Building a Better App

February 21, 2013

Patient engagement is a requirement for providers and payers alike that hope to thrive in the new healthcare economic environment, and one of the keys to that engagement is connecting with patients through mobile technology.

But how do providers and payers design that perfect health app? If providers and payers are looking for direction, they should check out a new resource from the always-helpful Agency for Healthcare Research and Quality: Designing Consumer Health IT: A Guide for Developers and Systems Designers.

Consumer health IT can dramatically impact patient care by facilitating such vital functions as medication management, remote patient monitoring, and tighter communication between patients and their care providers. The guide is particularly timely because in the next few years, health care providers will focus as never before on electronic linkages with their patients. Many hospitals and health systems have patient portals on the Internet, with access to rudimentary health record information, and perhaps the ability to e-mail physicians. Some offer mobile versions of those portals. But providers have so far been under no outside pressure to get patients to use those resources.

Patient-oriented health IT is officially on the national agenda through the federal “meaningful use” program, which gives billions in cash incentives to providers for using IT to improve care (and in 2015 is scheduled to start penalizing holdouts by reducing their Medicare payments). The most recent set of criteria for meaningful use, to be phased in starting in 2014, requires an active effort to link patients into the information loop. Not only do providers have to make patients’ information available to them online, they also have to show that at least 5% of the patients have accessed that information in a given year. That percentage is likely to increase with the next round of meaningful use requirements.

For providers to achieve those levels, the consumer health IT they offer has to get much, much better. For example, an online survey conducted in 2011 by Consumer Health Information Corp. showed that 26% of health-related mobile apps are only used once, and most others are abandoned after no more than 10 uses. Less than 3% of apps survive to become “favorites.” While a third of health IT professionals responding to a recent survey said their organizations were allowing patients to access their information from mobile devices, only 13% were developing their own apps for that purpose.

While most of the new 19-page AHRQ Guide is a straightforward review of “Software Development 101,” with commonsense tips like assembling a knowledgeable design team and getting input from potential users at every phase of development, it also includes points that developers new to healthcare may overlook. For example, it recommends making sure the data coming into and out of an app conforms to widely used standard formats, and emphasizes paying attention to HIPAA and other privacy/security requirements. And it even highlights the most obvious concern of all, which can still elude young, healthy, programmers:  their users are very likely to be old and/or sick.

The guide also includes an invaluable resource list of reports and websites, both healthcare-specific (like the National Health IT Standards Committee) and general (like, which contains the accumulated wisdom of Jakob Nielsen, one of the world’s foremost usability experts).

Should providers develop their own apps—or put their house brand on apps designed by others—to cement patient loyalty and increase satisfaction? Maybe, in the short term, says Chris Wasden, Global Healthcare Innovation Leader for PricewaterhouseCoopers.

“Provider apps will only have staying power to the extent that they create value for just their own system in unique ways,” he says. In other words, they have to work their way into that 3% of apps that users can’t live without.

But in the long run, Wasden says, mHealth will be about making connections that go far beyond a single hospital, physician group or health network.

“I think that provider-branded apps have real issues if they aren’t designed and supported to eclipse the geographic limits of the provider network,” he says. Increasingly, meaningful use will include easy, comprehensive data sharing amongst providers, and the app development world will have to take those requirements into account as well.

Wasden says successful mHealth apps should fulfill the following six criteria:

• Integrated: into healthcare plans, clinical process, and the user’s lifestyle

• Interoperable: with electronic health record systems and information exchanges

• Intelligent: providing real-time alerts and intelligent guidance for patients, and  actionable information for physicians

• Socialized: providing personal coaching, direct physician support, or other caregiver linkage

• Outcome-oriented: With demonstrated success in improving care and reducing costs

• Engaging: Allowing patients to configure settings, messaging, and interaction modes

Effective electronic connections with patients will be a key survival strategy for providers in the next few years as reimbursement changes to reward effective care. As a recent report from the Bipartisan Policy Center points out, engaged patients have lower costs, better outcomes, and greater satisfaction with their healthcare. They are more likely to do what their providers tell them, and more likely to make healthy life changes. “Online and electronic tools that play such key roles in many other aspects of American life—from how people manage their finances to how they shop for goods and services—can be leveraged to accelerate and support patient engagement efforts in health care.”