This is a deceptively difficult question: Simple is used by thousands of healthcare workers and health systems managers.
Healthcare workers are the main users of the Simple Android app. They register patients into the hypertension/diabetes control program and then monitor each patient's health over time. But there are key differences.
Medical officers (MO) are empowered to treat patients, which in the context of hypertension and diabetes care means that they can titrate (i.e. intensify) a patient's medications if appropriate. In a small hospital (PHC), medical officers might be the primary users of Simple. In a larger hospital (CHC, SDH, DH), many medical officers are too busy to enter data and more junior staff will manage Simple.
In many facilities, nurses manage the use of Simple. Particularly in large facilities, a is likely staffed by nurses who take BPs and manages Simple. Patients with high BP measures should be referred to a medical officer, who will manage treatment. Often patients return to the nurse after seeing the medical officer, so their data can be entered. They are the primary users of the .
Community health officers (CHO) are mid-level health staff who can treat some non-complex conditions and are primarily the senior staff at Health & Wellness Centers (HWC) in India. In some contexts, the CHOs treat patients and record their details in Simple. Note: There are many HWCs in India, so there are many CHOs.
Some hospitals have dedicated staff for data entry. They are responsible for submitting monthly data (usually in spreadsheets or paper forms) to local government officials. They might correlate data from the paper registers with records in Simple and they might compile totals from the Simple's Progress Tab to submit as part of their process.
The chief medical officer manages the hospital and is usually the most senior doctor. The chief medical officer might use the Progress Tab in the Simple Android app to monitor the facility's progress towards controlling patients' blood pressures.
Health system managers represent a wide group of people who are responsible for optimizing the health system to help more patients to control their blood pressure and reduce deaths.
At the Ministry of Health in a state or country, officials are responsible for tracking many programs, including hypertension and diabetes. They might use the Simple Dashboard to track progress in their region, but more likely they see charts when a nodal officer or cardiovascular health officer visits with them once-per-month to advise on how to strengthen the program.
A nodal officer is a government official with a particular focus area — there are NCD nodal officers in many Indian states or districts. In some states (e.g. West Bengal), the district nodal officer has a similar function to the cardiovascular health officer. The nodal officer might monitor the Simple Dashboard or (like the state officials) they might only see the data when a cardiovascular health officer shows them charts.
Cardiovascular health officers
CVHOs are surveillance officers hired specifically to manage 1-2 districts of a hypertension program. The India Hypertension Control Initiative has many CVHOs across India, primarily focused on improving the program. The same people are called different things in other countries. They are the primary users of the .
Why did we develop Simple? How can a data system benefit a hypertension control program?
Hypertension is the leading preventable cause of premature death worldwide, accounting for 10.7 million deaths per year, with most deaths occurring in low- and middle-income countries.
Large-scale hypertension control programs in low-resource settings face many challenges, including understaffed health systems with overworked staff often too busy to document detailed clinical data during patient encounters.
A strong public health program backed by a well-designed digital health information system has immense potential to save lives. An effective digital system must accommodate healthcare worker time constraints so the program can focus on providing high-quality clinical care.
A practical digital system is most likely to succeed if it: 1) is very fast and easy to use, 2) includes only a few key indicators, 3) requires minimal data entry, and 4) is designed with offline-first capability.
The best system is ultimately one that helps the most patients reduce their blood pressure.
Hypertension kills more people than all infectious diseases combined. Hypertension is also very common, affecting 20-35% of adults in most communities. That means that about 1/5 of adult patients in a hospital's outpatient department will present with hypertension. Practically, this means that enormous numbers of patients require counseling, measurement, and treatment — and those patients need to be monitored over time to ensure that their hypertension is controlled successfully.
As you can imagine, this volume of patient management is challenging in busy hospitals in places like India, Bangladesh, Sri Lanka, and Ethiopia.
17.9 million people die each year - from cardiovascular diseases (CVDs), an estimated 31% of all deaths worldwide
Out of 17 million premature deaths (under the age of 70) due to non-communicable diseases in 2015, 82% are in low and middle-income countries, and 37% are caused by CVDs.
75% of CVD deaths occur in low and middle-income countries.
