Advanced Real-time Comprehensive e-Partography Application

One of the most critical moments in maternal health is when a pregnant mother is in labour. In low-resource settings, most hospitals are overcrowded, understaffed, and ill-equipped. Vulnerable expectant mothers suffer most from this strain, and often have complicated childbirths. Most of these complications are preventable if proper monitoring and timely decision making is available. This situation is prevalent not only in developing countries but also rural areas and inner cities of developed countries.

With our solution, currently in growth stage, we are targeting the problem of labour complications and consequently maternal and child mortality. Nearly three million mothers do not survive during pregnancy and childbirth in low-resource settings. 80% of these deaths are preventable; the primary causes are complications during labour, late detection of complications and misdiagnosis. Even in developed country like USA, the maternal mortality rate is have gone up in the recent years per CDC. Although these conditions can be treated with timely detection and guidance, many expectant mothers do not receive the attention they need because facilities are understaffed and under-equipped. Midwives in these facilities rarely have time to fill out long patient history forms or have necessary expertise needed to provide high quality maternal care. As a result, vulnerable expectant mothers are suffering avoidably. During this period of child delivery, the healthcare professionals have to make quick decisions based upon the changing conditions of the patient in real-time.  It is critical to make informed and timely decisions to ensure most effective care is provided to the labouring women for safe delivery with excellent maternal and fetal outcome and great birthing experience.  Towards this purpose, World Health Organization (WHO) has recommended the use of Partograph and recently Labour Care Guide as tools to track the vitals of the patients in labour room for decision making. However, the current partograph being used is limited in scope and is a paper form-based tool. It is observed that in practice, with the labour rooms being crowded and less resourced, paper-based forms are rarely filled in real-time. Most of the forms are filled retrospectively for record-keeping and thus the purpose of real-time labour monitoring for informed decision making is not met. Moreover, the adoption of paper based Partogram is low as it is cumbersome to use, and lacks timeliness and responsiveness that is needed for medical professionals to make timely and informed decisions. A system that is easy to use and can provide real-time alerts on patient’s condition to address any complications shall be of immense help in improving quality of care and reducing mother and infant labour complications and mortality.

Our product, Advanced Real-time Comprehensive Partograph - arcPartograph, is a digital and interactive Partography system to be used in labour rooms to monitor conditions of pregnant women in real-time.  It is a comprehensive labour monitoring system and utilizes guidelines given by World Health Organization (WHO). It is designed to be used worldwide and supports multiple languages. It also incorporates country specific guidelines for maternal health. For example, LaQshya and DAKSHATA for India.

The paper based Partograph charts and recording of patient’s conditions have been digitized into a web-based software system, which is now available world-wide at www.arcpartograph.com. This system provides comprehensive, real-time monitoring, and has artificial intelligence-based alerts to inform medical staff of any adverse conditions. The arcPartography is very comprehensive as it includes prepartum period details, Partogram in latent and active phase, second stage and third stage details and postpartum monitoring too. It is real time with alerts and the action line. The application also provides complete Labour Care Guide for monitoring labour conditions in digital form.

The application is device independent and is delivered through internet through cloud. In low-income countries, where computing resources are not readily available, it can be used using smartphones. It is designed to reduce workload of midwives and nurses for data entry by prebuilding possible inputs and by automatically detecting correct shape and placement of the observations. This way this digital form can be filled in seconds where the paper-based forms are cumbersome to use. The ease of use of this system has significantly improved the adoption and correct use of Partographs in India’s labour rooms. The application enables complete monitoring of women in labour onsite and remotely. The observations entered are immediately evaluated by the reasoning engines to detect any complications. Upon detection, e-mail and SMS based alerts regarding the complication and suggestions for its resolutions are sent to the caregivers. With this, medical professionals can view charts, get alerts, give directions to staff, stay connected and stay informed about the woman's health and labour conditions in real-time even when they are away from the labour room. An added advantage is that less equipped facilities can be networked with well-equipped facilities for remote monitoring, advise and actions. In this COVID era, where physical presence is limited, arcPartograph utilizes digitalization for the labour room monitoring and enables expert physicians to provide guidance to midwives and nurses practicing in remote areas. arcPartograph creates full record of observations and provides complete documents for medico-legal purposes which becomes very helpful in case of a dispute or complaint.

The WHO data shows that the highest rate of maternal mortality is in Africa (>1000 per 100,000), India (<250) , Asia (<100), South America (<100), Eastern Europe (<100) and in the rural areas of Western countries (<50). Our current target population is in Africa, India and inner cities in the USA. For example, in Migori County in Kenya over 4,500 deliveries per month are being supervised with a single Ob/GYN doctor. Wardha district in Maharashtra India is supervising several satellite villages and government clinics where there are no qualitied Ob/Gyn. Senior Ob/Gyn doctors at Grady Memorial Hospital in Atlanta, GA are advising a number or rural clinics in East and Southeast Georgia. Most of these remote clinics are managed by midwives and nurses. All such locations need tools to perform real-time monitoring and convey results to remote medical professionals for guidance.

