Group Presentation Schedule

5:30: Katia, Kim, Liz

6:05: Ana, Joan, Hubert

6:40: Sue, Sami, Joelle, Toby

VisitAssist

Mobile Health Design | Katia, Liz, Kim

Goals

Goal: To improve communication between doctor and patient.

Organization: A student (high school or college) health center

What does it do: Allows patients to engage with their doctor by proactivley suggesting question topics and grouping common symptoms. The app also provides answers to FAQs or tailored questions for the patient's visit. Allows them to ask their own questions.

Who benefits: Doctor, patient and administrative staffHow do they benefit: The patient received specific,

valuable information, the physician's face-time is efficiently used to review, and administrative and non-physician clinical staff answer and ask fewer routine questions.

Target audience

Target audience: Students, less-engaged patients, those with chronic conditions, also your average person who may have questions but not necessarily be likely to ask them in person.

Target audience needs: Suggestions about what questions would be helpful to ask. Barrier is - don’t know where to begin with questions. Not time intensive, part of the waiting room routine.

How app addresses needs: Familiarizes patients with their symptoms and what helpful information they should seek -- and how -- from their provider Works seamlessly with the waiting room routine and can integrate with the EHR.

Personas

• Kaylao Young black college studento Chronic illnesso Wants app to help with asthma questions

• Melissao Young white high school studento Currently ill with monoo Needs to know the "right" questions to ask

• Joabo Young latino college studento Undiagnosed anxiety/depressiono Won't discuss emotional issues unless prompted by his

Doctor

Competitive Analysis

• PingMDo Pro: HIPAA privacy guidelineso Con: Glitches

• MyCharto Pro: Sync with web profile for easy sharingo Con: Not widely available to everyone

• MeVisito Pro: 24/7 provider access; database "suggestion"

for symptomso Con: Discourages patient/provider

communication beyond what patient generates

Using our app

Three main areas: • (1) View/Update Personal History• (2) Ask Questions• (3) Account Settings

Using our app

(1) Personal History• Medical/Personal history, goals• FAQ’s

Using our app

(2) Questions• Your Physician/PCP• Experts

▫ Patient can filter experts▫ Sourced from database

Using our app

(3) Account settings• Basics & Clinical• Guardian name if

requested by school• GPS predicts local

hospital and leaves option for user input

• Option to link insurance information to guardian or emergency contact

Evidence-based guidelines

• The most popular apps have these things in common:o Easy accesso No unnecessary featureso Flexible designo Attention to detailo Well testedo Free

• Teenagers and millennials:o Like an app that establishes their independenceo Have limited spending powero Prefer to interact via email/messaging

Evidence-based guidelines

• Approach to doctor-patient communicationo Patients want more meaningful discussions with

their care provider when making health care decisions.

o Want to know the latest medical evidence.o Want their provider to ask about their goals and

concerns for their health and health careo Want to be told the truth about their diagnosis

Successful usage

• By using their main form of communication - texts and email

• Modern design

• Provides them independence from their family

Improves on existing apps

• Ask an "expert"

• FAQs are created based on modeling of symptoms

Uses smartphone capabilities

• Contains a notification system

• Uses GPS to find local hospital(s)

• Syncs with EMHR of doctor's office

• Both iPhone/Android capable

Evaluation plan

• Planning the Sessionso Scriptedo Beta test with colorful, modern, fully-interactive

interfaceo Prompts assigned to userso Mock search results

• Conducting the Sessionso 2 moderators: one to conduct, one to assist;

scribeo Collect demographicso Each user given a mock health situation; searcho Ask before, during, after questionso Moderators prompted to ask counter questions

Evaluation plan

• Compiling Resultso Notes from assigned scribeo 1 -2 observers will watch moderator performance

and offer suggestions on script

• Prioritize and Reporto Include all positive and negative feedbacko Reaction, criticism, praise, problems, suggestionso Shared with all teams (development,design,

technical)

• Conclusiono Moderator's reporto Plans for moving forward

Development plan

• 1. Functionality: o Check every single screen and test every

buttono Figure out how different sections of the app

work with each othero Work closely with a developero This could take months and cost about

$50,000 after all the revisions ($100 per hr)

• 2. Design: o Make it look modern and attractive to our

audienceo Hiring a designer for this would run around

$10,000

Development plan

• 3. Going live: o iTunes connect account ($99 a year); pricing;

description; marketing ($1000)

• Cost of entire process: At least $61,000 but because we want to connect to EMHR and specific school networks it will probably cost much more.

