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How to Design and Develop a Mobile Health Application

With hundreds of thousands of mobile health applications now on the market, the challenge for healthcare providers is to design and develop an app that works well, looks good, and can be sustained.

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Healthcare providers looking to establish an mHealth strategy for patient or provider engagement likely see a mobile health application or two as a good place to start.

Mobile health applications allow healthcare providers to connect with patients and staff more quickly and dynamically, reaching out to them on the device of their choosing and at their convenience. Apps designed for a smartphone, tablet, or even a smartwatch  also allow users to access information when and where they need it, reducing time wasted searching for that data and boosting both engagement and satisfaction rates.

“Health systems are becoming very active” in mHealth app design, says Jeffery Kendall, senior vice president and general manager for enterprise mobile app designer Kony’s Americas bureau.  Whereas they used to contract mHealth app design to outside developers, he says, they’re now taking on that task with their IT departments or forging partnerships with developers.

“They’re behind and lagging in terms of expectations from their patients, and they also want to meet physician demand” for mHealth support, Kendall says. But in the process, they’re often jumping into the sandbox without a good grasp of mobile health application design considerations.

There are more than 260,000 mHealth apps now on the market, according to the latest figures from Research2Guidance.  Finding one that resonates with its target audience - be it patient or provider - can be a significant challenge. And in this arena, one small flaw could mean the difference between acceptance and oblivion.

How, then, can health systems and their development partners create an app that fulfills the expectations of both the provider and user?

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IDENTIFY A PROBLEM THAT NEEDS TO BE SOLVED

The key to successful mobile health application design lies in knowing how and why users will want to use the app, says Dr. Michelle Longmire, CEO and co-founder of mHealth app design company Medable.

First of all, define the problem being solved, and figure out why an mHealth app would be the best way to solve it.

“If you want something to be adopted, you must understand the use case very well,” she says. “Is an app actually going to help solve the problem you’re trying to approach,” or is it just another way of illustrating the problem?

Those not familiar with apps often see mobility as a solution rather than a tool, and they’ll end up designing something that mimics but doesn’t improve a healthcare function – for example, creating a mobile view of a health system’s patient portal.  That app might be useful, but not if it doesn’t have added value, such as mobile-optimized functions or data that cater specifically to users on the go.

Ed Gross, Kony’s vice president of product management, advises healthcare providers to start with simple projects, such as scheduling or patient flow in a busy area like the Emergency Department or Operating Room.

“Identify the small victories,” he says. “It’s very easy to give in to the temptation to bite off too much.”

This also helps providers get the lay of the land, acquiring knowledge and the confidence to move on to the next, bigger project - an app that combines several functions or one that spans several databases, such as insurance verification and bill-paying.

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KNOW THE TARGET AUDIENCE

Healthcare providers often make mistakes on this step because, as Gross puts it, “they have notoriously not been consumer-driven.” Only recently, with patient engagement efforts and satisfaction surveys, have providers found the need to listen to what the public wants.

This was particularly apparent in a 2016 report by Accenture, which found that two-thirds of the nation’s hospitals were offering mobile apps to their patients – but only 2 percent of their patients were using them. Too often, the report said, providers designed an app thinking they knew what their patients wanted.

“Simply having a mobile app is not enough,” Brian Kalis, managing director of Accenture’s health practice, said. “Hospital apps are failing to engage patients by not aligning their functionality and user experience with what consumers expect and need. Consumers want ubiquitous access to products and services as part of their customer experience, and those who become disillusioned with a provider’s mobile services - or a lack thereof - could look elsewhere for services.”

“Today’s consumers place more expectations on their providers to interact digitally, driven by the customer experiences they have had with services in other industries, and most providers are letting them down,” the Accenture report emphasizes. “Thus in the increasingly competitive healthcare market, providers that ignore the mobility needs of today’s always-on patients could lose them to competitors.”

In short, providers need to know who will use this new app, and why.

"Don't assume you know what's important to patients," Ophelia Chiu, head of design strategy and innovation for New York's Memorial Sloan Kettering Cancer Center, said during a session on mHealth app design at the 2015 mHealth Summit in Washington D.C.

While working on the health system’s MyMSK app early in 2015, she said, "we actually asked them what they needed and we designed that into the specifications."

Kendall says it’s also important to know what a target audience likes or doesn’t like. An older audience would prefer larger type and easier directions; a younger audience more color. An app designed for consumers will need to employ different language than one designed for clinicians.

“But don’t make any assumptions” on usability, Kendall says, such as expecting every Millennial and GenXer to know how to use an app or every senior to be afraid of the technology.

“There’s no one formula for usability,” agrees Longmire. “It’s not just about look or feel, but also about user expectations.”

“There’s been an enormous amount of interest lately in attractive design,” adds Gross. Providers are now beginning to realize they – and their apps – have to look good. An attractive app will attract users, while a boring one will turn people away.

Games  and gaming technology can also make an app more attractive to certain target demographics.   Developers are incorporating quizzes, contests and social media into the app platform to keep users interested and promote engagement. This can be especially effective when creating an app that targets behaviors and behavior change, as in chronic care management.

For providers designing apps for their staff, gamification has proven effective in pushing out education and updates on resources. For instance, when creating an app to keep clinicians abreast of the latest viruses or methods for identifying and treating hospital-acquired infections (like sepsis), a quiz might make that information go down a little bit easier.

