Heather Underwood

The design and implementation of the PartoPen maternal health monitoring system

The World Health Organization advocates the paper partograph as the single most effective tool for monitoring labor and reducing labor complications in developing countries. Used correctly, the partograph can serve as a tool for early detection of serious maternal and fetal complications during labor, allowing sufficient time for an appropriate response. However, in order to be effective, the partograph must be used correctly. Recent studies in Kenya reported that less than one fourth of partographs were completed in accordance with WHO guidelines. In developing countries, lack of training and continuing education, exacerbated by limited resources, represents a serious barrier to effective partograph use. The goal of the PartoPen project is to increase the effectiveness of the partograph using an interactive digital pen with custom software, together with partograph forms printed with a background dot pattern that is recognized by the pen. This paper describes the design and implementation of the PartoPen system, and the technical evolution of the PartoPen system during studies that evaluated the PartoPen in use in Nairobi, Kenya from June 2012 -- August 2012.

Improving Maternal Labor Monitoring in Kenya Using Digital Pen Technology: A User Evaluation

Paper-based systems for monitoring maternal labor have been shown to reduce life-threatening complications in low-resource environments; however, significant barriers exist to the use of these tools in developing countries. This paper presents the PartoPen - a digital pen system that enhances a common labormonitoring form known as the partograph. The PartoPen system provides real-time data feedback and reinforces birth attendant training, while retaining the paper-and-pen interface currently used by most healthcare workers. In this paper, the results from a preliminary user evaluation of the system in a Kenyan hospital are described. The qualitative results collected in this study indicate that the PartoPen system is easy to use, and addresses many of the current barriers facing effective partograph use in developing countries.

The PartoPen in practice: evaluating the impact of digital pen technology on maternal health in Kenya

This paper critically examines the use of digital pen technology at two key points in the healthcare system in Kenya: nursing student training and patient care in public labor wards. The PartoPen system -- a digital pen software designed to enhance the paper labor monitoring tool known as the partograph -- was evaluated with 95 nursing students at the University of Nairobi (UoN), and with 50 nurses in the labor ward at Kenyatta National Hospital (KNH). Students using the PartoPen had significantly higher scores on partograph worksheets than students using a silent PartoPen, especially on challenging and high-risk labor cases and on difficult sections of the partograph. In the maternity ward study, nurses unanimously reported positive improvements in the number of partographs they were able to complete, but these qualitative responses were not supported by the quantitative data. We discuss the results of both studies, and what these results suggest about the potential value of the PartoPen at different levels of the healthcare delivery and training hierarchy.

PartoPen: enhancing the partograph with digital pen technology

Existing paper-based systems for monitoring maternal labor have been shown to reduce life-threatening complications in low-resource environments; however, significant barriers exist to their use in developing countries. In this paper I describe a system that enhances a common labor-monitoring form, the partograph, using a digital pen. The digital partograph system provides real-time data feedback and reinforces birth attendant training, while retaining the paper-and-pen interface currently used by most healthcare workers. The system is currently being evaluated in Kenya.

Improving Partograph Training and Use in Kenya Using the Partopen Digital Pen System

This paper presents the findings from two studies of the PartoPen system – a digital pen software application that enhances the partograph, a paper-based labor-monitoring tool used in developing regions. Previous studies have shown that correct use of the partograph significantly reduces pregnancy complications; however, partographs are not always correctly completed due to resource and training challenges. The PartoPen addresses these challenges by providing real-time decision support, instructions, and patient-specific reminders. The preliminary studies described in this paper examine how the PartoPen system affects classroom-based partograph training among nursing students at the University of Nairobi, and partograph completion in labor theater use by nurse midwives at Kenyatta National Hospital in Nairobi, Kenya. Initial results indicate that using the PartoPen system enhances student performance on partograph worksheets, and that use of the PartoPen system in labor wards positively affects partograph completion rates and nurses’ level of expertise using the partograph form.

Using Digital Pens for Maternal Labor Monitoring: Evaluating the PartoPen in Kenya

The goal of the PartoPen system is to enhance the partograph, a paper-based labor monitoring tool intended to promote timely delivery of quality care by birth attendants in developing countries. The PartoPen digital system provides audio instructions for measuring and recording labor progress indicators, real-time decision support based on recorded measurements, and time-based patient-specific reminders. Previous studies of the PartoPen system showed improved partograph completion rates among students in nursing classrooms at the University of Nairobi (UoN) in Kenya. This paper presents the results of two continuation studies conducted in the maternity ward of Kenyatta National Hospital (KNH) in Nairobi. In this paper we identify and discuss the interrelated factors impacting PartoPen adoption and use in the labor ward at KNH, and review the challenges and opportunities likely to face digital pen deployments in other healthcare settings.

Partopens at the Point of Care

The goal of the PartoPen system is to enhance the partograph, a paper-based labor monitoring tool intended to promote timely delivery of quality care by birth attendants in developing countries. The PartoPen digital pen hardware and software system supports partograph use by providing audio instructions for measuring and recording labor progress indicators, real-time decision support based on recorded measurements, and time-based patient-specific reminders for taking measurements. Earlier work found the PartoPen system effective in nursing classrooms at the University of Nairobi (UoN), Kenya where the PartoPen was used to support teaching and training of students in maternal labor monitoring procedures. This paper presents the results of several follow-on studies conducted in the maternity ward of Kenyatta National Hospital (KNH) in Nairobi. Through these studies, we successively refine our understanding of the benefits of PartoPen use in this setting. We also identify and discuss the interrelated factors impacting PartoPen adoption and use in the labor ward at KNH, and review the challenges and opportunities likely to face digital pen deployments in other healthcare settings.