A system for monitoring is one of the core pillars of a hypertension control program based on the World Health Organization's . By recording a high volume of follow-up visits by patients with hypertension, it's possible improve the health system more quickly. Fundamentally, Simple is a system of feedback loops to improve patient treatment and strengthen health systems.
Just with minimal information about each patient's current BP measures, medications, a health system or hospital can monitor:
In the graphs above, an epidemiologist or health official can read a story. BP control rates in region are increasing over the last 3 months, great! This is a result of declining "Missed visit" rates (blue chart) and also that more patients who come back have their BP controlled now (red chart). If we want to continue to increase BP control, we could focus on returning even more patients to care or we could try to reduce the red number further (e.g. by counseling patients on medication adherence, by ensuring medical officers are treating to protocol, or by sending patients home with longer prescriptions). This region has a good BP control rate (above 50% is good!), so maybe we would focus on identifying more people in the community with hypertension and start treating them — 35,525 might only represent 5% of the local population with hypertension.
Other indicators are also tracked. For instance:
Lost to follow-up patients: How many patients have not visited in over 1 year?
Calls made to patients: How many calls have healthcare workers made to patients?
Medication titration rates: How often are medical officers intensifying treatment for patients with uncontrolled blood pressure?
See our section for a detailed list of indicators and definitions.
Patients want to know whether treatment is succeeding. Clinicians strive for better management of each patient. Health system managers and public health officers are concerned with system performance and entire populations, often millions of people.
The core challenge, therefore, is to design software that meets the needs of all three of these groups while operating within severe time constraints at the point of care.
Simple is designed to be a pragmatic tool. A typical clinical visit in India lasts 3-4 minutes. In Bangladesh it's closer to 2 minutes. A busy clinician is juggling many tasks in this tight time: taking blood pressure and blood sugar measures, diagnosising, prescribing, and counseling the patient.
Keep in mind that clinicians don't come to work to do data entry. They focus on treating patients.
If we expect thousands of overworked healthcare workers to enter a high volume of data for a large percentage of their patients, we need to make fast and easy.
A digital health information system that minimizes and streamlines data entry allows healthcare workers to concentrate their limited time on providing direct patient care. Registration of new patients requires entry of patient information, demographic data, and health history, which needs to be done only during initial intake. A well-designed digital system can accomplish patient registration and first clinical visit in approximately 80 seconds (exclusive of physical blood pressure measurement): scan ID card to determine whether the patient is already registered and if not decide whether to enroll as a new patient (6 seconds); verify or enter patient information and demographics and conduct brief survey of cardiovascular history and risk, including current medications (66 seconds); enter blood pressure readings (6 seconds); and schedule follow-up visit (2 seconds).
After initial registration, healthcare workers need only scan the patient ID card and verify identity, enter blood pressure readings, verify current medications, and schedule follow-up, all of which can be done reliably within about 15 seconds. Variables required for patient registration must also be kept to an absolute minimum or many patients will go unregistered and their data unrecorded. There are many important variables of interest to epidemiologists and program managers. By evaluating these additional variables in specially designed studies on specific groups rather than for every patient, more reliable data will be collected and, most importantly, front-line health workers’ time to interact with patients will be respected and protected.
Designing with the pretense that healthcare workers have more time than they do results in software that is never adopted, is used inconsistently, or collects inaccurate data. Usability by front-line staff should be prioritized over any other consideration.
A tool that is fast to use can also be fast to train; minimizing data entry minimizes what healthcare workers need to learn. Train users in situ at hospitals and clinics, ideally in less than 1 hour, to reduce overhead costs for conducting trainings and to enable implementation scale.
Staff turnover and task sharing are common. If the digital tool is easy to learn, trained staff can teach others.
Based on metadata from more than 1.8 million patients, the Simple mobile app is widely used and performance remains very fast (approximately 80 seconds for registration and entering data from the initial clinical visit and 15 seconds to enter follow-up visit data). Data dashboards are easy to produce and disseminate and widely used by program staff. In Bangladesh, hypertension control rates more than doubled within a few months, from approximately 20% to 45%, in clinics that adopted the Simple app, although other program improvements likely also contributed to this increase.