• Timeline: The first step will take at least six weeks to complete, and another two weeks with the designer. The hardest part will be trying to sync this app with school health systems and electronic health records

Marketing plan

• Partner with ACHA and ASHA o Will ensure proper marketing to target audienceo Improve visibility and credibilityo Promote to health prof. associate, hospitals, small

clinics in areas with large student population (e.g. Boston); large regional and inner city high schools

• Platformso iOS and Androido "Health and Fitness"; "Education"; "Medical"

categorieso Immediate launcho Possible Blackberry AppWorld launch with good

response

Marketing plan

• Priceo Free o Small advertisement

bars at bottomo If affiliation becomes

costly - will suggest that app cost $1.99 to cover costs

o Not ideal - high school and college students not inclined to pay for apps

Limitations

• Linking with EHRs is logistically difficult because of interoperability issues and HIPAA privacy concerns.o Suggest partnering with major EHR vendor to ensure

interoperability, sustainability, and expertise

• The "use-case" is limited; students may be unlikely to download the app without first being prompted by a cliniciano Emphasize marketing campaign and awareness,

rewards during roll-out, etc.

• Grouping symptoms and suggesting questions may contribute to psychosomatic perception of conditions and self-misdiagnosis

MYndMedsMisMedMent

(Spanish) MYndMeds:

the app that mindful keeps me on track

Mobile Health Design 2013 Online Course

Tufts University Medical SchoolFinal Presentation

Group Three: Hubert Park, Joan Storey& Ana Villanueva

MYndM

eds

MOBILE HEALTH DESIGN

MYndMeds- Organization:

Psychiatry Clinic

- Goals for app: 1. Increase effectiveness of 20 minute medication visits, for patients with depression, in waiting room and seamlessly transfer data to MD.

2. Improve and make more efficient data collecting, regarding satisfaction with medication.

3. Increase adherence to treatment.

Target Population- Both men and women

- All age groups

- Bilingual or monolingual

- Different levels of depression

- Patients with low literacy and low health knowledge, and low technological knowledge and platforms

Target Audience’s needs

Patients need to know a) Easy technology to

answer questions -a small training before they have the app on their hands-

b) Treatmentc) Drug’s Frequencyd) They’re important

to their physiciane) Follow up tips

MYndMedsConcept Statement: : 1) Assess patients’ knowledge about

their medication (s). 2) Formulate and coach patient to ask

personalized question.

How app addresses needs:1) Patients will satisfy their need of

communication

2) Doctors will satisfy their need of information to evaluate the medication effectiveness and follow up on it.

3) Both will save time and we’ll avoid to be too impersonal.

A Review of PersonasPersona#1 Belkis Rosario

Working mom in early 40’s

History of abuse

Suffers from depression

Originally from Dominican Republic

Limited English

She lives with her mother, grandmother, and five kids. One kid with ADD.

CC: “I forget to take my medications and I suffer from bouts of severe depression”

A Review of PersonasPersona#2 Carolyn Walker

• 24yo African-American female.

• Attends city college and lives in inner city.

• Boyfriend who’s not always faithful.

• Individual therapy for 2 years for depression.

• Low self-esteem and “moody”.

• Rx: Celexa to some improvement

• Patient’s Chief Concern: “Wondering if I should stop the medication”

A Review of PersonasPersona#3 Irving Johnson African-American gay male in his early 30’s;

Dx with HIV+ in 1990

Rx: Combivir, Prozac (80mg).

Marijuana and ecstasy on weekends.

Depression, anxiety; HTN and hypercholesteremia due to HIV meds.

Anonymous sex but wishes for a long-term partner.

Very active in pro-gay movement.

Likes to look “buff”, worried about weight gain.

CC: “80mg Prozac is beyond FDA recommendations”

Lessons on Personas & Scenarios for our app’s designThey need: Easy, comfortable, and relaxing app Something appealing to maintain her interest in future visits –music-Ensure privacy/confidentialityInformation on current medications: risk, benefits, and alternativesFacilitate efficiency in time spent with MDs A “fear free to technology”

environment

COMPETITIVE ANAYLISIS

Competitive AnalysisAfter reviewing several

apps that might compete with ours, we conclude:

Market offers “psychmeds”, “dosecasts”& “doctors’ notes”, among others, but they not put together all our goals.

Competitive AnalysisBorrow

Multiple language

Simple lines

Easy downloadAvoid

• Poor instructions

• Lack of empirical research/data

• Lack of expert advisory board

• Lack of data Security

• Lack of personalization/customization

FORMATIVE EVALUATION PLANS

Actual Formative Evaluation- Consent to video record

- Evaluator/interviewer and a scribe

- Ana and Joan will interview because they are warm and friendly

- Hubert will transcribe because he types fast

Formative EvaluationGoals:

- Appeal

- Usability

- Effectiveness

Questions to Ask on Appeal- Do you find the colors easy to

look at?