The arcPartograph tool and methodology have been implemented in several treatment facilities in India and Kenya. The results of pilot show significant improvement in the quality of care provided in the labour rooms, reduction in labour complications by early identification of risks due to alerts and alarms. In particular, the availability of timely and comprehensive data on patient’s condition has reduced Caesarean Sections being performed and has eliminated the adverse effects on mother and baby. It has allowed timely instructions to be given to staff due to alert-based monitoring. Also, it has been extremely useful in monitoring labouring women and providing timely advises at by senior doctors remotely.

Our current customers are medical colleges and hospitals that provide child birthing care in low-resource clinics. Since its release in March 2022, arcPartograph is purchased by and implemented at two major medical colleges in India. These medical colleges have a number of rural clinics attached with them. It is being piloted in two counties – Migori and Kisumu in Kenya and two hospitals in South Africa and five hospitals in India. We are giving introductory webinars to Ob/Gyn societies of Nepal, Bangladesh, and Sri Lanka, and expect to get them on board soon.

We have a well-rounded team of business professionals and renowned Ob/Gyn medical doctors to provide technical guidance. The medical professionals that are part of the team are practicing doctors in deep rural areas in India and Kenya. They have first-hand knowledge of challenges that are faced in rural clinics and by pregnant women. The technology professional are seasoned experts in developing global software applications conforming to the standards required by different countries. Besides this, we have also partnered with organizations that facilitate innovations outreach programs in healthcare. They are pivotal in disseminating the pertinent information to the practitioners in their countries.

The team is described as follows -

Mr. Ram Pandit, Ph.D., Chief Executive Officer, Applied Decision Technologies, Inc.

Ram Pandit, founder and CEO, brings over 30+ years of experience in Healthcare, Field-services, Manufacturing, Logistics and Transportation to ADecTec, Inc. At ADecTec, he provides vision and set strategic directions for the overall growth of the company.  Ram holds a Ph.D. in Operations Research from the University of Illinois at Urbana-Champaign. He has also held faculty positions with leading universities in the USA. He has published in international refereed journals and holds multiple US patents for the technologies that he developed

Professor Dr. Poonam Varma Shivkumar, MBBS, MD, Technical Advisor

Professor and Head, Department of Obstetrics and Gynaecology at Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India

Dr. Poonam Varma Shivkumar has received Advance training in SHRH from Uppsala University, Sweden and, Advance training in Obstetric HDU/ICU, FUNDACION, Cali, Colombia, NTTC, JIPMER. She has received Clinical Skills Trainer’s training for EmOC, CMC, Vellore. She is an active participant in national and international professional communities. She is a core member of PPH Working group, FIGO, President SWOGS, Principal Investigator for E - Partography, JDF, USA, Still births and Previable Birth Defect Project, WHO SEARO, Low-cost salivary progesterone for predicting preterm births , All Children Thriving , Grand Challenges, Bill Melinda Gates Foundation, EMOC & PPTCT & Co-Investigator for Hypertensive Pregnancy in community - ICMR and Nonsurgical contraception Oregon University, USA, PPH Bundle project, MGH , Harvard, USA. She is very active in professional societies. She has given oration on RMC, 96 guest lectures, presented paper, chaired in International and national conference as IMA, FOGSI, AMOGS, NOGS, GCC in Srilanka, China, Thailand, Sweden, Finland, Kenya, London UK, Boston, USA, Cali Colombia to name a few. She has over 78 research papers in International refereed journal and has written 8 Chapters in International and National journals

Professor Dr. Anuja Vivek Bhalerao, MBBS, MD (OBGYN), Technical Advisor

Professor and Head, Department of Obstetrics and Gynaecology at N.K.P. Salve Institute of Medical Sciences, Nagpur, Maharashtra, India

Dr. Anuja Bhalerao has conducted her Fellowship in Uro-gynaecology with Prof Shull in the USA. She is the Operating faculty UROGYN at her institute. She has been a dedicated teacher and researcher of over 30 Years in the areas of Obstetrics and Gynaecology.  She has received Best teacher, Research paper award multiple times. She has over 52 publications in National and International journals. She was named Principal Investigator for WHO PPH Bundle project with MGH, Harvard university USA. She has participated in several National and International conferences as chairperson. Her presentations received Best Video Awards at AAGL and various conferences

Monica Oguttu, Founding Executive Director of the Kisumu Medical and Education Trust (KMET), Kenya. Africa Business Development and Implementations. Providing Innovations in Healthcare to medical professionals in Kenya.

