📱
Simple app features
The main features of the Simple Android app, created for healthcare workers to record patient visits. The app is optimized to record a very high volume of patient follow-up visits.
Simple being used at a health facility in India
In many countries, patient visits are very short. In India, a typical visit with a clnician is about 3-4 minutes, in Bangladesh it's closer to 2 minutes. That's only a few minutes for an entire clinical encounter. When we ask clinicans how we can help them, the almost universal answer is: "Don't make my life harder." We take the responsibility of protecting clincians' precious time very seriously. One of core tenets of Simple is that it can be fast... really fast. The median time to record a hypertension or diabetes follow-up visit is 16 seconds.
Even in a lightning fast encounter, it's possible to record all of the necessary data to drive key feedback loops that will improve patient health. We have included the following features after ruthless consideration about how to keep Simple simple.
The key purpose of Simple is to record BPs. Entry is simple, but manual: find the patient and add their systolic and diastolic blood pressure readings. Basic error-checking ensures BPs aren't outside normal limits.
By default, Simple records BP entries at the time of recording. However, users can change the date to any time in the past. This is useful when adding older entries that were recorded on a paper record.
BPs can be edited at any time on the same day that they were entered. On the next day, entries are not editable.
We have considered adding measures automatically with Bluetooth connectivity to BP monitors. However, the general unreliability of Bluetooth connections, the added complexity, and the lack of many Bluetooth-enabled BP devices in the field, means that we have not built this feature.
Simple optionally supports recording blood sugar and HbA1c measures. This feature can be enabled for entire groups of facilities or for individual facilities. Today, most facilities in Simple record both BPs and diabetes measures.
Types of diabetes measures:
- Random (mmol/l or mg/dL)
- Postprandial (mmol/l or mg/dL)
- Fasting (mmol/l or mg/dL)
- HbA1c (%)
Diabetes measures can be back-dated and edited in the same way as BP measures.
Simple records a patient's current anti-hypertensive and diabetes medications. This is used as a record for clinicians to titrate medications to protocol and also drives the titration reports in the Simple Dashboard.
The "Current medicines" list in Simple is not a prescription — it is a record of a patient's current medications. Important features like duration, instructions, warnings, time-of-day, and signatures are excluded in order to keep Simple simple. Most health facilities already have a well-understood paper prescription system that is used well.
To make data entry as fast as possible, Simple has a preset list of common medications and dosages. This helps healthcare workers to pick the right medicines, fast. All hypertension protocol medications are listed here. The list is driven from the Simple Dashboard and can be customized per region.
Users can enter any medication manually. A preset list of common drug names helps users to do this quickly and consistently.
At almost every patient visit, patients are given a follow-up appointment. Keep in mind, public hospitals in many countries don't have "appointments" at specific times — an appointment is a reminder to return-to-care on a specific day.
Appointments are primarily used to identify patients who are overdue for a follow-up visit. These patients are added to overdue lists in the Android app and the Simple Dashboard. They also may receive SMS messages or phone calls encouraging them to return to care.
Hypertension protocols usually have a default follow-up period of ~30 days. We can set a default follow-up period from the Simple Dashboard — this is usually set to 28 days so patients A) return before their medications run out and B) the day is usually one when the hospital is open (i.e. if a patient visits on Friday, they'll follow-up on a Friday).
In countries where this is enabled, Simple sends patients reminder messages to come back to care. Message timing is based on the patient's
Appointment Date so, for example, a patient could receive a message 3 days after their expected appointment date.Text messages support variables, so we can send a message like:
{PATIENT NAME}, you are {DAYS SINCE APPOINTMENT} late for your BP measure at {FACILITY NAME}
Which would be sent as:
John Smith, you are 2 days late for your BP measure at PHC Blueberry.
Simple has the ability to test different messages and timings to see which are most effective at returning patients to care.
For instance, we can test 4 different messages to patients:
{PATIENT NAME} please return soon for your free medicines.
{PATIENT NAME} please return soon for a BP measure.
{PATIENT NAME} please return soon to prevent risk of heart attack or stroke.
{PATIENT NAME} your doctor asks that you return soon for a BP measure.
Simple will track which patients have a visit recorded in the next 2 weeks and we can compare which messages were most effective.
One of the most important functions of the Simple app is the ability to find the right patient quickly. In some places like Punjab, India, or Bangladesh, many patients share the same surnames and there are many common first names.
Very few regions have useful Patient ID cards that could be used for fast, reliable patient look-up. If we could use National IDs or drivers licenses, we would support them.
