Focus groups and smart designers aren't enough. Developers need to dig deeper into the patient's world and the clinician's workflow.
Creative passion and the need to fill a void aren't enough in the development of mobile health applications. Developers must start with a penetrating analysis of the patient niche or clinician population they aim to serve. They need to get into the heads of their end users.
If you're designing a mobile app for diabetics, for instance, it helps to have the disease or be a veteran endocrinologist who knows all the challenges patients with diabetes face day in and day out. Otherwise, it's essential to elicit the help of knowledgeable patients and clinicians. In effect, developers have to become a diabetic or a diabetes specialist. That means attending the American Diabetes Association scientific sessions, reading professional diabetes journals, even investing in some of the popular blood glucose monitors and using them to prick fingers and take readings.
The developers of AT&T's WellDoc Diabetes Manager clearly did their homework before rolling out the mobile app and Web service. The smartphone app serves as a coach to help patients monitor and interpret their blood glucose readings, and it offers practical advice on how to handle problems, factoring in the individual's medication, lifestyle, and blood glucose monitor results.
If, for instance, a man enters the fact that his blood glucose (BG) is 60 mg/dL, he will get a warning that the reading is too low, be asked to check again, and then get a recommendation to consume 15 grams of fast-acting carbohydrates--say, a half cup of apple juice--to counteract the hypoglycemia. The app even explains that it will take about 15 minutes for the juice to raise his BG levels. The coaching app also feeds into a Web service that's manned by case managers with tools that let them track BG levels over time to spot dangerous trends.
If that's not impressive enough, Diabetes Care, the premier professional journal in the field, just published a randomized clinical trial that indicates the app actually improves clinical outcomes. Patients who used the app saw, on average, a drop of 1.9% in their glycated hemoglobin, a measure of long-term blood glucose control, while members of a control group who didn't use the app experienced only a 0.7% drop. Each 1% drop in glycated hemoglobin translates into a 44% reduced risk of diabetes complications.
During an interview with InformationWeek Healthcare, Casey Helfrich, the chief architect at UPMC's technology development center, explained that while there were a lot of apps out there, their EMTs thought "none of them really got it right or were pragmatic in the field." Many complained that in order to get their jobs done, they would have to use more than one app, and that the currently available programs had too many fluff features.
One of the advantages of UPMC's app is that it doesn't require users to leave the application to go to any external data sources. All the relevant information has been installed directly into the program itself. It's a standalone app with several key features, including:
-- All the Pennsylvania Department of Health protocols for basic and advanced life support.
-- Detailed information on all 57 drugs that EMTs are allowed to administer in the state. The developers also added a cross-correlation feature, so that the name of any specific drug discussed in the protocols section is also a link to details in the drug information section.
-- A list of all hospitals in Western Pennsylvania--unlike some competing apps, which included only hospitals the EMT users are affiliated with.
-- GPS functionality, so that EMTs could report latitude and longitude coordinates when a med flight is needed.
Despite the fact that UPMC hasn't marketed EMS Navigator, there have been about 800 downloads in the few weeks it's been posted in iTunes.
Helfrich's advice to software designers: Seek out clinical champions who will help keep the team grounded in what frontline users really need.
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