Development and User Testing of a Dynamic Tool for Rheumatic Heart Disease Management

Abstract

Objective: Most rheumatic heart disease (RHD) registries are static and centralized, collecting epidemiological and clinical data without providing tools to improve care. We developed a dynamic cloud-based RHD case management application with the goal of improving care for patients with RHD in Uganda.

Methods: The Active Community Case Management Tool (ACT) was designed to improve community-based case management for chronic disease, with RHD as the first test case. Global and local partner consultation informed selection of critical data fields and prioritization of application functionality. Multiple stages of review and revision culminated in user testing of the application at the Uganda Heart Institute.

Results: Global and local partners provided feedback of the application via survey and interview. The application was well received, and top considerations included avenues to import existing patient data, considering a minimum data entry form, and performing a situation assessment to tailor ACT to the health system setup for each new country. Test users completed a postuse survey. Responses were favorable regarding ease of use, desire to use the application in regular practice, and ability of the application to improve RHD care in Uganda. Concerns included appropriate technical skills and supports and potential disruption of workflow.

Conclusion: Creating the ACT application was a dynamic process, incorporating iterative feedback from local and global partners. Results of the user testing will help refine and optimize the application. The ACT application showed potential for utility and integration into existing care models in Uganda.

Fig. 1

Patient summary slides (data presented in this figure are imaginary). ( A ) Patient card demonstrating patient ID, prophylaxis prescription, adherence level, and BPG coverage. ( B ) Care plan demonstrating more detailed information regarding allergies, last echocardiogram, recommended interventions, RHD complications, and cardiac medications. BPG, benzathine penicillin G; RHD, rheumatic heart disease.

Fig. 2

Patient registry displays all active and inactive patients within the registry with various search features available to sort patient cards by desired features (such as prophylaxis management clinic, approaching BPG injection due, name, etc.). BPG, benzathine penicillin G.

Fig. 3

Reports display aggregate information on ACT registrants, RHD care (including referral and completion of surgical or catheter-based intervention), and BPG adherence which can be filtered by clinics at various health system levels. ACT, Active Community Case Management Tool; BPG, benzathine penicillin G; RHD, rheumatic heart disease.

Fig. 4

Offline BPG entry and reconciliation. ( A ) Offline BPG entry form used to enter an individual's BPG injection when internet connection is unavailable. ( B ) Stored BPG Form that automatically populates upon logging in to the ACT application once internet connection is reestablished. Users have the ability to view all offline BPG injections entered, fix any invalid forms, and then submit after which all valid entries are automatically reconciled and placed in the appropriate patient chart. Invalid forms are stored within an invalid BPG form repository where they can be addressed at a later date. ACT, Active Community Case Management Tool; BPG, benzathine penicillin G.

Fig. 5

Survey responses from partners regarding ease of ACT application tasks ( A ) and from test users regarding the ACT application ( B ). Responses regarding ease of tasks were rated from easy (1) to impossible (5). ACT, Active Community Case Management Tool.

Fig. 6

Assigned roles for ACT user testing assigned role is indicated first, followed by users fulfilling the role noted in parenthesis, and the users' position at UHI in italics . The * denotes that these roles were fulfilled by the same user. ACT, Active Community Case Management Tool; UHI, Uganda Heart Institute.