Making quality of care visible: iDeliver, a digital tool that supports skilled birth attendants in delivering high quality intrapartum care
Since early 2016, M4ID has been working with VecnaCares and Johns Hopkins University in the design of iDeliver, a digital tool that supports skilled birth attendants with guidance, documentation and relevant data during intrapartum care. The pilot will be tested in facilities in Trans Mara, Kenya during autumn 2016.
The tablet based interface will help midwives and other care providers to oversee women throughout their stay in a maternity ward. A birth attendant will use the tool first to collect the data on a woman’s labour signs and her health conditions. iDeliver will generate a visualisation of this data, enabling a faster assessment and prioritisation of clients. The data collected will also help facilities and government officials to manage facilities better and drive improvement efforts.
Technology and connected systems hold immense promise for helping skilled birth attendants provide better, safer and more informed intrapartum care for mothers-to-be, yet digital products and services are typically designed primarily for high resource contexts. With the design of iDeliver, we’ve looked to combine high quality design and usability with a contextually appropriate and intuitive interface.
The tasks and activities skilled birth attendants perform in low resource settings are many and varied. A large component of a typical birth attendant’s working time is spent on collecting data about the client and reporting this information onwards to facility managers and e.g. government officials. Many facilities have a chronic shortage of staff and working hours are long. With too many clients to care for, nurses and midwives find it challenging to keep an eye on everything, to be able to prioritise their tasks, make referrals and other arrangements and take fast and informed decisions.
“A midwife spends on average half an hour per client on reporting”
How iDeliver will make a difference
Through research and user testing we have identified five key areas how iDeliver will support the healthcare provider´s workflow:
1. Taking the right decision at the right time
iDeliver’s decision making support helps to identify clients’ risks and to support midwives’ decisions for a treatment. The birth attendant collects data of the woman and the tool suggests a possible diagnosis and recommendation for management or treatment.
2. Organising care providers’ tasks
Every woman requires a personalised monitoring program to be able to receive individualised care. iDeliver can assist in defining the monitoring program and and to organise users’ activities towards an improved workflow.
3. Connecting the actors of the service ecosystem
iDeliver will facilitate an individual skilled birth attendant’s interaction with other actors in the client’s service journey, including both colleagues in the same facility as well as outside service providers.
Because iDeliver tablets are connected to one another they will enable a smoother cooperation among different service areas. External integrations could also be added, such as sending SMS message notifications to a woman’s phone number to remind her to visit the facility when she is close to the expected delivery date.
4. Professional Development
iDeliver’s decision support tool is designed to strengthen the skills and knowledge of especially those at the beginning of their career. iDeliver assists the user in remembering standards and best practices, with gentle, non-threatening prompts emphasising the decision making autonomy of the user.
5. Improving communication with clients
iDeliver aims to also promote awareness and education around quality of care. This is manifested in how the service supports building rapport with the clients. In the application, the client’s name and photo are always visible for easy identification and allows the care provider to address her by name.
“Beautiful things work better” – Don Norman
A pleasant and well designed user interface increases service adoption and engagement rates leading to more usage and efficiency. This is well known to high end consumer gadgets and services who have long designed premium visual interfaces in order to increase user engagement.
Especially in the context of healthcare provider/care recipient interactions, well made visual interfaces can play a significant role in improving quality of care. The emphasis of iDeliver has thus been on designing an intuitive, pleasant interface that intertwines what the user needs, what the context requires and what is clinically sound.
In design, user experience principles guide the design and ensure this intertwining is successful.
Examples of the iDeliver User experience principles:
1. It’s alive!
- User’s feeling: “The interface changes based on what is happening”, “The interface shows me both the big picture and the small details”
2. My way
- User’s feelings: “I know my needs, I decide how to navigate towards a particular information”, “I’m the one in control, the service backtracks my decisions”, “I am the owner of the tool”
3. One step ahead
- User’s feelings: “The service understands my needs and highlights information and actions that I might want to interact with”, “The service is ahead of time, always showing and reminding me of what’s next, what will happen now”
In addition to interaction and visual design considerations, the branding – that is, the feelings that the service should inflict in the user – is reflected in the communication style adopted by iDeliver: iDeliver is a reliable companion for a midwife and generates a feeling of professional pride and being the best version of one’s professional self. The copywriting is friendly, responsive and resilient. iDeliver does send notifications, but the copy is delivered in a gentle and encouraging manner. By being visible and present, iDeliver makes the work of midwives, nurses and other care providers visible as well.
Wrapped in a strong visual concept and a brand that tells a story, we hope that iDeliver will be a pathfinder of innovative design for clinical tools.
How it will work
The iDeliver program is lead by VecnaCares who have developed the software and provide a robust hardware component especially for digitally connected devices in resource constrained settings. Learn more about the technology here.
iDeliver is a web application primarily designed for a tablet device experience. The hardware stores all data in real time where it’s hosted on a local server that provides wifi network for the tablets. Using open source software, iDeliver is primarily used as a web application.
iDeliver also comprises of a set of predictive clinical algorithms based on the research conducted by Johns Hopkins University. This allows the tool to have an in-built smart decision making support component, offering actionable recommendations on care and treatment to birth attendants.