RapidResponse

RapidResponse is a mHealth platform developed by the Earth Institute in collaboration with the UNICEF Innovation Group for the Millennium Villages Project. RapidResponse uses SMS text messages to facilitate and coordinate the activities of field based health care providers, usually community health care workers (CHWs). Using simple text messages, CHWs are able to register patients and send in health reports to a central web dashboard that allows a health team to closely monitor the health of their community. Powerful messaging features help facilitate communication between the members of the health system and an automated alert system helps reduce gaps in treatment.

Overview Summary

User Registration


Users are registered into the system via an SMS message that generates a @username and @id that is registered to the user’s phone. Once a user is registered they have access to the direct messaging and report functions of RapidResponse.

Upon registration, the system generates a user ID and user name that is linked to the phone number used in the registration.

USER REGISTERED> 5467593 registered to @5 @mcoulibaly (Coulibaly, Mamadou) at Tiby.

User Messaging

User messaging is a core service to RapidResponse that allows users in the system to communicate amongst themselves via SMS. With user messaging messages are relayed via RapidSMS from user to another by their user alias which is denoted with an @. This is done by including in the body of the message the @username you want the message sent to.

For example:

 @yndour great concert last night!

Would result in @yndour receiving:

 skeita> great concert last night!

This approach of routing through RapidResponse offers a number of advantages including:

  • Managed cost – If a toll free number or reverse billing is setup, it allows the implementer to cover the costs of the messaging allow members of the system to message between themselves without credit.
  • Phone numbers are replaced with easy to remember @aliases
    Stored messages allows for later analysis of message content and communication patterns.
  • Message logs allows for later analysis of message content and communication patterns.

Group Messaging

By including the @groupname in the message, group messaging allow a user to broadcast a message to a group of users.

@chw please come to Yala Clinic for a meeting this Friday.

Patient Registration

Users are able to register new patients via a text message that includes the patient’s last and first name, gender, date of birth, guardian’s name and contact number (when available) to the system.

Upon receiving the registration SMS, the RapidReponse checks to ensure that there is no patient listed in the system with the same name and guardian at that location. The location of the patient is currently tied to the zone of the user sending in the registration unless a location is passed to the system. If the patient appears to be unique, the system generates a patient ID and returns an SMS confirming the registration.

PATIENT REGISTERED> +28: DIALLO, Fatimata F/13M. Mother: Amie, Village: Kangaba

A message returns assigning the Fatimata the patient ID +28 with patient IDs always denoted with a “+”.

SMS Health Reports

SMS health reports provide the basis for reporting and monitoring the health status of patients in RapidResponse. Currently, RapidResponse has reports to support malnutrition monitoring used in a Community-Based Management of Acute Malnutrition (CMAM) program and malaria rapid diagnostic testing. The system has been designed to easily handle the addition of additional reports aimed at specific health problems.

All SMS health reports accept a common list of symptoms that can be used in any form simplifying what the health care provider needs to remember.

Malnutrition Monitoring Reports

Community-based Management of Malnutrition (CMAM) is based on the principle of using field based health care staff to monitor malnutrition in children through frequent home visits. CMAM uses two primary indicators to check for malnutrition: a MUAC (mid-upper arm circumference) measurement and an edema (swelling) check. In addition, health care workers are also trained to look for specific risk symptoms that pose significant danger to a child suffering from malnutrition which include: diarrhea, vomiting, chronic cough, high fever and unresponsiveness.

A malnutrition report starts with a MUAC form code and follows the following syntax:

Malnutrition Report

In this case child +26 has a MUAC measurement of 105, edema and is vomiting and has a diarrhea. Based on these measurements the system could go through the CMAM decision tree (see appendix) and return a diagnosis message back to the health care giver:

MUAC> SAM+ Patient requires IMMEDIATE inpatient care. +28 DIALLO F. F/13M (Amie). MUAC 105 mm,
Edema, Vomiting, Fever

An SMS report for a non-malnourished child would have a MUAC over 125 with no edema would look like:

MUAC +26 140 n

and would return:

MUAC> Child is not malnourished. +26 DIALLO F. F/13M (Amie). MUAC 140 mm

Malaria Rapid Diagnostic Test Reports

RapidResponse also includes an SMS health report for malaria rapid diagnostic tests (MRDT), an effective way of quickly diagnosing malaria in a patient at the household level. MRDTs are used whenever a child presents with a fever to diagnose whether or not malaria, a major killer in children, is at the root of the child’s illness.

Besides collecting the results of the MRDT test, the care provider is able to report whether or not a bed net is available at the household of the patient. The MRDT report shares the common pool of symptom codes available to the malnutrition report.

If the patient tests positive for malaria, RapidResponse provides a Coartem dosage recommendation based on the patient’s age. If the patient is a child under five and the result is negative or presents with any of the risk symptoms, RapidResponse will refer the child immediately to a clinic for further evaluation.

MRDT> Child +28, DIALLO Fatimata F/13M has MALARIA.  Child is less than 3.
Please provide 1 tab of Coartem (ACT) twice a day for 3 days.

Alerts

Automated alerts seek to keep the health care team abreast to the overall status of a community’s health by providing automatic updates to each other when important health events occur. Alerts are triggered by a range of events from the diagnosis of a medical condition to a change in treatment status. Similar to Twitter, RapidResponse allows users to “follow” other users to receive their alerts. Using this a CHW manager, for example, could receive an alert whenever a case of severe acute malnutrition is registered by one of the CHW’s they manage allowing them to provide additional support as required.

Follow-Up Alerts

Core to RapidResponse is an automated reminder system to help ensure that no patient falls between the cracks. When certain events occur, like when a patient enters into a home-based Supplemental Feeding treatment program with CMAM, a follow-up alert can be assigned to the caregiver assigned to that patient. When the time for a follow-up visit nears, in this case seven-days, a message will go out to the patient’s health care provider requesting a follow-up malnutrition monitoring report. After one day, if RapidResponse does not receive an update for that patient, the alert status for the patient will be elevated to urgent. At this point a reminder will be sent out on a daily basis not only to the health care to their manager and team mates for follow-up.

Clinical Diagnosis Reports

RapidResponse provides support for basic clinical recording basic medical diagnosis including lab results. Diagnosis are entered using ICD9 codes prefaced with a “-“. Multiple diagnoses can be entered in a single message and intermixed with additional free form text that allows for a clinician’s notes.


Lab results are also available in a clinical diagnosis report. Each lab test is associated with a code that can either be negative (-) or positive (+). For example, BS+ or BS-. Lab tests that require a numeric result like a Hemoglobin test would like HB+4.2.
Besides helping with end of month reporting, clinical reports provide a powerful means for patient referrals and follow up. Whenever a clinical report is submitted, RapidResponse loops through each symptom and sends an update to the patient’s health care provider with an update of a patient’s status. For example, if a child is diagnosed at a clinic with malaria, the child’s CHW would be immediately notified of the child status and requested to do a follow-up check the next day at the child’s home.