Antenatal Care Platform

System Overview

HISA MAMA is a shared patient-clinician digital platform tracking pregnancy from the booking visit to six weeks postpartum. The system digitises antenatal visits, risk assessments, fetal monitoring, Edinburgh Postnatal Depression Scale (EPDS) mental health screening, and generates an official antenatal card matching the national Department of Health format. Real-time red-flag alerts notify supervising clinicians of obstetric emergencies, VAI screening results, and clinical risk thresholds.

Intended Users

The system supports five user roles: Patient (mobile self-service, read-only clinical summary), Student Midwife / Clinical Student (visit documentation and assessment capture), Supervising Clinician (caseload review, escalation, countersignature, antenatal card generation), Administrator (registration, scheduling, records access), and System Administrator (configuration, user provisioning, audit log access).

Clinical Modules

• Module 1: Consent and POPIA Disclosure: Digital consent with patient signature capture and data usage disclosure in accordance with POPIA Section 11.
• Module 2: Patient Registration and Obstetric History: Full demographic capture, previous pregnancy outcomes, LMP, EDD calculation, blood type, serology, and medical history.
• Module 3: Booking Visit: Full first-visit assessment including weight, BMI, blood pressure, fundal height, fetal heart rate, and initial risk stratification.
• Module 4: 6-Stage Pregnancy Timeline: Structured visit records for each trimester milestone: booking, 16 weeks, 24 weeks, 28 weeks, 34 weeks, 36 weeks, and 38-40 weeks.
• Module 5: Fetal Kick Count Tracker: Patient-facing mobile module for daily kick count logging with automated alert thresholds.
• Module 6: Real-Time Red Flag Alerts: Clinical alerts for obstetric emergencies (pre-eclampsia, placental abruption), VAI screening results, safeguarding disclosures, and EPDS score thresholds.
• Module 7: EPDS Mental Health Screening: Edinburgh Postnatal Depression Scale administered at booking, 28 weeks, and 6 weeks postpartum with automated scoring and alert generation.
• Module 8: Clinician Dashboard: Caseload overview with risk stratification, upcoming visit schedule, and escalation queue.
• Module 9: Antenatal Card PDF: Auto-generated antenatal card matching the national Department of Health Road-to-Health format for hard-copy issuance.
• Module 10: HL7 FHIR R4 Export: Full record export in HL7 FHIR R4 format for integration with national EHR systems and data registries.
• Module 11: Offline Mobile Support: Progressive web app with offline capability for low-connectivity rural facilities, with sync on reconnection.

Technical Specifications

• Frontend: React 18 with TypeScript: mobile-first responsive design, PWA with offline capability
• Backend: Node.js REST API with PostgreSQL database
• Interoperability: HL7 FHIR R4 export API for national EHR integration
• Authentication: JWT tokens (30-minute expiry) with 2FA mandatory for clinical users
• Encryption: AES-256 at rest, TLS 1.3 in transit, HTTPS enforced
• Digital Signatures: Base64 PNG stored in private, non-public blob storage
• Offline Support: Service Worker with IndexedDB local storage, server sync on reconnection
• Alert System: Real-time push notifications for supervising clinicians on red-flag triggers
• Audit Logging: Immutable log of all write operations: user ID, action, entity, timestamp, IP address
• PDF Generation: Server-side PDF rendering matching DoH antenatal card template
• Hosting: South African data centre (POPIA-compliant jurisdiction)
• Backup: Automated daily encrypted backups with 30-day retention
• Uptime SLA: 99.9%

Regulatory Compliance

• POPIA (Act 4 of 2013): Lawful processing, explicit consent management, data subject rights, 72-hour breach notification
• Health Professions Act (Act 56 of 1974): Statutory record retention, professional scope of practice, clinical documentation standards
• HPCSA Guidelines: Supervised student role enforcement, patient confidentiality protocols, professional countersignature requirements
• National DoH Antenatal Care Guidelines: Antenatal card format and clinical visit schedule aligned with current national guidelines
• HL7 FHIR R4: Full interoperability standard compliance for EHR integration
• EPDS Clinical Protocol: Edinburgh Postnatal Depression Scale administered per validated clinical protocol with alert thresholds

Red Flag Alert Specifications

• Pre-eclampsia indicators: BP over 140/90 on two consecutive readings triggers immediate clinician notification
• Fetal kick count: Below 10 kicks in 2 hours triggers alert to supervising clinician and patient notification
• EPDS score: Score of 10 or above triggers safeguarding protocol and immediate clinician escalation
• VAI screening: Positive or inconclusive screen triggers mandatory clinician review before next visit
• Weight loss: More than 2kg loss between consecutive visits flags nutritional and obstetric review
• All alerts are logged as immutable audit entries and cannot be dismissed without documented clinician acknowledgement

Implementation Requirements

• Minimum browser: Chrome 110+, Firefox 110+, Safari 16+, Edge 110+
• Device: Desktop, tablet, or smartphone (responsive mobile-first design)
• Network: Online required for full functionality; offline mode available for visit capture in low-connectivity settings
• Training: Mandatory role-specific onboarding required. Minimum 4-hour session for clinical users
• Integration: HL7 FHIR R4 endpoint configuration required for national system integration (HISA team assisted)
• Data migration: Structured paper-to-digital migration process available (HISA team assisted)