by David Lee Scher, MD

First posted on The Digital Health Corner 01/31/13

There are an estimated 15,000 medical apps presently on the market and is expected to grow 25% per year according to one study.  There are issues which are common in the development of these apps and other categories of apps. However, some technical and non-technical issues are unique to the sector. As someone who does not design apps, I will offer a perspective which covers topics raised by different stakeholders concerning medical app development which might be of interest.

1.    The motivation for the app development is misguided. Regardless of the elegance, ease of use, enjoyable experience, or other appeal of a health app, if it does not address a specific problem, it will not be considered useful and subsequently not adhered to.  Just monitoring a physiologic parameter, a person’s mood, or collecting data because an app is able to do so is a recipe for failure. People searching for health apps (and health information in general) are likely doing it because of a health problem. Data must be collected and filtered in a way that it translates a message to the end-user, whether that be a patient or clinician.

2.    Lack of clinician involvement.  I am not saying here that clinicians need to be CEOs of mHealth companies.  What I am alluding to is the lack of clinicians’ input at all in the development of many of the technologies.   Technologies do not operate in a vacuum.  There are processes that the technology fits into which might very well need to be totally redesigned around the technology (this is a good thing, for many processes need changed).  These processes may range from someone’s personal schedule to instituting hospital case managers who advise patients on mobile apps. The app cannot be dropped on the lap of a CIO or clinician and be expected to be successful.  Connectivity of mHealth tools will be an important aspect of stage 3 of Meaningful Use adoption. This connectivity will necessitate workflow of data and messaging between patient and clinician.  It is imperative, therefore, to have clinician input into the design of the technology.

3.    Poor attention to usability.  Achieving the final construction of an app must include an in-depth consideration of the experience a user with the need for the app has. According to a guide to evaluating usability of medical apps by HIMSS, usability may be defined as “the effectiveness, efficiency and satisfaction with which specific users can achieve a specific set of tasks in a particular environment.”  I chaired a session at the most recent mHealth Summit on the topic of “What goes into making an extraordinary mHealth app?” which can be found at the bottom of this link.  There are great presentations discussing app design and user experience.

4.    Not knowing the healthcare landscape. Knowing the healthcare landscape is critical to determining a strategy of adoption. What are the available technologies that address this app’s goal? How can this improve or add to them?  Can the technology be used by multiple stakeholders? Might it be best to partner with another company to distribute or co-market my tool? Is my technology more valuable when incorporated into another offering (partnering with another technology)? Is this tool something the payer, provider, or patient would use/purchase (which provides the best/easiest path to sale/adoption)?

5.    Not building to regulatory specifications. It doesn’t matter how much wow factor the app has, if it doesn’t meet regulatory requirements [re: security, HIPAA, FDA (if necessary)], it will need to be reworked as a significant cost. New proposed regulations regarding handling of data from apps might affect development as well and these should be followed in the news closely. Of course the FDA final guidance document is anxiously being awaited.  Aside from regulations, developers might want to look at Happtique’s draft standards for their app certification program.  The final standards are forthcoming.

In summary, building code is a small part of developing a health app if one wants to be successful. It should be seen as a process with many layers requiring attention. Selling an app does not translate to adoption.  Selling a good app improves its chances dramatically.