The SL App is an android smartphone application (3.0 Honeycomb) developed by the Supporting LIFE Consortium. The application replicates the WHO and UNICEFs validated paper-based CCM decision aid routinely used by community health workers in Malawi. It supports tools for vital sign detection.
Electronic Community Case Management (eCCM)
The SL App asks HSAs to enter the same information they would usually be required to gather using standard practice, specifically:
- socio-demographic information (e.g. date of birth, gender, town of residence),
- clinical information (e.g. presence or absence and duration of symptoms) and
- clinical measurements (e.g. breathing rate).
Clinical data is entered directly into the application via touchscreen technology, either by selecting the appropriate option or entering free text. Completion of all clinical questions and assessment items was mandatory on the application for the CCM clinical decision rule to operate. The SL App can be run in English or the local languages Tumbuka and Chichewa. For this study, the default setting was English; the same language used in standard practice.
The SL breath counter is a breathing rate tool embedded within the SL App. During assessment of a child, the breath counter is selected by pressing the lung icon next to the relevant assessment item. The HSA is required to tap the screen in time with each observed inhalation. As standard CCM specifies breathing rate be measured for 60 seconds, the SL breath counter will be pre-set to this time period on all devices. SL eCCM does allow the user flexibility to select a shorter monitoring period (i.e. 15, 30 or 45 seconds), if they prefer.
To comply with standard CCM specification if shorter time periods are selected, the underpinning algorithm of the SL App determines the time between occurred tap events, to give a breath count reflective of 60 seconds. After the selected time period has elapsed, the number of breaths a child has taken is visually displayed, automatically populated in the relevant field and used by the clinical decision rule to compute illness classification and treatment recommendations.
Wireless vital sign device integration
Supporting LIFE explored the integration of wireless vital sign device into the application. A market review of sensors was performed to identify optimal-fit-for-purpose vital sign devices appropriate to meet the clinical trial environment, along with Community Health Worker ergonomic and patient point of care requirements. Wireless vital sign devices were evaluated and one sensor (Zephyr BioHarness) was selected as the vital sign device to be integrated with SL App. Integration of Zephyr BioHarness sensor with Android SL App enables the reading of patient heart and respiration rates via FDA approved sensors.
Both the Zephyr BioHarness Sensor and breathe counter were components of Supporting LIFE: Software Release (v4.0.0) titled ‘Disease Surveillance & Sensor Integration, released 30/09/14.