Clinical Workflows for CHO

Clinical workflow for the Community health officers (CHOs) is a job-aid or decision support application to manage clinical cases at Sub-centre -Ayushman Arogya Mandirs (SC-AAMs). It is in accordance with 12 expanded range of services at SC-AAMs under Comprehensive Primary Health Care (CPHC). The workflow is the quick checklist for management of patients who attend outpatient clinics of SC-AAM. It is a practical guide that provides tips on assessment of patient (eliciting history, examination and tests) for a patient with a particular presenting complaint. Based on the assessment, CHO will be able to quickly identify the patient needing immediate referral to emergency care. Workflows also provide tips of pre-referral care. For all non- emergency cases, the workflows provide suggestions for referral, teleconsultation or management at the SC-AAM. 


What are the principles of clinical workflows?

• Simple language
• Starts with presenting complaints
• Action oriented
• Comprehensive
• Clinically accurate
• Classification of conditions, not diagnosis

How to use the clinical workflows application?

1. The application has three sections- (A) Workflows (B) Assessment tools and (C) Treat and Counsel. Additionally, there is a search bar provided in the beginning of application to directly navigate through either of the above mentioned sections.

   • Workflows- After entering patient’s age and gender, CHO can either start a new assessment ‘OR’ can navigate directly to appropriate workflow based on the patient’s complaint.
   • Assessment tools- The assessment requiring further instructions or long questionnaires are hyperlinked in workflows to the specific assessment tools
   • Treat and Counsel- Under management, some actions are hyperlinked to corresponding ‘treat and counsel’. CHO can also navigate to the specific ‘treat and counsel’ if needed.

2. For all cases in red and orange categories CHOs should provide referral slip and enter in the referral registers

3. For those in yellow or green categories, CHO should apply preventive/wellness workflows that include:

   • Opportunistic screening for non-communicable diseases (for those eligible)
   • Follow up care for chronic communicable and non-communicable diseases (if any)
   • Assessment and promotion of health and wellness for all adults
   • Reproductive health services to all adult women in reproductive age i.e. 18-49 years
   • Specific preventive and wellness care for adolescents and elderly

4. Workflows also includes clinic or home-based care for persons needing palliative care 
 How is this application user-friendly?

• Only age and sex specific workflow interface opens after entering the patient details that makes CHO aware of required workflow.
• The action points in workflow are hyperlinked to corresponding ‘assessment tools’ and ‘treat and counsel’
• Besides using the workflow for real-time patient, the CHO or any person may use this application for their practice or as a ready reckoner as a search bar is provided in the beginning of workflow that allows user to directly find the complaints, conditions, assessment tools or management sections.