As we were preparing to come to Kenya, we were warned by our advisors that it might be difficult to receive honest feedback on our product because health workers might be so receptive to any health technology  that they would be averse to highlighting the downsides of our product.

Fortunately, we stumbled across a group of healthcare providers with strong opinions about what they want.  We sat down with members of the District Health Management Team to review wireframes, and started to review the deck slide by slide.  By the third slide, they looked skeptical as we tried to explain how technology would help providers to identify danger signs indicating that a child needed to be referred to a more advanced care center.  They explained that while this system seemed like it would be useful, they would prefer it if we solved their most pressing technology need first before moving on to difficult decision support systems.

One team member burst in with the insight, “people will use this if you reduce their paperwork.  Nurses spend far too much time doing paperwork, and it means they can’t see as many patients.  If you solve that headache for them, people will use your system.  And if you can integrate this with the reporting that everyone must do, providers will love you.”  It turns out that both public and private providers in Kenya spend upwards of 5 hours per week just tallying, reporting, and filing paperwork, time that would be better spent seeing patients.

We then asked providers to walk us through their systems, and it was no wonder that they were looking for ways to reduce the paperwork burden.  Over the course of the next few hours, the team showed us 15 different registers that they use for reporting and storage of information.  In many cases, the providers just store information in the registers, meticulously recording one line per patient.  Yet when the patient returns for follow-up care, it is too difficult to find that line of data from the register to use as reference, so the information serves as a basis for reporting to the central government.

The nurses felt that by first reducing the time spent on reporting, then adding additional features and integrating previous patient data into the new encounter, we would add significant value to the nurse’s experience.  This would serve as the hook for getting people to use the system, and anything else would be gravy.

Yet again, this simplified and crystallized our idea of what providers need.  Whereas chemists have been pretty clear about the type of POS system they want, providers take in so many different types of data that it’s been difficult to distill this into a simple tablet-based system.  With this newest version, we hope to save nurses time and energy and build from there.  And we were grateful to find a team that was willing to be so honest with us.