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Mobile Application Testing a Challenge in Healthcare

By Ryan Mcaskill

When it comes to mobile applications, the testing period is one of the most crucial. Launching an app that is not complete or filled with bugs is the fastest ways to ruin the reputation of an app and the company behind it. However, there is a difference between testing a game and testing a healthcare app.

In an interview with, Applause chief strategy officer Matt Johnston spoke about the challenges of testing healthcare applications, how the industry has changed and where it might be going. What is the mobile application testing process?

Matt Johnston: At it simplest, Applause is an app quality company. Whether its a web application or mobile app or or smart device or wearable, any kind of digital experience that you put in front of customers, our job is to help make sure users love it. That is everything from doing testing such as functional testing, security testing, usability testing, review analysis, crash reporting. Its everything from the very technical (does it work) to the softer side, like do people like my content.

Applause has been around since 2008, so we were around before the app stores were around, but we were really centered around web applications. We have 175,000 professional testers from 200 countries and we have nearly half a million devices in the hands of these testers. So Company X can come to us and say I want to test this new Android app across a bunch of different phones and tablets, across a bunch of different operating systems and we can do that.

READ MORE: mHealth Apps for Cancer Survivors Aren't Meeting Their Needs What has your interaction with the healthcare industry been like?

MJ: There are two types of mobile applications, back office stuff for employees, also known as B2E or business to enterprise, and then there are public facing user applications or B2C (business to consumer).

On the B2C side, I can tell you that the healthcare industry has been slower, than a majority of industries. If I compare it to retail or media or travel or even fitness, which is kind of a cousin to healthcare, it has lagged behind. It has been more of a case where you see industries like insurance, financial services and healthcare historically one to two years behind some of the other vertices in terms of innovation on the mobile side.

That is not to say that they are not using mobile for their B2E stuff. They may be using tablet applications to exchange information between doctors and nurses and support staff, but the things they put in front of patients is lagging behind. How has working with healthcare applications and providers changed over the years?

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MJ: When we started, even if you fast forward to 2010, 2011, 2012, we were not seeing many healthcare companies with mobile applications. It has changed, really, from nothing and now a lot of them are into their first and second, or even third generation mobile application. The first generation was really, “we need an iPhone app so people can find the hospital and read about the different doctors and services.” The second generation they start introducing new feature functionality like the ability to set an appointment or access content. Now we are starting to see more and more sophistication, like the ability to take a picture of a mole and send it to a specialist who can say, “yes you should come in and get that checked out” or the ability to access test results and learn if they are ready. Are you seeing more startups coming with mobile applications designed specifically for healthcare?

MJ: That has definitely been a trend and that has been true for the last three of four years. Of the first ten to 20 health companies that came to us, many of them were the upstarts. Now we are seeing more hospitals and hospital families coming to us.

We are seeing a lot of interaction with wearables. The other big innovation has been with Apple’s HealthKit. It’s one thing for a doctor to tell you to watch your calories and get more exercise, it’s another when they can start to close the loop and say “I know you are a FitBit user or Nike Plus user, so we can actually track your activity.” This allows doctors to not take a patients word for it. We are seeing more companies trying to close the loop between the exam room and what happens when they leave and come back the next time. Have you seen any common challenges from healthcare apps?

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MJ: Yeah, One of the challenges for wearables in general is that they are often a tandem devices. It needs to be paired with a phone or tablet and one of the quality challenges is that it is not enough to go make an Apple Watch app that works, it also has to integrate with an iPhone 5 and iPhone 6 and the iPad and iOS 7 and iOS 8 and 8.1 and 8.2.

It’s what we call fragmentation of different devices and OSs and its no longer just “wow, there is a lot of Android devices out there” but any wearable needs to sync and pair and play nicely with Android in order for the user to get a full experience and access the functionality.. How does working with healthcare applications differ from other industries, like a mobile game?

MJ: They are definitely different. The first thing is the learning curve of domain expertise. If I went you you and anyone else and said “Hey, test angry birds,” it would take you several seconds to figure out the rules of the game. That is not the case with more complex applications.

The second is that healthcare is a more heavily regulated industry. They have concerns around HIPAA and patient privacy, so they need to be very conscious of that. Not only the testers but our project managers need to be speaking the same language and understand the regulations of healthcare.

Anyone in healthcare that wants us to test a new version, they need to make sure that it has dummy data or sub data or something other than their production user’s data so that we can test it. This is something that most companies recognize, but that is not always the case.

In 2010, a company came to us and said “hey, we want you to test this,” and we said “ok, do you have any made up data, not real user data?” And they said “no, is that going to be a problem?” So they have learned in the last five years that you need to have dummy data and their are entire companies built around providing this dummy data that can be use for testing.

The third challenge, in a lot of cases, companies want the testers to be actual end users of their services. So we have gotten very good at finding Apple and Android testers that are users of that healthcare or financial services company. How do you categorize the healthcare innovation happening through mobile?

MJ: In healthcare, a lot of the mobile innovation isn’t B2C. That is the more visual part that the media and patients see and like, but a lot of the innovation is around patient records or charts or test results to be shared between doctors or with this nurse or that specialist that might be in a different hospital or time zone. I do think there is a lot of innovation happening in the back office of healthcare. We have even tailored new services to these groups that want to create early adopter subsets for trials of new software to get feedback before rolling it out to all of my employees.. Why so much innovation in B2E?

MJ: I think there was a lot of room and need for innovation. There was a lot of paper floating around and room for human error involved with back office operations. There was also a lot of low hanging fruit there, just going to less paper and less hand writing.

One thing digital does well is structure information. You click either yes or no, there is no human hand holding a pen that ticks in between the two boxes. Removing the subjectivity increases precision and repeatability. When you are talking about healthcare, the stakes are very high. They are much higher than they are in retail or gaming.

Also, it’s an opportunity to innovate and I don’t just mean innovation for the sake of innovation for a Harvard Business Review case study. I mean that they can either pull costs out of their business model or they can differentiate their services and grow. I don’t think it’s theoretical, I think it’s commercial because they see ways to make things more efficient and lower costs. What are your thoughts on ResearchKit and how it can impact the industry?

MJ: I was amazed when I first heard the numbers. My first thought was George Orwell got it all wrong. he was saying big brother would come and steal our information and we voluntarily hand it over, pretty consistently too. I had to laugh at that.

That said, if they get the consumer adoption of it, then there is enough data points and I think it could be a runaway success. It will help companies connect, not just with users from a marketing and research point of view but get to the good ideas faster. It could be very powerful if they can get and keep enough consumers and data points.


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