Records for Life


In June 2013, the Gates Foundation announced an interesting idea for a competition: to remake the child health record. How great?! A contest that blended global health delivery, health information systems, design thinking, and a bit of tech.
The Records for Life contest (pdf) was open to anyone, even students, so we put out a call to Duke global health undergrads. Over the course of a few weeks in October, we established a core team and got to work.


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In low-resource settings where patients are not always empowered to advocate for their care, providers are often overburdened, and task-shifting to less qualified personnel is common, a well-designed health record can help patients and providers chart a healthy pathway from antenatal care through delivery, early childhood development, and future family planning.

Check out our final submission! We created the document using Google Slides because it made collaboration easy. The appearance seems to vary slightly by screen size and browser, so look at the pdf to see our final formatting.

We approached the design process with Kenya in mind. Kenya currently uses a 34-page resource called the Kenya Mother and Child Health Booklet. We attempted to make this record book easier to use while still offering a comprehensive product, and we proposed several opportunities for improvement that could apply in most other country contexts:

  • introducing inserts for each additional pregnancy/birth to eliminate the need for multiple record books with duplicated medical histories
  • designing paper forms that facilitate electronic data capture, either through manual data entry or automated photo processing
  • empowering patients to ask questions of their medical providers by writing in the record (an activity typically reserved for providers)
  • providing a mechanism to record and track multiple births (twins, triplets)


Low-cost, point-of-care electronic data capture is already a reality, even in some of the poorest settings. But we are far from saying goodbye to paper.

Whether as a backup for digital capture tools or as a main method of data recording, paper-based forms will continue to play an important role in health information systems for some time to come. However, not all paper forms are created equal.

While usability from the perspective of providers and patients is paramount, good form design should also consider ease of retrospective electronic data capture. These two objectives create a tension between a user’s preference for free-form written responses and a form’s space constraints, versus the need to standardize user input to facilitate data capture and coding.

In our submission, we attempted to resolve this tension by standardizing essential user inputs through a design that enhances rather than detracts from usability. Our forms are designed to ease the burden of manual data entry; it would be a trivial effort to create an electronic mask matching our forms that a data entry clerk could use to enter paper form data into an electronic records system like OpenMRS.

But our real innovation is the use of response “bubbles” that could be digitized by capturing a photo of the form and processing the image with existing technology like GradeCam. With a basic smartphone in hand, a health information officer could digitize every record onsite or at headquarters.

Our redesigned paper forms standardize data input and introduce the bubble format. These design features could make manual data entry easier and enable automated data capture for facilities with smartphone camera. Just snap a photo of the page and let the imagery analysis software convert hand-filled bubbles into electronic data.

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We made it into the top 40 semifinal round, but our journey stopped there. Congratulations to the winning team!

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