- Did the logo reveal its purpose?

- What was the first thing to look at when you found this app? (I don’t get this question)

- Did the name of the app reveal its use?

- What would you like to know that you did not know before?

- Do you find the app easy to navigate ?

- What do you know about your medications? (e.g. name, appearance)

Questions to Ask on Usability (1)

- Did the name of the app reveal its use?

- Have you used a smartphone or iPad before? How comfortable are you using those devices?

- Would you prefer to talk or type?

- Does “X” persona seem like anybody you know?

Questions to Ask on Usability (2)

- Would you use this app if the receptionist asked you to use it upon your arrival?

- Would you use this app if the doctor asked you to use it upon your arrival?

- Do you think you need a training session to use it?

Questions to Ask on Usability (3)

- Does this app help you know more about your treatment/medication?

- Are there any health issues that are missing in this app?

- What are your primary sources of information about health issues?

- What else do you want to know about depression and its treatment?

Questions to Ask on Effectiveness (1)

- MCQ: When did you last take your medication? (Today/yesterday/last week/last month/ don’t remember)

- How well do you think the medication is working?

- What side effects do you have?

- How worried are you about becoming addicted to this medication?

- How worried are you about others knowing about your medications?

Questions to Ask on Effectiveness (2)

- What other things do you think help with your depression: “Botanica”, exercise, prayer, etc.

- Would you like to see a short video on your medication?

- Would you like to know why this medication was chosen instead of another one?

- If we had a website, would you have access at home or at a library?

Questions to Ask on Effectiveness (3)

OUR APP DESIGN

Name: MYndMeds/ MisMedMent(Spanish)

Logo: M

YndMeds

Slogan: MYndMeds: the app that mindful keeps me on track

MYndMeds

- Check-in app at a psychiatrist’s office

- Provide relaxation via music

- Review of Rx meds

- Facilitate efficiency in patient-provider interaction

WIREFRAMING

Wireframing

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MYndMeds/ MisMedMent (name & logo)

(Slogan)MYndMeds: the app that mindful helps me keep on

track Patient name Patient Date of Birth Patient medical record number Name of patient’s doctor Date and Time of Visit

This comes pre-

loaded

MYndM

eds

NEXT

Intro pageThese are communicating texts to make our patients feel welcome and comfortable. NE

XT

MyndMeds it’s a new app specially created for you!

MyndMeds wants to make your visit to the doctor a better experience!

Get ready to answer clear questions about your meds, symptoms and feelings.

Intro page

Tell your doctor about your medication. What do you like and not like?

What questions do you have about your medications

Learn more about your treatment and medications

NEXT

Intro page

Your doctor will be able to see your answers about how you take your medications, how you feel about them, and what you want to ask automatically in his/her computer

NEXT

Slogan: MYndMeds: the app that mindful helps me keep on track

Intro pageMake the most of your time with your doctor.When you complete MYndmeds prior to seeing your doctor, S/He will know:- Whether you feel your medication is working- How and when you take your medications- How you feel about your medications- What, if anything, you wish could change about your medications

- MYndmeds teaches you more about the medications you take and how they work - MYndmeds helps you decide what you want to ask your doctor when you see him/her

Intro page

Thanks for using MYndMeds!

MYndMeds, the app that mindful helps me keep on track!

Recruitment Plan- 10-15 subjects of varying

demographics

- E-mail blast to current patients

- Selected subjects will be asked to arrive 30 minutes early to their next scheduled appointment

- ~20 minute MCQs and open-ended questions

- $50 gift card to Amazon, Target, or Starbucks

ONGOING EVALUATION- User surveys

MARKETING AND PROMOTION

Sponsorhip: call together different mental health institutions, private practices & Med labs to support us

Promotion: app stores and sponsors web pages

Platform: Ipads at every doctor’s office

Price: Free

THANK YOU! QUESTIONS?

Final Group PresentationJoelle, Sami, Sue, Toby

DOConnectGoals:

• To improve the efficiency and quality of the time spent during the patient/provider interaction

• Streamline communication• Enhance patient satisfaction, adherence to

treatment/care and retention• Improve patient health outcomes

The Need is Critical

• The average primary care physician in the US serves an estimated 2,300 patients

• For a PCP to provide all of the recommended acute, chronic, and preventive care for 2,500 patients, the PCP would need to be providing care 21.7 hours/day

• Patients receive only an estimated 55% of recommended chronic and preventive services.

