Cht-core: Make it easier to identify at risk individuals in the app

[yembrick]

We learned from CHWs in the PA pilot that they cannot easily see who their high risk patients are in the app. In fact, most told us that the only way you could know who was high risk was to wait for them to appear in the tasks tab.

Currently, we have the patient profile configured to show an individual's risk status and display an icon (shield) if they are high risk. However you have to be on the individuals profile directly to see this, it is not visible anywhere else in the hierarchy.

Some ideas:

• Show the shield icon next to the individuals name in the people list in the household profile.
• Show the shield icon next to the household that contains a high risk individual in the list of households
• Show a target that has a count of current high risk individuals
• recommend some design work to explore these (and other) options

[ecsalomon]

Another option would be to sort/filter households/patients on risk status

[MaxDiz]

cc: @n-orlowski may be good to include in any sorting/filtering options being considered in #5776 and #5886

[n-orlowski]

@yembrick could this be tagged as a covid-related issue? Making Covid patients more visible?

[kennsippell]

@senseibara Relevant to Muso's COVID risk reporting workflows?

[yembrick]

I replied to @n-orlowski in slack instead of here, but I definitely think this is relevant for COVID workflows, for both contact tracing and diagnosis/rdt/referrals to care.

[joyannee]

Specific user story for contact tracing is "As a tracer I would like to know if there is someone associated with a specific COVID case that hasn't been traced" Right now we have the danger sign associated with untraced people but need to know from the list of if people if a contact within the COVID case "household" has yet to be traced, since we cannot assign a state based on another's at the moment, we can't identify them unless one goes into the "household". This requirement would be particularly helpful in this case. Show the shield icon next to the household that contains a high risk individual in the list of households

Another feature would be to easily identify the new contacts as they come in to the app from another system. In the Palladium project, patients in the KenyaEMR are being replicated in the CHT for contact tracing, it would be helpful to distinguish between new contacts and old ones. Ideally something like making the new contacts bold or including the word new on the top right hand side perhaps. cc @derickl @JenniferMuli

[MaxDiz]

This feature has been requested by a few partners recently. Adding to v3.10 to start design. If ready in time, eng can pick up, but it should not be a blocker for the release.

[n-orlowski]

Hi team,

See below for the explorations of this issue with annotations outlining the potential options for the People tab and variations of the Household and Individual pages looking at placement of icons, continuity, visual language and user friendliness.

Based on these I've also put together a recommendation for a scalable system where the "Risk" icons and labels (labels to show more specific risk information, ex. pregnancy, covid, etc) are used consistently and recognizably through the flow from people tab to person page.

Let me know if anything needs further clarification; looking forward to getting feedback!

[mmureithi]

Have we considered placing the icon in the biodata section as above in the household's and person's profile page?

@n-orlowski

[n-orlowski]

@mmureithi Yes, something we considered but felt like having two prominent icons in this section might be unclear and break the design on smaller screens (if you are talking about putting it with the HH name). I also thought about including the 2 icons in the people list and decided against it due to the real estate they would take up in a single row (then followed this thought process onto the other pages).

Looking at another alternative based on your feedback could be something like this

where the Household and Person icon stay the same however I think it makes sense to keep the shield icon with the individual in the HH and follow the placement on the person page

Curious to know your further opinions :)

[ecsalomon]

@n-orlowski Thanks for putting together these designs. I really like how this is looking. I love the cleaned up look of the Icon right option but think the MVP with Icon left is also looking good.

I agree with your concerns about the Dropdown option introducing confusion about selecting the HH page vs dropping down, and I think @helizabetholsen would agree that we don't want to demote the importance of the household page -- especially as we think about continuity of care and communication of household risk (e.g., This household has 3 people with pre-existing conditions putting them at risk of severe illness for COVID-19).

I also like the HH page design in your most recent comment for HHs with at risk individuals where we don't consider the HH at risk, but I wonder if we need to distinguish these in the HH list?

