Smartphone-based Clinical Decision Support System for Hypertension and Diabetes Care at Primary Health Care Facilities in Solan, Himachal Pradesh: the mPower Heart Project

Hypertension and Diabetes have emerged as major public health challenges in India. Although these two conditions can be effectively managed at primary care settings, poor quality of primary care services results in huge burden of undiagnosed and under-treated cases of hypertension and diabetes at the community level. In order to address such critical gaps in care the Centre for Chronic Disease Control and the All India Institute of Medical Sciences attempted to develop a mobile phone technology enabled intervention in the Solan District in collaboration with the Government of Himachal Pradesh.

A carefully developed smartphone based clinical management decision support tool was developed for the use of nurses at the outpatient clinics of five Community Health Centres (CHCs) in Solan in order to help the Medical Officers in screening and provision of treatment of hypertension and diabetes. The smartphone tool helped the nurses to run a clinical risk score to identify people with likelihood of having undetected diabetes.

outpatient clinic attendees, above the age of thirty, for diabetes and hypertension. Using the smartphone DSS a personalized management plan is computed for such diagnosed patients with the concurrence of the Medical Officers. The DSS computes management plan based on evidence based clinical management guidelines in order to reduce medical errors and standardise the care from all the CHCs. In addition, the patient record generated by the software is helping patient evaluation during follow-up visits.

The DSS has the following features:

  • Generation of electronic patient records and creating records locally and at a central database.
  • Clinical risk score for detecting patients at risk for diabetes
  • Generation of personalized management plan for diabetes
  • Generation of personalized management plan for hypertension
  • Suggestion for choosing optimal drugs, and contraindications
  • Generation of serial data to provide continuity of care during follow-up visits
  • Utility to export data to statistical software packages for analysing temporal trends

  • An interim evaluation of the mPower Heart Project using clinical outcome at three months shown that, among 2080 patients with hypertension, a reduction of 13.1 +/- 13.8 mmHg was observed in mean systolic blood pressure from 149.1+/- 20.2 mmHg to 136.0 +/-16.0 mmHg. Similarly, the mean fasting glucose level was reduced from baseline 179.2 +/- 65.2 mg/dl to 145.7 +/- 42.6 mg/dl in 508 diabetes patients.