• Half of the US adult population has a chronic condition

Source: Altschuler et al (2012). Estimating a Reasonable Patient Panel Size for Primary Care Physicians with Team-Based Task Delegation. Annals of Family Medicine.

Target audiences, audiences' needs, how DOConnect addresses them

Target audience: Patients in the hospital system

• App helps by...

o Saving time (fill out history, concerns before arriving)

o Building relationship (put faces to names, get on same page re. treatment goals)

o Compiling concerns & questions before visit

• Want to...

o Streamline & speed up visit

o Feel like they have a relationship w/ doc

o Feel prepared for visit, get most out of limited time w/ doc

Target audience: Physicians' offices

• App helps by...

o Saving time so can have more meaningful time spent with patient

o Building relationships with patients = better care provided

o Improved efficiency: can see more patients

o Better educated patients can better manage disease and are less costly

• Want to...

o Make visits more efficient

o Save money, time

o Have a relationship with patients

o Have healthier patients

Competitive analysis & design/marketing implications

• Examined Care360, MyChart, Tonic Health, My Medical • Need for an app that is two-sided: links the providers and patients

and fosters communication between the two• It needs to WORK – not be buggy or crash, can't lose patient info• Need automatic reminders that new information is available via the

app• Beneficial to build off of what the EHRs already do and expand

upon that, rather than "reinvent the wheel"• How to keep app free and ad-less? Integrate with existing EHR

system/subscription• App needs to be tailored and appropriate for target audience• If target audience is broad, keep app design simple and easy to

use• Connect with computer for ease of entering information• Ensure security of personal information / HIPAA compliant

Personas

1. Robert, 65: fibromyalgia

2. Suzanna, 41, & Becky, 13: struggling with weight

3. Angela, 23: healthy young adult

4. Francisco, 50: back pain, recent immigrant

Scenarios & app use, benefits

• BEFORE the appointment, DOConnect o tells Angela there was a cancellation at an earlier timeslot; tells Robert &

Francisco their providers are running late, provides relevant educational health-related reading material/videos

o lets all personas fill out insurance & medical history forms ahead of time, lets Francisco request an interpreter

• DURING the appointment, DOConnecto reminds Robert to ask his physical therapist the questions he previously noted

o allows NP to send info on STIs & birth control to Angela via patient portal

o permits more time discussing stretches, pain, diagnosis w/ Francisco

• AFTER the appointment, DOConnecto allows Francisco to track his pain & exercise regimen, Suzanna to track her

blood pressure, Becky to pick from a selection of healthy recipes

o has a copy of Angela's new prescription, in case the pharmacy doesn't have it

Map of app structure

Map of app structure

Wireframes

Development plan

• Partner with an existing EHR company that has a wide reach

• Develop in partnership with the EHR o Builds off of existing EHR system and ensures

compatibilityo EHR company can provide resources: financial,

staffing, support o Wide-spread dissemination and high impact (buy-in

from hospital systems... soon everyone will be on EHRs)

Evaluation plan

1.) Formative evaluation: conduct focus groups with providers and patients during the development stage, sampling various demographics

2.) Roll out to limit pilot site(s) for further testing prior to release

3.) Formal evaluation of app once released: RCT to evaluate patient-reported outcomes, ability to manage disease. Full cost assessment.

Marketing Plan: Platform and Promotion

• Develop in partnership with either an insurance company, hospital system, or EHR system (such as Epic)

• Use partnership to bolster promotional efforts

-Contacts

-Piggyback on current advertising

-Mention on company website, Facebook page, Twitter

• Will be available on iPhones, iPads, and Android phones

Marketing Plan: Promotion

• Promote to both healthcare professionals/hospital systems as well as patients

• Market to healthcare professionals and hospitals as way to ensure patient satisfaction and retention

• Market to patients as a way to manage their health and streamline visits to the doctor

Marketing Plan: Price

• With so much competition, the app needs to be free to the patient

• Doctor office pays a subscription fee for their patients

• $150 per year

• Justification: app provides services to keep patients happy which results in better patient satisfaction and retention; streamlines electronic health record system for admins

Limitations

• Competitorso There are other options already out there! (e.g., Care360, MyChart,

Tonic, My Medical, others)

• Access o People without smartphones may be most in need, least likely to be

reached

• Cost o Further limits access, even if the cost is to the clinic (clinics that work

with under-served populations or that are already over-burdened may

be most in need, least likely to be able to afford the fee)

Next steps

• Cost assessment: how much will developing the app cost? How much cost-saving potential does this app have?

• Develop prototype

• Pitch to EHR company and create a partnership

• Conduct formative evaluation for feedback from patients and providers prior to the release