[helizabetholsen]

Thanks for flagging, @ecsalomon. This is correct, I think we need to be thinking more about risk communication at the household scale, as well as the individual. For example, in the context of our equity lens work entire households might exhibit risk factors related to increased vulnerability to a) contracting COVID-19 or b) facing disruptions to PHC as a result of COVID-19.

When we are using measures like maternal education or HH wealth in our risk scoring, these are factors that need to be considered at the HH level. We will likely need to think critically about how we would score and communicate HH risk - in addition to individual patient risk.

Perhaps we could have an icon to denote HH risk and another to denote individual patient risk - or there could be a distinguishing label within the HH page itself?

cc @yembrick

[n-orlowski]

Thanks for the feedback, team! Looking at this issue with these new considerations we have come up with the following:

Reducing the visual noise here by removing the family icons in the people tab as well as creating "Risk" cards on HH and individual profile helps bring them to attention while still keeping the content scannable.

The proposal is to use the shield (protection) icon as a more general indicator, with a "Has risk" label (as HHs and individuals can have more than one risk each) and to click in to see more details.

LMK about any thoughts! cc @ecsalomon @helizabetholsen

[MaxDiz]

R&L team clarified that there are no immediate project deployments for this improvement. There is some remaining design work to be done. It may make sense to bump to v3.12 and bundle design/dev with #5706 and #5708. For discussion at the next roadmap planning meeting.

[MaxDiz]

Based on discussion with the Roadmap planning team, we are bumping this issue to v3.12. Design work can continue in the meantime.

[n-orlowski]

Latest iteration is to have 2 levels of priority for MVP, labelling high priority items as "Priority Care", visible across the app and including a card on the contact pages.

The concept here is to simplify the identification for priority items without losing the indication of person or task type by including a coloured bounding box for each icon. This is also clearer than simply adding a conditional icon (ex. shield) as by only using 2 colours a user can easily scan for important tasks.

Additionally I'd propose to use a single colour for active tabs to not confuse additional colours with other meanings.

[michaelkohn]

I think it looks great. It leads me to these proposed assumptions and questions:

Assumptions

• Conceptually, this new design caters to two levels of priority: priority and non-priority (not sure of best terminology)
• There are three entities that might have a priority associated to them: families, family members, and tasks
• Tasks associated to a priority family can be priority or non-priority
• Tasks associated to a non-priority family can be priority or non-priority
• Tasks associated to a priority person can be priority or non-priority
• Tasks associated to a non-priority person can be priority or non-priority
• Tasks associated to a person can be priority or non-priority regardless of that person’s family’s priority
• Other places and/or place contacts higher in the hierarchy do not require priority (at this time)
• Tasks associated to places/place contacts higher in the hierarchy can still be considered priority or non-priority (using existing functionality)
• Existing Task functionality caters to two levels of task priority, high and medium
• Existing Task functionality allows you to conditionally identify that task as being high risk or not based on a function
• The only thing that the existing task priority does is control the existence of an additional line of text
• We will want to be able to query a family or person's priority in PostgreSQL and not have to recreate the rules in SQL so will want to store the priority on a doc (instead of just ephemerally on a contact summary, for example).

Some conceptual / non-visual questions:

• What are some of the ways a person, family, or task might be considered priority? For example… based on a risk score, danger signs, risk factors, etc… (looking for broad examples).
• How will app developers specify a person or a family as being priority? Would this be the same as how Tasks are configured to be priority?
• The CHT doesn’t really have a defined family or family member concept… it’s more of a convention (clinic = family, for example). Do we need to prevent priority from being configured at different levels?
• Should a family be considered priority if any of their family members are identified as priority? Would that be based on design guidance or enforced by the toolkit?
• Should a person be considered priority if their family is considered priority? Would that be based on design guidance or enforced by the toolkit?
• Would priority be accessible to SMS schedules?

[n-orlowski]

@michaelkohn

Most assumptions are correct however:

• Non-priority families and/or non-priority people should not receive priority tasks

For other stuff:

• Priority/risk examples: Economic vulnerability, unlikely to deliver at facility, late illness identification (@ecsalomon can add more)
• Unsure about how to specify priority but I imagine it would be the same as tasks are configured..
• There may be an instance where a clinic/nurse may need to be identified as at risk or a priority, I don't think we should make it exclusive to households only but open to more feedback/thoughts on this
• A family can be a priority as a unit without labelling every individual as priority (however if an individual is a priority, the household needs to display the priority icon for visibility on the highest level, ex. people tab)
• Priority does not seem to be accessible to SMS schedules (unless you have any suggestions on how that might work?)

