CAST: Data Management App
A unified, codified, cloud-based system for managing patient records and treatment quality
In ten years, MiracleFeet has developed the systems and partnerships to treat clubfoot in 29 countries, where over 75,000 new cases occur each year. We needed a streamlined data collection tool to support and track patient progress across our growing global network of clinics and providers who are increasing access to clubfoot critical treatment.
Our mobile data collection app, CAST, is transforming how we gather and use real-time data worldwide and amplifying our focus on treatment precision and program quality.
The Need & Challenges
MiracleFeet needed a tool to collect enough data to be useful, but not so much data that it would prevent partners or clinic staff from consistently using it. It also needed to be a globally relevant system—useable across multiple languages and country contexts.
One of the major challenges of using mobile technology in low-resource settings is that internet service is not always reliable. This can lead to difficulty syncing data, putting patient records at risk of being inadvertently deleted. However, paper records also consume a great deal of space, are more likely to contain errors, and can be easily destroyed in the event of natural disasters or extreme weather.
CAST is the best tool we’ve ever had. It motivates providers to do a better job.Physical therapist in Tanzania
Funded by a $1 million grant from Google.org, MiracleFeet partnered with Dimagi to develop the CAST mobile application, an offline-capable and mobile-optimized solution that allows the organization to keep electronic medical records, improve clinic management, and monitor and evaluate the quality of treatment and patient outcomes around the world.
CAST syncs with Salesforce to render user-friendly dashboards with sophisticated analytics and reporting capabilities. This system amplifies and enhances all stakeholders’ focus on treatment precision and quality, from program managers to country partners and clinicians. The data we collect through CAST allows us to track and better understand patient outcomes among different age groups and case types.
Nearly all MiracleFeet-supported clinics have adopted the application. CAST is now used in 300+ clinics across 29 countries, storing nearly 50,000 patient records to document full treatment progress and long-term outcomes.
CAST improves the quality and availability of clubfoot treatment.
The ability to enter data in an app and have real-time access to relevant information has transformed how MiracleFeet works with local partners. CAST improves service delivery in several ways. It helps us:
Track patient dropouts: Addressing patient dropout is one of the most challenging aspects of our work. The ability to quickly and easily follow up with patients who miss appointments or relapsed in treatment is an incredible improvement.
Improve KPIs and patient outcomes: CAST has also been influential in improving treatment outcomes and tracking key indicators, like tenotomy rates, for example. This minor surgical procedure is a key component of clubfoot treatment yet is sometimes skipped because not all providers are trained in or comfortable with the technique. Through CAST data, we can see where tenotomy rates are low and design trainings and campaigns to ensure providers consistently include this critical step.
Design local interventions: Data from CAST gives our partners a roadmap to increase access to care where gaps exist. It helps us determine where to prioritize new treatment locations based on where patients live and where current clinic volumes are higher than birth estimates predict. Additionally, we can pull clinic-level reports on patient age at the beginning care, which tells us where additional early-identification training and awareness activities are needed so children begin treatment as infants, not in the toddler years or later.
What's next for CAST?
Brace compliance: Since the most common cause of clubfoot relapse is poor brace compliance, using a brace sensor that sends data to CAST will allow us to determine when braces are not being used as prescribed. Knowing this, we can proactively reach out to parents to provide support and information about the importance of wearing the brace every night for several years. There are two prototypes currently in development, supported by pro bono teams in India and the UK.
Early identification and referral: We’re investigating the feasibility of an app component that helps midwives and frontline healthcare workers identify children born with clubfoot at birth—possible through an integration with other prenatal and newborn screening tools–so MiracleFeet partners could pro-actively follow up with families.
Tracking equipment and inventory: Tracking brace inventory and other treatment supplies (casting materials, etc.) in CAST could improve supply chain efficiencies and ensure clinics have what they need without devoting significant time to inventorying supplies and communicating/anticipating upcoming needs. This is in the idea stage at the moment, but we are keen to investigate feasibility.
Two-way communication: Facilitating and tracking communication between providers and parents, and between parent groups, can greatly enhance patient support and adherence. There are many tools that facilitate this type of communication and community-building so we’re optimistic about the possibilities.
Doctor-to-doctor communication: If a provider encounters a difficult or unusual case, they could consult other doctors who have experiences treating similar cases. This communication is already taking place to some extent, but centralizing it within CAST would make it easier for providers working in remote places to access the global expertise of other physiotherapists and orthopedic surgeons.
Telemedicine: Providing video consultations when possible to patients would help increase efficiency and aid in overcoming some treatment barriers such as transportation hurdles. Thanks to COVID, these consults are being utilized more frequently. Centralizing and enabling this capability within the app would make mobile consultations much easier for providers.