Patients can be searched by
NAME, PHONE, or HOSPITAL ID number. The manual search is a type-ahead search and will display patients at your facility before patients registered at facilities nearby.We invented a simple ID system that we call a BP Passport and Simple supports some official IDs such as the new Ayushman Bharat Health Account in India. Users can scan a QR code on the ID and use that QR code data to look up patients at all follow-up visits.
The BP Passport ID is extremely basic and does not contain any PII (Personally Identifiable Information). The main function is a unique QR code on each card that contains a UUID (i.e. a gigantic number). We also display a 7 digit hash of the UUID on the front of the card, which can be used to search for the ID manually.
A stack of blank BP Passport IDs ready to use
In the BP Passport above, the QR code and hash might be:
ID: 04b25d4c-cc7f-4cae-ad18-f438053acc2c
Hash: 7204949
A user will scan the QR code and associate it with the patient's record. Next time the patient visits, the user will scan the QR code again and immediately see the patient's record. This is a huge timesaver and reduces duplicate records.
The BP Passport card also serves a less technical purpose. The patient can see a record of when they are expected for their next follow-up visit and the inside contains information about their recent BP measures and current medicines, which can travel with the patient to any medical provider.
The Simple app stores many patient records entirely offline. This means that a facility can treat patients for days or even weeks with limited internet access. When the user gets access to the internet, they sync their records to the centralized cloud-based server.
Please read our blog post explaining how we think about offline-first apps in the clinical environment: https://www.simple.org/blog/offline-first-apps/
We optimize Simple to be able to handle many patient records on each device. Our benchmark is to support ~30,000 patients per device, even on a mediocre Android smartphone.
Important! All patients from a district's sub-region are synced to every Android user working at facility's in a sub-region. We know that patients travel to different clinics. For example: a patient might visit a local Health & Wellness Center for regular check-ups but will have travel to the PHC 2km away if they need a medical officer to change their medications. So, a user at Facility A will sync patient data from Facilites B-to-Z in case one of those patients comes in the door.
The Simple app automatically generates a patient line list of overdue patients which can be used to encourage patients to return to care. Patients are listed in order of cardiovascular risk and time overdue.
When healthcare workers reach out to patients, they mark the result of each contact. Simple can track when patients transfer to private care, are unresponsive, have died, etc. When users mark results of calls, the data is displayed in the Simple Dashboard, so health officials can track the activity.
In India, healthcare workers often give community health workers line lists of patients for home visits. Simple supports downloading a
CSV or PDF of the overdue patients list for sharing with community health workers.In India, Simple supports "secure callings", which masks the user's personal phone number from the patient. This is similar to how ride-sharing apps hide the driver's phone number from the passenger when calls are made.
The progress tab in the Simple app gives users feedback on how their facility is progressing towards their goals for treating hypertension and diabetes.
Note, the progress tab is designed to show a facility's progress, not each healthcare worker's progress. This is both simpler and reduces fear of judgement by managers.
An example Progress Tab showing data and graphs
The progress tab is techincally generated from the Simple Dashboard and then synced as a piece of HTML to the app.
The app contains some basic instructions on how to use the app itself, as well as how to conduct basic activities like taking an accurate blood pressure reading.
Simple now supports monthly reporting of drug stock. Each month, users are reminded to submit a web form with their drug stock data. For each protocol medication, users enter the
# of tablets received, # of tablets in stock, and (if the facility redistributes medicines to satellite clinics) # of tablets sent out.Based on the data submitted and the number of patients assigned to the facility, Simple can calculate how many "patient days" of medicines are in stock. This data is shown in the app and in the Simple Dashboard.
The drug stock feature is a web form, so it is not available when users are offline.
Simple has a very limited telemedicine feature which connects healthcare workers with a medical officer over WhatsApp. When treating a patient, users can select "Tele-consult" to auto-transmit key information about the patient to a designated medical officer, who can initiate a teleconsult to discuss the patient's treatment, send an e-prescription, and jointly update the patient's record.
The telemedicine feature is used in a set of pilot facilities in India and is designed to adhere to Indian telemedicine law.
The Simple app is translated into many languages. This means that the user interface is translated into the common languages understood by healthcare workers in India, Bangladesh, and Ethiopia.
Note: Simple's patient search does not support multiple scripts. For instance, if a patient is registered in the Latin alphabet as Advika cannot be found by searching for आद्विका. We encourage administrators to train users to adopt a single data entry standard in a region.
The Simple app supports the Ethiopian calendar, so BP dates, appointments, and other key dates are displayed using the Ethiopian calendar conversion. Note that the Simple Dashboard and the Progress Tab in the Simple app (which is driven by the Dashboard) does not support the Ethiopian calendar yet.
Last modified 8mo ago