KMET is an indigenous organization established in 1996 based in Kisumu with a network of over 350 health providers expanding access to quality Maternal and Child Health in underserved communities.

Monica is a Renowned Registered Nurse/Midwife/Public Health specialist and an Alumni of Harvard school of Government. She garnered her leadership skills at Kenyatta National Teaching and Referral Hospital where she managed a busy maternity unit for 15 years. She is known for her ability to promote collaboration between government officials, private and public sector providers and communities to work together for results. Her top priorities are Advocacy for quality health services, task shifting/sharing, Innovative Business models and community engagement towards social accountability. She has been a member of various Technical Working Groups and boards e.g., WHO Technical Working Group for Task shifting/Sharing, Kisumu County Health Taskforce, FIGO PPH TWG and Board member of IPPF/SAAF and IPAS among others.

Our biggest challenge currently is funding to hire informed sales and marketing personnel. We are recruiting professionals in different countries to market and sell the application. We find that doctors believe medical professionals more than non-medical persons. This process is slow due to bootstrapping. Another barrier being faced is the long sales time with government organizations. This is expected due to government procurement processes and regulations. To curtail is cycle, we need to increase awareness by presenting the application in conferences and with advertising. Thus, availability of funds shall certainly help overcome these barriers.

Our solution improves pregnant women and girls' wellness through a targeted approach on pregnancy monitoring in labouring mothers to detect high risk pregnancies and promote timely medical intervention, averting the risk of complications for the mother and the baby. At present, the monitoring is done mostly manually and on paper. Most of the time local judgment is being used; and often the outcome depends on the expertise of the caregiver on the scene.

ArcPartography completely changes the landscape of caregiving in labour room. With real-time alerts, decision support and remote collaboration, expert guidance now can be made available to everyone. This solution has the potential to impact lives of pregnant women across the world and significantly reduce the childbirth complications and mortality.

This solution will be of interest to other practitioners and solution providers due to the innovation in the area of maternal health quality improvement. There are still several open avenues of innovation that can be incorporated into this application, such as integration of sensors to automatically gather observations, integration with referral and transport processes to ensure timely response to an adverse condition requiring transfer of patient to more equipped facilities.

It shall be of interest to insurance companies to understand how this product can help reduce labour complications and hence consequently reduce the cost of overall care.

Our main goal is to significantly improve the quality of maternal health care. Our plan to achieve this is to enlarge our product footprint in Kenya, India, Bangladesh, South Africa, Nepal and the USA with implementations and education.

 We have observed that the current use of the application has achieved 31% reduction in Cesarean Sections, 53% reduction in labour complications, and 54% reduction in NICU admissions. These have direct impact on wellbeing of mother and the baby. We expect such reductions to become widespread with the adoption of arcPartography.

We have also created a training and educational version of the application to train new students, nurses and midwives in monitoring and mitigating labour complications. This shall prepare the upcoming caregivers to be effective in reducing the mortality of mother and child and provide overall better care.

Our process includes several steps to measure impact. In the short term, in our pilot studies we are tracking outputs such as number of pregnant women monitored and number of complications averted and looking at improved care for expectant mothers through intermediate outcomes such as how often a midwife responds to aberrant vital signs, how often she adjusts treatment, and how a midwife’s workload is reduced by saving time manually plotting vital signs on paper partograph. In the long term, we will be looking at how implementation of our device improves maternal and infant mortality and reduced complications.

We will use the following impact indicators to measure success and to compare data from a comparison group, such as an adjacent clinic area receiving standard maternal care at labor. We expect a difference (effect size) between the two groups of at least 25– 30 percent in the achievement of these indicators, as follows:

1. Number of women being monitored monthly with arcPartograph
2. Number averted Cesarean Sections
3. Number of reduced false alarms on Labour Complications
4. Number of reduced NICU admissions
5. Number of students trained using Educational and Training version of the arcPartography.
6. Number of new implementations
7. Number of new webinars and number of attendees to learn about arcPartography. Indicator 1 shows the adoption and use of arcPartograph. Indicators 2, 3, and 4 are based on the premise that real-time monitoring and detection helps respond to complications early resulting in safer childbirth. Early identification and prediction of labor complications through arcPartograph, and effective labor monitoring through it, will lead the clinician to attempt to collaborate with other experts and chart out a safer course of action for the delivery. This shall result in overall less complicated childbirth and shall also reduce the mother and child mortality.

Our theory of change is based on the premise that the overall quality of care that is being provided to a pregnant mother at the time of her crucial need – during delivery – can be significantly improve by providing vital information on the patient’s conditions to qualified caregivers in real-time enabling the caregivers to respond timely to avert the complication.

