Clinical Care Management | Moana Digital Health

Overview

The Clinical Care Management module is where clinical work happens inside Moana. Every patient interaction, from an outpatient consultation at a rural health post to an inpatient admission at a district hospital to an emergency presentation requiring immediate triage, flows through a structured clinical workflow that ensures every action is documented, every handover is informed, and every clinical decision is supported by the patient's complete history.

The module is designed for the operational realities of health systems that face high patient volumes, limited specialist staffing, unreliable connectivity, and the concurrent demands of managing both individual patient care and population health programme obligations. It does not assume stable infrastructure or a full clinical team at every facility. It is built to function with the staff and connectivity that are actually available.

Clinical workflows in Moana are structured but not rigid. Outpatient visits are broken into discrete, saveable steps so that a clinician interrupted by an emergency can return to a partial record without losing work. Inpatient admissions use atomic workflow transitions that simultaneously close the originating encounter and open the admission, preventing the duplicate records and missing handover information that cause clinical risk in paper-based systems. Emergency presentations are triaged with defined severity levels and pre-built order sets that allow a single clinician to initiate a full diagnostic workup in seconds.

The clinical decision support layer operates continuously across all workflows, checking prescriptions against allergy records and interaction databases, flagging overdue preventive care interventions, and surfacing clinical recommendations based on the patient's active diagnoses. Every alert is configurable. Every override requires a documented reason. Clinical autonomy is preserved; accountability is never compromised.

Non-communicable disease management, vertical programme enrolment for TB, HIV, and PMTCT, and multidisciplinary care planning are all integrated into the same clinical workflow layer, so a clinician does not have to work in a separate system to meet programme obligations. Programme data flows automatically into the national surveillance layer for Ministry of Health reporting.

Core Capabilities

Outpatient Consultation Workflow

Outpatient visits are structured into discrete sequential steps: triage, vitals, chief complaint and history, clinical examination, diagnosis with ICD-10 coding and certainty levels, investigations ordered, medications prescribed, clinical notes, and finalisation. Each step creates its own timestamped record, so if a clinician is interrupted at any point, the partial visit is preserved exactly as entered. Diagnosis fields support ICD-10 codes with certainty levels ranging from confirmed through probable to suspected, supporting both clinical precision and population health coding accuracy. Multiple diagnoses per visit are supported. Visits can be finalised by the treating clinician or countersigned by a supervisor.

Inpatient Admission and Ward Management

Patients can be admitted from an outpatient encounter, directly from the emergency department, or as planned admissions from scheduling. Admission uses an atomic workflow transition that simultaneously closes the originating encounter, creates the inpatient admission record, assigns a bed, and notifies the ward team, preventing the documentation gaps that occur when these steps happen separately. Ward management covers bed assignment, shift handover notes with structured clinical status summaries, daily progress documentation, medication administration record integration, and discharge processing with auto-generated discharge summaries linked to the patient's permanent record. Expected discharge dates are tracked at ward level to support capacity planning.

Emergency Department Triage and Fast-Track Ordering

Emergency presentations are triaged using a five-level scale: Resuscitation, Emergent, Urgent, Semi-urgent, and Non-urgent. Triage assessments are timestamped and attributed to the triaging clinician. A real-time ED queue dashboard updates via WebSocket, giving the entire emergency team visibility into patient volume and acuity at a glance. Pre-defined clinical order sets, including Chest Pain Protocol, Stroke Protocol, Trauma Protocol, and Sepsis Workup, allow a clinician to order six to eight investigations and medications in a single action, dramatically reducing the time from presentation to investigation in time-critical emergencies. Wait-time threshold alerts notify supervisors automatically when patients in higher-acuity triage categories exceed defined waiting periods, enabling proactive response before patient safety is at risk.

Structured Clinical Documentation

SOAP notes, nursing assessment notes, procedure records, specialist consultation notes, and customisable clinical templates are available to all authorised care team members. Documentation is timestamped, attributed to the authoring clinician, and available immediately to the rest of the care team. Records are locked on finalisation or countersignature and cannot be altered without a new versioned entry, maintaining the integrity of the clinical record for medico-legal and audit purposes. Custom documentation templates can be configured by facility administrators without developer involvement, allowing facilities to add documentation workflows that match their specific clinical protocols.

Multidisciplinary Handover

Structured shift handover tools ensure that the incoming care team receives a complete, standardised briefing on every patient's current status, outstanding clinical tasks, active alerts, and pending investigations. Handover records are retained in the patient's clinical history, creating an auditable chain of care continuity across every shift. In facilities where nursing and medical handover are separate processes, both are supported independently with role-appropriate content.