“Interval reinforcement is a proven way to increase knowledge retention,” says Mary Hallice, healthcare practice lead for QStream, which develops online gaming services. “In the medical field where (clinicians) must take in and retain a lot of information, a reinforcement method that’s engaging and conveniently available has tremendous benefits to both learning and on-the-job performance.”

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Source: ThinkStock

DESIGN FOR SIMPLICITY, SCALABILITY AND SUSTAINABILITY

Gross says mHealth apps should be designed in modules, like a LEGO kit.  When it’s time to upgrade the app, or if an app needs to be fixed, a developer can pull out the modules that need work and insert them back into the framework when ready.

“Don’t re-invent the wheel,” says Kendall. Use models and frameworks developed by others, and modify them as needed, he says, and incorporate what has worked before. Once that framework is established, it’s easier to go in and add elements that personalize or brand the experience.

Longmire tells developers to avoid creating multiple interfaces or entry points, especially when accessing other data points, like an EHR or scheduling platform. Integration with other apps or portals has to be seamless, so that one’s workflow or daily routine isn’t adversely affected.

“You want to understand what tools or things these people are already using,” she says.

Likewise, Longmire says an app should be designed so that upgrades and new services are added at the back end, through a dynamic interface.

That’s also an important step in promoting sustainability and scalability. Kendall says developers should configure an app so that it can be upgraded easily to accommodate new uses and users.  An app that looks out of date or fails to keep up with increased user demand will be abandoned, and it will get increasingly harder to lure those users back.

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TEST. THEN TEST AGAIN. THEN TEST AGAIN.

“People might not understand a good user experience, but they do know when they’ve had a bad user experience,” Gross points out. Map out all the different ways an app can be used and test them out. If choosing between two or more different functions or features, spread them out and test them all, to see which works and feels better.

Robert Lacis, senior director of customer services at Apperian, says customer feedback and analytics are important in planning for sustainability.

“Whether distributing test or production apps, collecting user comments and app ratings can provide invaluable closed-loop feedback to app administrators and developers,” he said. “This helps developers in planning the next iteration of the app. Beyond initial user feedback, app analytics can help administrators understand more about actual app use patterns. These adoption metrics will help the administrator and app owner determine an app’s true penetration and use.”

Longmire, of Medable, says testing should be done as soon as possible in the development phase – so-called “discovery sessions” might be used to help define expectations.

Also, audit and collect data at the back end, so that developers can study not only how an app is used, but why it’s not used or abandoned. If users aren’t getting past a certain function or command, it’s safe to assume that step is too complex or confusing.

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RUN IT BY THE PRIVACY AND SECURITY EXPERTS

Data security has been an ongoing issue since the first mHealth app appeared on a user’s smartphone.

First and foremost, an app should be up front with its privacy policy, providing access to privacy information before the app is even purchased (if it’s a paid app) or downloaded.

“Even though a privacy policy is not the be-all-and-end-all for building consumer trust, there is no excuse for failing to provide one – doing so is the baseline standard,” John Verdi, vice president of policy for the Future of Privacy Forum, said in a 2016 study. “App platforms have made it easier for developers to provide access to privacy policies. Consumers expect direct access to privacy policies, and users can review them before downloading an app.”

Security is also vital in apps designed by providers for their own workforce.

“Mobile app policies allow administrators to control access to individual apps and provide data protection at the app-level,” says Lacis, of Apperian. “This can be done with app wrapping, a method of applying security policies after the app is compiled. To ensure a healthcare app has the highest level of mobile security, institutions should incorporate government-level data encryption, corporate authentication requirements for sign-on, self-updating apps and app expiration policies that enable an app for a predetermined amount of time – helpful for workers who are accessing apps for multiple healthcare institutions.”

Also, any mHealth app that deals with personally identifiable patient information has to meet HIPAA guidelines. The Department of Health And Human Services, office of Civil Rights and ACT | The App Association all have a number of online resources dedicated to helping providers and mHealth app developers understand how an app must meet HIPAA standards.

Simply put, because privacy and security are such important considerations – and because so many healthcare breaches have been reported these past few years – providers should turn to the experts to make sure their app is safe and secure. That means enlisting the aid of the legal department, and perhaps bringing in an outside security firm to run extra tests.

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MAKE IT ACCESSIBLE TO ENCOURAGE WIDESPREAD USE

Healthcare providers need to make it easy for end-users to download their app, or it will go unused,” Lacis says. “There are a few different ways to distribute apps. If there is only one critical app with a defined user group, a download link to an app managed with policies might do the trick."

“On the other hand, a well-instrumented private app store can drive the highest levels of adoption and user experience, while also serving as a source of analytics to help manage ongoing app health,” he adds. “A private enterprise app store is an effective way to reach a wide range of users including direct employees, contractors and visiting physicians without compromising security by deploying apps in a public store.”

Longmire says healthcare providers have to understand that a mobile health app “is really a consumer experience, as opposed to a healthcare experience.” If they’re creating an app merely to check the box on mobile engagement, she says, they don’t understand the app’s value.

“Mobile apps require a lot of investment,”  adds Kendall. Done right, they’re a tool put in the hands of users to create an effective healthcare experience. Done wrong, they ruin the experience and end up at the bottom of the toolbox, unused and forgotten.

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