In qualitative interviews, healthcare workers consistently rate the Simple app highly and emphasize how it reduces their burden of work and helps them to efficiently manage patients, monitor progress to improve blood pressure control, and deliver better care to patients
See an example hypertension treatment protocol from Punjab, India
See "How to take a BP: BP Measurement checklist" to learn to take a BP
85% of all CVD deaths are due to heart attacks and strokes. (Statistics from 2017)
People with cardiovascular disease or who are at high cardiovascular risk due to the presence of one or more risk factors (such as hypertension, diabetes, hyperlipidaemia, or already established disease) need early detection and management using counseling and medicines, as appropriate. (source)
Quick overview of patient’s recent history
Big picture view of where blood pressure is controlled and where to focus effort
Constraints
Time constraints; hypertension treatment is a low priority
Roughly 15 seconds available for data entry; high turnover so easy training is key
Manages other programs; little time
BP controlled
How many patients have visited recently with their blood pressure under 140/90? This is the critical indicator to measure a successful hypertension control program.
BP uncontrolled
How many patients visited recently but their blood pressure is not controlled yet? These patients need to be treated successfully to bring their BP under control.
Missed visits
How many patients are not regularly receiving care? These patients need to be encouraged to return to care.
Registrations
How many patients are enrolled in the hypertension program? How much of the estimated hypertension patients in the population does this represent?
Relationship to software
Uses individual blood pressure measurement data
Uses software to ensure each patient receives correct treatment
Uses aggregate data from software to determine system performance
Ultimate goal
Monitor their own progress toward blood pressure control
Monitor each patient’s progress to control blood pressure
Monitor blood pressure control of patient population
Critical needs
Monitor progress, visit convenient clinics
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.
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 .
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.
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.
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.
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.
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.
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.
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.
Patient leaves and picks up medications from the front desk on the way out.
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.
The CHO, Auxiliary Nurse-midwife (ANM), or next most senior staff will greet and treat patients. Lines are typically short.
The same person who is treating patients typically records BP measurements, medication refills, and other details into Simple.
Simple is the fast, free app for clinicians to manage their patients with high blood pressure and diabetes. More details at Simple.org
This is a truly free, . has two main components: a mobile app for Android and a secure web-based Dashboard.
The Simple Android app that is used by healthcare workers to:
Enroll patients in a hypertension and diabetes control program
Record patients' BPs, blood sugars, and current medicines
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.
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.
Set future appointments for patients
Contact overdue patients to return them to care
Track an individual facility's performance at controlling patients' BPs
Github: simpledotorg/simple-android
The Android app is primarily written in Kotlin
A web-based tool that allows managers to:
Track facility, district, and state-level performance in real-time reports
Manage users, facilities, and more
Overdue patient line lists
Deduplicate patients
Automatically send text messages to patients to return them to care
API to manage data across mobile devices and to integrate with DHIS2 and other applications
Github: repository
👩💻 The dashboard is primarily written in Ruby on Rails and PostgreSQL
The main features of the Simple web-based Dashboard, which is used by health officials, surveillance officers, and system administrators
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:
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?
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.
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 CSV files 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 for a description of how healthcare workers submit data. In the Dashboard, officials can view the current Patient days of 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.
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 Patient IDs, Names, 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
FAQs
Simple has an unusual method of enrolling new Simple Android app users. Android app users self-enroll by doing the following :
Download the app from the Play Store
Enter their own name, mobile, and choose a PIN
Choose their work facility from a list of all Simple facilities
User is now in a temporary status
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.
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.
Are patients being registered in large facilities and reassigned to smaller, more convenient facilities?
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?
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?
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?
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?
A Dashboard admin needs to call the user, verify they're permitted to manage patients, then they are approved.
Once approved, the user is in approved status and Simple starts syncing data to-and-from the cloud.
Power user. Can manage the entire deployment.
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.
In many countries, patient visits are very short. In India, a typical visit with a clinician 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.
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 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 — 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:
Which would be sent as:
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:
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 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 (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.
In the BP Passport above, the QR code and hash might be:
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:
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.
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.
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.
The Simple app supports the , 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.
{PATIENT NAME}, you are {DAYS SINCE APPOINTMENT} late for your BP measure at {FACILITY NAME}John Smith, you are 2 days late for your BP measure at PHC Blueberry.{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.ID: 04b25d4c-cc7f-4cae-ad18-f438053acc2c
Hash: 7204949
