Capturing Signs of Child Abuse
Ann & Robert H. Lurie Children's Hospital of Chicago
Dr. Mary Clyde Pierce, an extremely active and passionate advocate for child abuse prevention, came to igNew to team up on a research grant to develop an easy to administer test to help doctors, social workers,and others distinguish regular childhood injuries with actual child abuse. igNew’s part in the study was to create a software application that could collect a wide range of data from patients in a live clinical setting.
Child abuse is obviously a serious problem. But it’s compounded by the fact that doctors, in many cases, do not in fact have a clear way of distinguishing between injuries that happen as part of a normal childhood and those that are malicious in nature and are a direct result of child abuse.
Dr. Mary Clyde Pierce has had a passion for child abuse prevention for as long as she can remember and has dedicated a big part of her life to the subject. igNew got involved because Dr. Pierce wanted to collect definitive research in the area, and wanted software that could track detailed data points about children that were potentially affected.
To that end, igNew worked with Dr. Pierce and her cohort Kim Kaczor on developing a web application for the iPad that could be used in a live clinical setting both to capture extensive medical history, personal history, and above all accurately track the location and types of injuries on a patient.
Discovery & Design
The initial discovery & design was conducted onsite in Chicago with Dr. Mary Clyde Pierce and her cohort Kim Kazcor. There was a wide range of data to collect so we needed to understand how the data was collected, who were the people that collected the data, what the data was, and the flow of how and when data collection occurred.
We spent several days just combing through the specific data points and talking with Dr. Pierce and Kim about challenges in getting the level of detail needed to make the study valid.
During discovery, several key challenges were identified. One, it became apparent that live data collection in a clinical setting was going to be difficult due to the fact that we had to limit the time doctors, nurses, and other caregivers would spend entering data in the application vs. spending time with their patients.
Two, we needed to ensure that collecting the data could be done anywhere, so we needed the hardware the software was placed on to be mobile, but it also had to be durable.
Three, there was a LOT of data, so we needed a way for caregivers to easily understand and find the questions that were needed to ask and know when data collection was complete.
The first decision in development was to decide on hardware. Since ease of use was a top concern and iPads were already popular in the caregiver community, we went with those. Additionally we found a specific carrying case that would give the iPads more durability in the clinical setting as well as making them easier to transport.
Next we designed and built a quick way to onboard patients that would factor in HIPAA compliance, focus on speed and ease of use, and also determine eligibility of patients to participate in the study.
Once patients were onboarded, we developed a system of queues where depending on the role of the caregiver and what data still needed to be collected, patients would show or not show up.
Finally, and perhaps most importantly we built the wide array of data collection screens. To start, data collection was categorized into different forms that would key off common terminology caregivers were already familiar with.
Next, each form would have a color coded status to indicate if it had been started and was in progress, not been started, or was completed.
Finally, in the forms themselves, each collection point was collapsible and again color coded for status (not started, partially completed, answered). Because questions weren’t always answered in a certain order, the collapsible nature allowed caregivers to visually see and scroll to all the questions, expand and answer them, and then move on to ones that were color coded as not answered. Additionally, answers when entered were automatically saved in the background so caregivers did not have to wait for screen refreshes or go through the hassle of clicking save buttons. Caregivers could also navigate away and come back to forms at any time.
It’s worth mentioning here that one of the most critical data collection parts of the app dealt with recording the location of bruises, abrasions, and cuts on a patient’s skin. Working with Dr. Pierce and Kim, a 3d model of a child was developed where injuries could be “drawn on” and automatically indicate the specific body regions that were affected.
Since building the software originally in 2011, the study has been ongoing for several years and igNew has been providing support during that time. The application has been successful and data has been collected on thousands of patients. With the study set to conclude in 2016, so far results have been extremely promising and it looks as though Dr. Pierce and Kim will indeed be able to meet their goal of creating an easy to administer and highly accurate test to distinguish regular childhood injuries from actual child abuse.
Implications for children everywhere are astounding to think about and it’s been invigorating and rewarding to be part of such an effort.
Presently, although the study is not all the way finalized, Dr. Pierce and Kim are already traveling the world speaking of the preliminary findings. So much more is to come of this and igNew is excited to see where this goes and help in any way that we can.
Dr. Mary Clyde Pierce
Professor of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Luire Children's Hospital of Chicago