Creating a Digital Protocol

Owned by Vibha Bhirud
Last updated: Jan 05, 2021 by Neha Verma
4 min read

Ayu 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 that is hierarchical and shows the relations between pieces of the whole, like a family tree. It allows you 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 complaint 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, software used to build mindmaps. https://sourceforge.net/projects/freemind/

Nodes: Nodes help connect various branches throughout the mindmap. The 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. Fever Protocol

Step 3: Create ‘Parent nodes’ from the root nodes. These are the first level of protocol questions

eg. [xx] Duration, Nature of fever, Timing, Severity, etc.

Step 4: Create ‘Child nodes’ from the parent node. These are the possible choices for the first-level questions. Many such levels further probing the choices can be nested under each of the nodes.

In Nature of fever (parent node), child nodes would be All day Constant, Irregular, Periodic which are the sibling nodes of each other.

 

Attributes: Attributes define the characteristic of the node. Nodes can be given different attributes depending on the desired outcome. The attributes used in digital protocols are:

  1. display: The content written in this attribute will be displayed on Android. This attribute is used to simplify clinical language for the users.

  2. 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.

  3. language: The content written in this attribute will be displayed on the Web Application. This attribute is used concise into clinical language for doctors.

  4. 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.

  5. input-type: This attribute allows the user to insert values depending on the different types. There are 5 main input-types:

    1. number: prompts a text box to insert numeric values

    2. text: prompts a text box to insert text values

    3. duration: prompts a text box to select duration from days, weeks, months, years

    4. date: prompts a text box to select date in dd/month/yyyy format

    5. 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>type the name of the attribute. Do not put extra characters like period or space.

  1. display

2. display-xx: Replace xx by the initials of the language. Use Unicode format.

3. language

4. pop-up

5. input-type

Step 6: Create a Past Medical history and Family history protocols can be created following the previous steps.

Step 7: Create a Physical Examinations protocol following the previous steps. This protocol contains all the physical exams of all screening/chief complaint 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.

STEP 8: In order to trigger the right physical exams on the screening/chief complaint protocol, type the second and third level nodes of physical exam protocol in the content box in the exact way as it is written in the physical examination protocol. Add the attribute “perform-physical-exam” on the root node and add the value of the physical exam as “Eyes:Redness;Eyes:Swelling;Eyes:Redness”. This should correspond to a physical exam in the physical exam mind map.

STEP 9: Add your citations and references. Click on the root node and in the bottom section, you will see notes where you can add the source of the protocol.

 

Tips:

  • It is recommended to limit to 3-4 nested levels of nodes to avoid confusion for the interface user.

  • Translations will have to be inserted manually for each protocol at each node.

  • 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 as per the user literacy eg. easy to understand, everyday local words 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

  • The Intelehealth Android App requires 4 kinds of digital protocols:

    • Chief Complaint eg. fever, menstrual pain, AND/OR Screening protocols like hypertension, diabetes

    • Past Medical History

    • Family History

    • Physical Exams