Operationalizing CARE in the field

As the technology is set up, it is important to have a system on the field to operationalize the systems to aid the health department in managing the pandemic.

What is CARE?

CARE is a web-based Hospital management system with special focus on Capacity augmentation and Load Balancing. It is an Open Source software with an MIT license built by a group of volunteers. It can be utilised by anyone for free and it shall remain so forever.

To learn more about CARE and its features, CLICK HERE.

How does CARE work?

CARE connects all healthcare facilities within your region (district/state/country) in one network. The critical details of healthcare assets are entered into the system first-hand by each healthcare facility. This Data is projected on the district level dashboards so that the district team (district collector) has all relevant information to take decisions.

Data Flow in CARE:

Each hospital enters data about the 3 things

• Patients

• Bed capacity and availability

• Oxygen availability and consumption

The data entry at each hospital is closely monitored and enforced by a team appointed by the district collector.

A short 6min video of recurring data entry at any hospital is available here.

A War Room (Control Centre) is set up at the district level where the dashboards are viewed to make quick decisions on the field.

How to operationalise CARE within a district.

1. The district collector issued an order mandating each hospital (government as well as public) to register within CARE and update information on bed capacity and availability every set interval. The latest order by the Ernakulam district collector is HERE for your reference. The order must have the following points:

   • Must provide for setting up of a central COVID Control centre (War room) for the district

   • A CARE Nodal Officer must be appointed.

   • Must mandate that all hospitals within the district register themselves on CARE within the said date and update details at least every 3 hours.

   • A time period must be mentioned within which training of all staff in using CARE must be achieved. The Nodal Officer for Training must be responsible for this.

2. The collector identifies one high level health official (in case of Ernakulam, Dr. Mathews Numpeli, the District Program Manager of Ernakulam, National Health Mission) to be the CARE Nodal officer for deploying the system.

3. Under the Nodal officer, there are the following officers specifically for specific functions:

   1. CARE Enforcement officer: Ernakulam district is divided into 7 Taluks. The PROs of the Health department at each Taluk is responsible for ensuring compliance of the above mentioned Order in point 1. The PROs from Taluks report straight to the PRO of the district. Law enforcement is engaged to deal with any resistance from the field to ensure data entry.

   2. Nodal Officer for Capacity building and Augmentation: This officer identifies exactly where the maximum load on healthcare is and works towards increasing infrastructure like setting up new COVID treatment centres with the support of government and private contributions.

   3. Nodal Officer for Oxygen: This person heads the committee that manages oxygen. The committee has representatives from the department of industries to identify suppliers and ensure supply, the RTO (enforcement) to ensure logistics for the oxygen and also Law Enforcement to ensure safety while transporting the oxygen.

   4. Nodal Officer for shifting: There is one officer specifically to ensure shifting of patients from one hospital to another happens smoothly on CARE. He must liaison with ambulance managers and the RTO to optimise logistics.

   5. Nodal officer for Training and Human Resource Management : This officer will ensure there are enough data entry operators and that training on using CARE is given to all. This officer also manages engagement of volunteers to manage data.

4. The MOs in each Panchayats are held responsible to patient management within their jurisdiction.

5. A district central war-room is set up displaying all the dashboard.

6. The war room has a team of 15 data entry staff continuously monitoring data entry from the hospitals and immediately identifying any lapse.

7. A district level shifting team that works around the clock must be set up to operate shifting. The team must at any point in time have at least 2 doctors, and 8 logistics managers to ensure smooth shifting.

8. There is a Mobile Training Team of 10-15 people for training all users on the field.

CARE: Data collection and enforcement.

At Hospital (Facility) Level:

There must be one person at each healthcare facility to enter the details regarding

• Patients

• Capacity and bed availability

• Oxygen, supply and consumption

The CARE system facing the hospital staff is very easy to use and efficient. The registration of a hospital can be done within 5 minutes while the periodic updation of data takes up less than 5 min. Click HERE to see a demo of the registration and data entry from hospitals

At Panchayat Level:

At panchayat level, the Medical Officers are responsible to update the status of COVID patients under Home Care.

At Taluk Level:

The PROs of health department at each taluk oversees that the data entry happens at each hospital promptly.

At the District Level:

There is a team of at least 15 data entry personnels at the district control room to monitor and ensure accuracy of data collected from the field. They also immediately identify if there is any lapse from any hospital.

The CARE Capacity Dashboards shows when each hospital has last updated their information. The Nodal CARE Enforcement Officer will supervise this system.

Capacity Building

The Nodal person for Capacity Building at the district control room will identify the areas where capacity is lacking using the CARE Capacity Dashboard. The officer engages with private/public organizations to build capacity by setting up COVID treatment centres or increasing the bed capacity of hospitals.

Oxygen Management

There is an Oxygen Committee functioning out of the District Control room. The committee comprises of:-

• Staff of the Department of Industries: These staff coordinate with the suppliers and the industries in identifying resources.

• Regional Transport Officers (Enforcement): The officer arranges for vehicles to transport oxygen in a timely manner

• Law Enforcement: Wherever required, the police must be engaged to ensure safety of transportation of oxygen

The Oxygen Modal Officer coordinates with all the above individuals and gets real time data on availability of oxygen in each hospital, the burn rate etc from the CARE Oxygen Dashboard.

Shifting of patients:

There must be a central shifting team comprising of

• Doctors: To clinically assess and identify which patient must be shifted to which facility

• Logistics Managers: They use the CARE Capacity Dashboards to identify bed availability and arrange for Ambulance for transportation.

NOTE: In Ernakulam, only emergency shifts are executed by the District Central Shifting team. The shifting of patients that are not so severely sick (like shifting a patient from home to a Covid Care Centre etc) are executed at the Taluk Level. If this model is followed, 2 persons at Taluk level to manage local shifting will also be required.

CoronaSafe Network has also developed a logistics management system to control the ambulance systems called the SURAKSHA NETWORK.

Training and HR Management:

Training:

Training is conducted through an online certification course on CARE available HERE.

Training material in the form of videos is also available HERE.

A mobile training team of 10-15 members must be set up to conduct targeted training sessions wherever necessary.

HR Management:

Table of Human Resource Needed:

Position	Number	Background/ designation
Data Entry (Central Team)	15	Volunteers/ Data entry staff
Data Entry assistants	In each hospital (need-based)	Volunteers
Panchayat Head to supervise patients under Home Care	One in each panchayat (need-based)	Medical Officers at each panchayat
Shifting Team: Logistics Managers	16 ( split into shifts to work 24 hrs)	volunteers/ Field level staff
Shifting team: Doctors	4 ( split into shifts to work 24 hrs)	Doctors
Shifting: Zonal/Taluk Level	2 in each zone/taluk, based on need	Volunteers/ Field level staff
Training Team	15	volunteers/staff with good communication skill
Zonal Heads	One for each zone/Taluk	Health department zonal heads
Nodal Heads for enforcement, capacity building, oxygen, HR management, and shifting)	5	Senior health officials
CARE Nodal Officer	1	Head of the COVID Task-force from Health Department