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Developing effective mobile health applications: Tips from the field

With patients, providers, government agencies and venture capitalists all clamoring for newer and better mobile health applications, developers may feel the pressure to rush their apps out the door. Doing so, however, could mean missing out on important hardware and software features.

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Several presentations at this year's mHealth Summit offered lessons from end users, vendors and health IT executives in creating mobile health applications and devices that are ready for easy and effective use in the hospital, the desert or the mountains. Ten tips appear below.

Adapt to the small screen. Casey Helfrich, chief architect at the University of Pittsburgh Medical Center's Technology Development Center, said the physical limitations of most devices offer an opportunity to build good mobile health applications. Small screens, touch screens and power constraints will force developers to get away from the "kitchen sink" mentality in building electronic health record (EHR) systems and other clinical applications for the PC.

Keep it simple. EHR systems contain a ton of personal health information. Most physicians only need a fraction of that PHI at one time -- a problem list, for example, or a roundup of recent lab results. That's why a recent Department of Veterans Affairs Innovation Initiative (VAi2) pilot used a custom-built iPhone and iPad patient viewer app instead of using a Citrix Systems Inc. virtualized desktop to access the EHR, said Neil Evans, M.D., associate chief of staff for informatics and co-chief of primary care at the VA.

Keep it really simple. Matthew Berg, information and communications director for the Millennium Villages Project, urged developers not to "over-engineer things," pointing out that phone calls and text messages are among the easiest things to do with mobile phones. Such simplicity has an added benefit -- Berg finds patients and case workers more receptive to mobile health applications when they know they are interacting with a person instead of an automated system.

The right pictures are worth 1,000 words. Using images and videos, especially to explain sensitive health topics, can engage patients, Berg said. Case workers can also benefit from step-by-step checklists that point out what to look for in a routine patient visit. Use images wisely, though, said Hank Fanberg, director of technology advocacy for Christus Health. Many patients, and even case workers, cannot afford unlimited smartphone data plans.

Next year's trends in mobile health applications point to wellness and chronic disease management. Both involve closely monitoring patient activity.

Make it cheap. This applies to organizations of all types. The Christus Health IT staff spends $50 million "just to keep the lights on" at its 375 sites and supports 800 software applications, all of which require identity and access management, data management, mobile device management and other privacy and security measures, Fanberg said. As a result, he said, adopting mobile health applications that require providers to pay for interfacing, cloud data access and vaporware is pretty much out of the question.

Make it scalable. The experience of the Veterans Health Administration demonstrates that, once users have access to some data, they want it all, Evans said. Doctors were able to call up a patient's lab results but could not, for example, tell a patient when his next lab test was scheduled. Having built the patient viewer application with scalability in mind, adding such functionality was not difficult, he added.

When in doubt, default to HIPAA. Patient data privacy policies around the world generally lack the scope and influence of America's HIPAA. However, mobile health applications used elsewhere should still demonstrate HIPAA compliance -- if for no other reason than to prove that they will work in the United States. When using Kenya's 3G cellular networks to transfer patient data related to antiretroviral treatments, Qualcomm Inc. built permissions into its mobile health applications and encrypted the data, the database and the data transmissions, said Erica M. Whinston, the company's senior manager of government affairs. In addition, no data left the country.

Inside, check your infrastructure. Mobile health applications accomplish nothing without robust hospital wireless network infrastructure. "Wireless black holes" -- which range from basements and elevators to radiology departments and rooms filled with boxes upon boxes of paper medical records -- must be identified and mitigated for a successful wireless network implementation, Fanberg said. Networks should also be partitioned so that PHI use is subject to stricter security than, say, patients playing Angry Birds in the waiting room.

Outside, check the weather. Next year's trends in mobile health applications point to wellness and chronic disease management. Both involve closely monitoring patient activity. This requires developers to consider how software and hardware will respond to extreme temperature and altitude. For SenSaris, whose SensPack contains Bluetooth-enabled devices such as a glucometer and blood pressure monitor, this meant adapting its technology to the snow of the Alps and the Himalayas, said CEO Michael Setton, Ph.D. It also includes solar panels and, when thick clouds appear, batteries -- though not standard AA batteries, Setton said, as those tend to end up in MP3 players and other consumer devices.

Engage the locals. Mobile health applications present a tremendous technology learning curve to patients, providers and technical support staff, especially in the developing world. Keys to achieving what Berg described as a "culture of information use" include developing and training a local workforce, finding project leaders from the business and medical spheres, and demonstrating how data can be aggregated to identify macro trends. "Active management is absolutely critical," Berg said.

Let us know what you think about the story; email Brian Eastwood, Site Editor.

This was first published in December 2011

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