How to use it?
As we have learned in the previous sections, in Telemedicine, particularly in our Ayu protocols, a task shifting happens from the doctor to the health worker. That means a part of the patient’s case evaluation (history taking/screening and physical examination) is done by the health worker and the rest (case evaluation and treatment plan) is taken care of by the remote doctor.
The CHWs and other authorized personnel using the app are given a comprehensive Tech and Ayu training and then refresher courses are held every quarter to add more skills and/or to refresh the memory of initial training. These health workers are also given general medical training about the different organs and a review of human body systems and training their trainer (master trainer) is held every quarterly. Training is an important component of the intervention and must be periodically reinforced to ensure the fidelity of use of the protocols by the CHWs.
As is typical of CHW based programs, the CHW works according to the schedule fixed and carries her backpack kit (all medical and associated devices) to the place concerned. She then sets up the necessary infrastructure. Once the patient comes, she opens the app and enters all the patients' details and vitals after due consent and data privacy. She then starts taking history as per the Ayu protocols following which she examines the patients, after following the necessary universal safety protocols, and enters her findings in the app and uploads the case evaluation to the doctor. This entire journey, right from recording the patient details to upload to doctor is based on a series of checklists prompted by the Ayu.
PIC: A health worker with her kit explaining the process to a patient.
The CHW may also use some protocols to guide them in tasks that they are trained to perform autonomously without the need for a remote doctor. For example, a home-visit protocol for post natal care can guide the CHW in checking if the infant has received the necessary immunization or check if they have received Vitamin A supplementation. The protocols can also guide them in providing the necessary treatment in keeping with the CHW’s level of training.
Another example use case of the Ayu protocols may be in diagnosis and management of conditions such as childhood diarrhea using the Integrated Management of Neonatal and Childhood Illness guidelines by the WHO. The protocol can prompt them to look for danger signs and provide decision support to the CHW and prompt them to give the infant oral rehydration or prompt a referral if certain danger signs are identified.
In later sections of this wiki you can learn about the existing library of Ayu protocols developed by Intelehealth and also learn how to program Ayu by building your own protocols. Please contact us, if you are interested in accessing or contributing to the library of protocols built by Intelehealth (these have not been open sourced currently).
PIC: Health worker setting up the Center in Odisha, India
PIC : Patients lining up outside the Telemedicine center in Odisha, India