[ecsalomon]

To add a bit on this question:

The CHT doesn’t really have a defined family or family member concept… it’s more of a convention (clinic = family, for example). Do we need to prevent priority from being configured at different levels?

I would say that we should support _whatever is the level displayed in the contacts list for the user_ and all levels below that (whether this is families + family members or clinics + nurses or some other combination) being priority, but not any levels above that.

[michaelkohn]

Thanks for the feedback @n-orlowski @ecsalomon

Priority/non-priority tasks

Non-priority families and/or non-priority people should not receive priority tasks

@n-orlowski I agree that they should not automatically be priority tasks, but since tasks themselves are an entity that can independently have a priority associated to them, a non-priority person should be able to have a priority task (as it works today).

Priority for all places and contacts

Other places and/or place contacts higher in the hierarchy do not require priority (at this time)

[NO] I don't think we should make it exclusive to households only but open to more feedback/thoughts on this

[ES] I would say that we should support whatever is the level displayed in the contacts list for the user and all levels below that (whether this is families + family members or clinics + nurses or some other combination) being priority, but not any levels above that.

Cool. I hadn't heard a specific user story for this but I agree there doesn't seem to be a reason to purposely make it not possible elsewhere in the hierarchy.

---

I have some more technical questions and ideas that I'd like to chat through with an eng rep. @garethbowen who should I chat with?

[ecsalomon]

| @n-orlowski I agree that they should not
| automatically be priority tasks, but since tasks themselves are an entity
| that can independently have a priority associated to them, a non-priority
| person should be able to have a priority task (as it works today).

Our thinking is that if you have a status/condition that elevates a task to
high priority, that status should show on your profile

[n-orlowski]

Updates for MVP:

• Removed 2nd line on People (people tab + family members section)
• Removed diamond icon on title row of the condition card
• Remove single-color tabs (using our regular multi-color)

*Edit to flag that these removed components are still desired and will be considered in later iterations

cc @michaelkohn

[michaelkohn]

Summarizing the actual changes that I think need to be made in the MVP.

• [ ] Stylize task icons for high priority tasks. Using existing task functionality for identifying a task as ‘high’ priority, stylize high priority tasks as yellow w/a diamond background (see above mockup) wherever they are displayed in the app.
• [ ] Stylize task icons for non-high priority tasks. Non-priority tasks should be blue w/a square background wherever they are displayed in the app.
• [ ] Change color of priority.label text when displaying tasks. Currently this is red, change to grey everywhere this line is currently displayed.
• [ ] Introduce capability to calculate a “risk” attribute for contacts (people and places). I’ll continue to call it “risk” here, but there was some debate on what to call this. There is a FHIR resource called ‘flag’ that might be a good option for this.
• [ ] The risk attribute should be available to contact summary.
• [ ] The risk attribute should be available to condition cards.
• [ ] The risk attribute should be available through the API (hydrate, contacts_by_phone, etc...) .
• [ ] The risk attribute should be available to tasks for that contact.
• [ ] The risk attribute should be available in analytics/PostgreSQL.
• [ ] The value of the risk attribute at any point in the past should be available in analytics/PostgreSQL.
• [ ] Stylize icons for contacts that are at risk. These should be yellow w/a diamond background wherever the contact icon is displayed.
• [ ] Stylize icons for contacts that are not at risk. These should be blue w/a square background where the contact icon is displayed.
• [ ] On the contacts tab, when viewing a place (such as a family), show icons for people associated with that place (family members).
• [ ] Stylize form and report icons. Wherever forms and report icons are currently displayed, stylize them as blue.

[MaxDiz]

Project timing has been delayed so removing from release. This should be scheduled after the "what's new" modal has been updated to better inform users of changes.