We enable this by providing an easily accessible, affordable and easy to use solution to caregivers. This solution is designed after visiting and discussing with over 14 Ob/gyn professional in India and Kenya to understand the challenges faced and what is feasible in labour rooms to deploy such a solution. In essence we utilized a proven effective methodology of Partography developed by the World Health Organization and improved it significantly with the use technology and innovative ideas to be acceptable on a wide scale. We eliminated the shortcoming of the paper partograph and made it an interactive, informative and collaborative decision support tool.

Our process of change can be summarized as follows –

Framework – provide educational and training to students, nurses, midwives on the use of Partograph using arcPartograph application.

Pilot – prove the effectiveness and quality improvements of the application by conducting pilots and presenting results.

Adoption – grow the adoptions with webinars, tutorials and implementations for the application to be used in labour rooms.

Outcomes – gather the data to evaluate key performance indicators demonstrating the effectiveness of the application

Impact – improved quality of childbirth, averted complications, reduced over-treatment and mortality.

The arcPartography application is cloud-hosted web application. It uses latest architecture such as micro-services and tools to ensure high performance. It is user configurable for the users to customize the application for their use. It is made mobile responsive to be usable on mobile devices without the need to download anything. It is designed to be highly secure and tightly permission based to secure patient data. It allows remote collaboration with expert doctors with midwives and nurses in the labour rooms.

The application has embedded Artificial Intelligence based smart logic to evaluate observations and provide alerts and suggestions for the complications. It is designed with open architecture to be able to integrate with several different technologies and applications that may already be in use the hospitals.

The application is designed to store large amount of patient related data for multiple years. Since the patient health related data is highly confidential, only the hospitals have access to data of their patients. We as a company do not access that data directly. However, to track Key Performance Indicators (KPIs) we solicit processed data that is independent of any particular patient related information from the hospitals. We use this data and KPIs, to demonstrate the effectiveness of our solution.

We strongly believe in a diverse organization. We provide equal opportunities to all. We understand that not all may have the same expertise to start with, therefore, we have put together a comprehensive training program for our team members to learn our processes. Furthermore, we conduct a detailed orientation for all our new members to learn about different religions, cultures and locations of our team members. This is to ensure they are aware of working conditions, expected behaviors and be respectful to each other. In our current organization, we have Hindu, Muslim, Sikh, Christians, Men, Women, Indians, Kenyans and Americans all working together.

Our solution addresses the quality improvement in the labour room. Therefore, we primarily market to hospitals and clinics that facilitate deliveries. Therefore, our target customers are government and private organizations. Our business model is detailed as follows -

Business- to- business (B2B): Government and developmental organizations. We target government and developmental organizations for large sales with the initial pilot. The B2B model will involve direct sales with an annual contract for software maintenance and updating. We also offer a subscription model, in which our solution is paid for every partograph created and there is no capital investment. This model can be implemented through nongovernmental organization champions who work or wish to work with the government. It can increase the scalability of the solution.

In private hospitals, arcPartograph is offered both on a traditional lichens and support basis, and on a subscription basis. However, the traditional license has a limit of hospitals that a private organization can enroll under the same license. Therefore, the traditional license includes fees for number of hospitals included. The subscription model that charges for every partograph created is offered with a minimum monthly payment of about 30% of expected partograph to be created per month. This ensures that the application is used and not abandoned. The subscription model includes the ongoing support.

We plan to achieve scalability through the following growth model. We want to present and market the solution differently in the private versus public and urban versus rural health segments. In the private sector, we want to enable monitoring of high- risk mothers, both in clinics and remotely supervised by health workers. First, we will collaborate with the most influential urban midwives, gynecologists and obstetricians and promote the solution through local midwives and nurses’ union and conferences.

Meanwhile, we are partnering with the Association of Obstetricians and Gynecologist of India, Kenya and Bangladesh, which includes 20000 gynecologists. We are educating them about arcPartography through webinars, tutorials and giving them access to the application for a limited time to try. We have also created an education and training version of the application to train students, nurses and midwives who shall become the future users of the application. Besides this, we are partnering with research universities to conduct research on new advances in Partography. These research studies use our current application to understand the effectiveness of this solution.

We expect that these efforts shall increase visibility of our solutions and consequently its adoption. Since the scope of this application is global, we anticipate that revenue potential shall be significant. 

We launched our application commercially in March 2022. We offered our application for piloting to organizations in India, Kenya and South Africa. So far, two medical colleges have purchased the application. The institute Mahatma Gandhi Institute of Medical Sciences (https://www.mgims.ac.in/) has purchased the traditional license, and the institute NMP Salve Institute of Medical Sciences (https://nkpsims.edu.in/) has opted to use the application on a subscription basis.

Currently, the application is undergoing government approval process in Kenya and South Africa. We expect to deploy our solutions there later this year.