call center staff. Can only manage overdue patients list.
- Power user. Can manage the entire deployment.
Many places have used paper records to manage patients. The bulk import function allows data entry operators to fill out a spreadsheet with thousands of patient records and import that historical data into Simple.
Power users can manage specific features by country or even by Dashboard admin. This allows the Simple team to test new features only flagged on for specific Dashboard admins or to enable features only in some regions.