As chief medical information officer at the Cleveland Clinic, Dr. David Levin is very interested in mobile healthcare applications.
“This is an extremely hot area, and we spend a lot of time both making and looking at apps,” he told the audience at HealthBeat2013 in San Francisco today.
But Levin also stressed that not all healthcare apps are created equal.
“The 'crApps' far outweigh the apps,” he said.
Developers of healthcare apps often complain that promising apps fail because healthcare providers are resistant to adopt new technologies. But another HealthBeat speaker, Jeff Tangney, CEO and founder of Doximity, a social networking site for physicians, points out that doctors have been on the cutting edge of mobile technology since the 1950s, when they were the first to use pagers.
In fact, Levin said, many healthcare apps don’t succeed because they simply aren’t very good.
“More often than not, there are lots of critical holes in what we see on the market today,” he said.
Some apps fail for technical reasons—the connection’s not stable, the data doesn’t flow, or they just plain don’t work, Levin said. Others are technically sound but don’t take into account physicians’ workflows or how patients fit into the equation.
Levin used as an example an app the Cleveland Clinic created to help patients with diabetes manage their disease. It required the patients to input data about their blood glucose levels manually, which Levin compared to trying to use Quicken personal finance software if data from your bank or credit card company didn’t flow in automatically.
“It didn’t stick; the patients didn’t buy it,” he said.
But another of the team’s initial failures, a pain assessment tool for nurses to use in an in-patient setting, ultimately became a success. The reason? The developers sought out feedback from the nurses and incorporated it into their designs.
“We learned together to refine the product and make it fit their needs,” Levin said. Quick feedback lead to a quick fix and ultimately a successful app, he said.
The key to creating successful apps—or any digital health technology, for that matter—is considering workflow, Levin said.
“Too often, what I see is a physician, nurse, or patient doing most of their stuff over here, then somebody shows up with an app, but you’ve got to look over here to [use it], and it just doesn’t work,” Levin said.
He also told of a tool his team created to help physicians calculate patients’ International Normalized Ratio (INR), which determines how fast their blood is clotting and whether their blood thinner medication needs to be adjusted. In the past, physicians calculated INR on scratch paper or in their heads. The Cleveland Clinic wanted to make it easier, so a team there developed a Web form, but it initially failed because providers had to input the information manually. Adoption increased dramatically when the team adapted the form to import data automatically from patients' EHRs.
“It wasn’t that we changed the content of it,” Levin said. “It was about the workflow.”
—Jamie Hartford is the managing editor of MD+DI.