The HxGuide is a compilation of digital protocols built out as mindmaps. A mindmap is a graphical representation, like a flowchart, describing a logical process flow. It is a diagram which is hierarchical and shows the relations between pieces of the whole, like a family tree. It allows to make and take notes in a creative and logical way that helps to map your ideas and brain pathways.
A complete protocol set will include the screening/ chief complain protocols, past medical history protocol, family history protocol and physical examinations protocol.
Let’s create a digital hypertension screening protocol set using a mindmap.
Step 1: Download and open Freemind, a software used to build mindmaps. https://sourceforge.net/projects/freemind/
Nodes: Nodes help connect various branches throughout the mindmap. Root node is the base idea or concept. Any subnode of a given node is called a child node, and the given node, in turn, is the child’s parent. Sibling nodes are nodes on the same hierarchical level under the same parent node. Nodes higher than a given node in the same lineage are ancestors and those below it are descendants.
Step 2: The single node seen on a new file is the ‘Root node’. This is the main title of your protocol
eg. Hypertension screening
Step 3: Create ‘Parent nodes’ from the root nodes. These are the first level of protocol questions
eg. [xx]
Step 4: Create ‘Child nodes’ from the parent node. These are the second level of protocol questions. Many such levels of questions can be nested under each of the nodes.
[INSERT IMAGE}
Attributes: Attribute define the characteristic of the node. Nodes can be given different attributes depending on the desired outcome. The attributes used in digital protocols are:
display: The content written in this attribute will be displayed on Android. This attribute is used to simplify clinical language for the users.
display-xx: The content written in this attribute will be displayed according to the language setting on Android. This attribute is used to translate the content in display attribute or node to local language. eg. display-fr will have translated French content, display-hn will have translated Hindi content and the user can switch between language from Android App.
language: The content written in this attribute will be displayed on the Web Application. This attribute is used concise into clinical language for doctors.
pop-up: The content in this attribute will show as a pop-up box on Android. This attribute is used to prompt health messages to the patients and/or action items to the health workers.
input-type: This attribute allows the user to insert values depending on the different types. There are 5 main input-types:
number: prompts a text box to insert numeric values
text: prompts a text box to insert text values
duration: prompts a text box to select duration from days, weeks, months, years
date: prompts a text box to select date in dd/month/yyyy format
range: prompts a text box to select a numeric range with pre-defined unit eg. 4-5 days or 10-12 cigarettes per day
Step 5: Allocate appropriate attributes to each node. Create attributes by right click>Edit Attributes>typle the name of the attribute. Do not put extra characters like period or space.
display
[INSERT IMAGE]
2. display-xx: Replace xx by the initials of the language. Use Unicode format.
[INSERT IMAGE]
3. language
[INSERT IMAGE]
4. pop-up
[INSERT IMAGE]
5. input-type
[INSERT IMAGE]
Step 6: Create a Past Medical history and Family history protocols can be created following the previous steps.
[INSERT IMAGE]
Step 7: Create a Physical Examinations protocol following the previous steps. This protocol contains all the physical exams of all screening/chief complain protocols. The second level of node is the location of the body where the physical exam is performed and the third level of node is what physical exam is performed.
[INSERT IMAGE]
Advanced attributes:
perform-physical-exam: This attribute connects the screening/chief complain protocol to physical examination protocol. This attribute is used on the root node to trigger relevant physical examinations questions
pos-condition:
neg-condition:
STEP 8: In order to trigger the right physical exams on the screening/chief complain protocol, type the second and third level nodes of physical exam protocol in the contnt box in exact way as it is written in the physical examination protocol.
[INSERT IMAGE]
Tips:
It is recommended to limit the level of questions to 3-4 levels to avoid confusion for the user.
Translations will have to be inserted manually for each protocol.
Once an attribute is created, it shows in the drop-down. Select from the drop-down to avoid creating incorrect attributes.
The content in the display attribute must be easy for a low-literacy health worker with basic medical training.
The content in the language attribute must be concise in medical lingo for the doctors
The content of the pop-up attribute may get lengthy. It is recommended to type it first in a text editor and then pasted on Freemind
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