For one of Healthcare Informatics’ 2015 Tech Trend stories, I interviewed several health IT leaders about their thinking on mobile app development. One of my favorite quotes from that story was from Rasu Shrestha, M.D., chief innovation officer for the University of Pittsburgh Medical Center (UPMC) health system in Pittsburgh: “Many healthcare organizations have embraced mobility for the sake of leveraging mobility,” he said. “But we don’t believe in just doing mobility to put a checkmark on a requirement list. Yes, we have done mobility. But it has to be a very purposeful embrace of mobility.”
A few recent webinar presentations and interviews have reminded me that many clinicians are working on developing mobile apps with specific agendas in mind. Some are focused on enterprise apps that can improve physician workflow and access to data as they move around a hospital or clinic; others are creating narrowly focused apps that reach across their discipline to solve particular pain points. Still others are beginning to develop consumer-facing apps but tied to specific chronic disease management programs within their health systems.
During a recent webinar hosted by the Society for Imaging and Informatics Management, George Shih, M.D., associate professor of clinical radiology at Weill Cornell Medical College and associate attending radiologist at New York Presbyterian Hospital-Weill Cornell Campus, described how the radiology department has begun developing its own mobile apps to improve work flow.
“We have a small software development team, and most of the work we do involves developing web apps to improve operations, work flow, and education,” Shih said. “We are able to create apps completely customized for our needs. We are currently focusing on improving workflow at our outpatient sites. Our first app is aimed at the patient registration process. We are still in a fairly early state. We are alpha testing at this point,” he said.
Shih then introduced two other radiologists who have created a series of iOS apps to address pain points in radiologists’ work flow and made them available free through the App Store. Charles Lau, M.D., and Ahmed El-Sherief, M.D., both are academic radiologists now working in the Veterans Affairs system.
Lau noted that there are many guidelines available to help radiologists, but they aren’t packaged efficiently enough for use in demanding, high-volume practices. “So we set out to make life easier for ourselves and for those around us,” he said. “We identified the pain points in chest radiology and addressing them became the blueprint for our company,” he said. Clinicians won’t use apps unless they deliver meaningful value, he added. “We carefully observed physicians and identified those pain points that affect patient outcomes.”
First Lau and El-Sherief explored embedding utilities within applications they use at work. They also looked at creating self-contained apps in the desktop radiology workstations they use everyday. “But we discovered there are a lot of hoops you need to jump through to deploy these enterprise solutions,” Lau said. There are restrictions on what you can do and it wasn't clear how they would share those more widely or how long it would take. “That was when we began taking a hard look at creating at smartphone apps. With a little bit of time and work, we figured out how to take and package the guidelines into simple and intuitive iPhone app and share it with thousands of people around the world,” he said. In fact, Radiologiq’s seven apps have more than 40,000 users worldwide.
Lau admitted that they have a pretty unique business model. “We do everything ourselves — all the coding and debugging. And the apps are entirely free and also ad-free. Whatever profit we are giving up by not charging is overwhelmed by the larger number of users we can reach by keeping the app free.”
El-Sherief said one key decision was whether to build the apps themselves or use a third party. They realized they could not afford the $50 to $250 an hour needed to hire programmers and graphic designers. “We made the decision to code and build apps ourselves. The pros are that we control our code and app and it is easier to maintain, and we have freedom to experiment. Among the cons are that it takes lots of personal time. And even though we know how to code, we may be unable to tackle advanced tasks.”
They also had to decide whether to try to create one landmark app that addressed all the pain points or to tackle the problems in little pieces. “We decided to pursue modular development by creating smaller apps that attack individual pain points, which gave us time to grow and opportunities to put lessons learned to work,” Lau said.
Finally, some health programs focused on specific conditions are starting to work on app development for their patients and clinicians to share. Erica Jones, M.D., is the director of the brand new Heart Health program of the Dalio Institute of Cardiovascular Imaging at Weil Cornell Medical College. As the program begins its work with patients who have had a recent cardiovascular event, Jones believes it is important to include a smartphone app connecting patients and clinicians.
“We are working with a company called Medical Avatar to develop patient-centric mobile apps that will provide real-time data to participants and physicians that will motivate and modify behavior,” she said. Our vision is a way to share data between someone who has had a cardiovascular event and someone who is a sponsor in a mentor/mentee relationship. I think part of the problem of people not sticking with medical apps is that they don’t have a human component, so it is too easy to forget about it.” Having a mentor/mentee and physician access to the data is key,” she said.
Jones said she thinks more health systems targeting chronic conditions will start tailoring their own apps to work with small groups of patients. “The only way to show true change in a population is to limit the population,” she said. “If you have a specific population you are targeting, focus in on one section of that population. Once you see change there, then you can expand it out. I think if you want to see something get traction, you are going to have to start with a limited population and then branch out.”
Later this week I am scheduled to interview Larry Barnes, CIO, and Michael McEldowney, director of IT, at the Salina Regional Health Center in Kansas about their deployment of mobile apps in a community hospital setting.