GitForCOVID

Using GitHub to organize COVID emergency response.

The Question

Can we use GitHub to maintain patient records in a hospital? Here is a possible approach, and some illustrations.

Motivation

With second wave of COVID burning through India, many organization are responding by setting by hospitals. I learnt about one such organization, Doctors for You, which has - as on May 09 2021 - set up 16 COVID hospitals, and plans to double in 2 weeks. While they hasted to deploy people and resources, they also need agile, robust and cost-effective ways to organize information.

Need

From a leader in this organization, I found out that these hospitals require the following:

1. Supply chain management - for drugs
2. Personnel management - for doctors, nurses and paramedics
3. Bed allocation - these hospitals are inpatient care facilities
4. Patient tracking - admission, treatment and discharge

This post seeks to address items 3 and 4.

Approach

GitHub is likely the world's most used software development, and it's bug/ spec management feature (called Isssues) lends itself to tracking information in general. Issues are composed of comments, they can be tagged, assigned to users, added to milestones, and opened/ closed. These features are mapped to patient management and bed allocation functions in the next section.

Other features of the GitHub platform that are useful in this scenario are - organization-based data access control, role-based edit/ view access control, data isolation (using repositories), and the availabiilty of robust, well-design iOS and Android apps.

If you prefer, you can jump straight to examples by clicking here [INSERT URL TO SAMPLE ISSUE].

Structure

Issue Content > Patient Records

Issue numbers are unique, can be used as patient IDs. All edits to issues can be tracked.

1. Issue Title > Patient Name, age/ gender
2. Issue Comment 1 > DoB, Emergency contact Mobile # & Address
3. Issue Comment 2 > Date of Admission, Chief Complaint
4. Issue Comment 3 > Workup/ triage details
5. Issue Comment 4 > Medication plan
6. Later issue comment > notes from care providers

GitHub allows us to add comments using templates. This feature can be used to ensure that users are prompted with enter appropriate data.

Assignment > Users (Care Providers)

1. Issues can be assigned to users (more on user management later). In this case, users = care providers.
2. Issues can be assigned to multiple users at a time. GitHub allows up to 10 simultaneous assignees, which is sufficient to cover 3-shift operations with both medical and nursing staff.
3. Users can assign an issue to other users, and unassign themselves (if they have the requisite permission).

Tagging > Labels (Bed Number)

1. Issues can be tagged with labels.
2. Labels = a composite of Ward & Bed number.
3. Labels can be color coded.

Opening and Closing Issues

1. Once a patient is discharged from the hospital, or in the event of death, their records can hidden from view by closing the issue.
2. Issues can be reopened in case of re-admission.
3. Users can also comment on closed issues - in case they want to add details post-discharge.
4. Once an issue is closed, it should be unassigned and untagged.

Multi-Location setup > Repos

1. GitHub organizes information in repos (code repositories)
2. One organization can have multiple repos, and individual repos can be set to public or priate access.
3. Each repo can map to a hospital location.

Access Control > GitHub roles

1. GitHub offers 3 primary types of roles for organization accoutns - owners, members, and collaborations. More details here.
2. Hospital admins > Owners, Care providers > Members, Short-term specialists > Collaborators.

Example

1. Sample hospital with 10 beds; 5 in a male ward (with green labels), and 5 in a female ward (with blue labels).
2. 2 sample patient records
   1. Open record for a male patient, assigned to a bed + user.
   2. Closed record for a female patient, who has been discharged.

A variety of filters are available on the issues page. Here is one snapshot.

Limitations

1. Checking for open beds is difficult
2. Medication cannot be pulled from a standardized list
3. Cannot set mandatory data fields - issues are free-text by design

Benefits

1. Highly flexible, robust, and ready for use
2. Can be a good interim solution until a "regular" hospital management system is deployed

Misc

Concept Contributors

• Sagar, a gifted Android developer and all-round technology enthusiast.

About Me

I run a medical technology design & development firm, Lattice Innovations (www.thelattice.in). I have spent the last 15 years in healthcare - mostly in medical devices and software, but also with experience in running hospitals in rural/ peri-urban West Bengal.