Clinical Decision Support Rules

Four categories of clinical decision support rules operate across the clinical care layer. Alert rules fire immediately when a defined clinical condition is detected, such as a patient with a documented penicillin allergy being prescribed amoxicillin. Recommendation rules surface advisory guidance based on patient data, such as an HbA1c test being due for a diabetic patient. Workflow step rules insert mandatory confirmation steps into specific clinical workflows, such as a second clinician sign-off before a high-risk procedure is documented as completed. Preventive care rules trigger recall notifications for overdue vaccinations, routine screenings, and chronic disease review appointments. Every rule type is configurable per facility. Overrides require a documented clinical reason, maintaining the full audit trail without blocking legitimate clinical judgement.

NCD Screening and Chronic Disease Management

Dedicated NCD screening workflows cover diabetes screening with fasting blood glucose and HbA1c tracking, hypertension screening with blood pressure trend analysis, cardiovascular risk assessment, and cancer screening protocols. Patients identified with chronic conditions are enrolled in disease management programmes with structured review schedules, medication adherence tracking, and automated recall alerts when a review appointment is overdue. NCD programme data feeds the national surveillance system, contributing to Ministry of Health population-level NCD indicators including hypertension prevalence, diabetes management rates, and screening coverage across facilities and districts.

Vertical Programme Enrolment and Cohort Management

Patients can be enrolled in vertical health programmes directly from their clinical record. Supported programme types include TB treatment with standardised regimen tracking and treatment milestone documentation, HIV management with ART regimen recording and viral load tracking, PMTCT with pregnancy-to-delivery-to-infant linkage, and NCD programmes. Each programme maintains its own cohort with compliance monitoring, defaulter identification, and treatment completion tracking. Programme enrolment data feeds the national surveillance layer for real-time Ministry reporting on treatment coverage, defaulter rates, and programme outcomes without requiring separate data entry into a parallel system.

Care Plan Management

Structured, goal-oriented care plans are generated from a patient's diagnosis, treatment objectives, and clinical history. Plans are shared across the entire care team and updated collaboratively as the patient's condition progresses. Each care plan links to the encounter record from which it was created, and care plan updates are versioned and attributed. For patients with complex or chronic conditions managed by multiple clinicians across multiple visits, the care plan provides a single shared source of truth for treatment intent and progress.

Clinical Document Generation

Formal clinical documents are generated automatically from source records without separate data entry. Discharge summaries are produced from the inpatient admission record, including admission diagnosis, treatment received, investigations performed, medications at discharge, and follow-up instructions. Referral letters are generated from the referral record with the patient's relevant clinical history automatically included. Documents are idempotent: regenerating from the same source record returns the existing document, not a duplicate.

Who Uses This Module

Medical Officers and Specialists

Primary users of consultation and admission workflows. Document diagnoses, order investigations, prescribe medications, manage care plans, and complete discharge processing.

Nursing Staff

Complete triage assessments, record vitals, document nursing assessments and notes, manage medication administration records, and participate in structured shift handover.

Programme Officers and NCD Nurses

Manage vertical programme enrolment, track cohort compliance, identify defaulters, and record treatment milestones across TB, HIV, PMTCT, and NCD programmes.

Hospital Administrators and Department Heads

Monitor ED queue status, ward occupancy, outstanding handover tasks, and clinical decision support override logs for governance and quality improvement purposes.

How This Connects to the Rest of Moana

Clinical Care Management is the central workflow engine that connects every other clinical module. Diagnoses entered here trigger drug safety checks in Pharmacy. Investigations ordered here create orders in the Laboratory and Radiology modules. Inpatient admissions drive bed status updates in Scheduling and Bed Management. Discharge summaries draw on all clinical history to produce the final document. Programme enrolment data feeds the Public Health Surveillance System. Billing entries are generated automatically from clinical events recorded in this module, eliminating parallel administrative entry.

Standards and Interoperability

Clinical encounters are structured to FHIR R4 Encounter, Condition, Procedure, and CarePlan resources. ICD-10 coding is supported across all diagnosis fields. HL7 v2 ADT messaging supports admit, discharge, and transfer notifications to connected systems. Clinical decision support rules are implemented using standard rule types compatible with CDS Hooks patterns. Programme data outputs align with WHO indicator definitions and national M&E framework requirements.