Marcos Athanasoulis, Dr.P.H., M.P.H., Chronology.MD Technical Director, Healthy Communities Institute
Kathleen Morrison, M.P.H., Chronology.MD Co-Project Director, Healthy Communities Foundation
Our technology team has included a diverse group: a health informatics researcher/CTO, an architect, a health services researcher, and a UCB undergraduate/patient/usability specialist. Because our project experienced administrative delays and personnel setbacks during the first year of funding, the beginning of 2011 required an expedited execution of our app technology. With four people and four very different levels of expertise in the various disciplines required to develop a mobile health app, the effort has been fun, challenging and occasionally frustrating, but ultimately rewarding and educational.
We developed two apps for this study: the Chronology.MD app that allows patient participants to enter data on an iPhone/iPad/iPod, or via SMS text message on other types of phones; and the Crohnograph app, which provides visualizations of the patient data in trend line form on the iPad.
Some challenges we addressed include:
- Multiple technology partners
In addition to Apple devices, each patient also received a Withings Body Mass Scale and a Fitbit activity monitor that are used to collect ODL data (e.g., weight, steps taken, sleep) . We brought in technology partners, including iMedic8 (the medication adherence app upon which we built our platform), so that we didn’t have to reinvent the wheel. Working with iMedic8, Withings and Fitbit brought us great capabilities but meant coding our apps to conform to all of these existing platforms.
- Multiple authentication methods
Similarly, the authentication processes for Withings and Fitbit were different. One supports direct back-end authentication while the other requires the user to navigate to their site on the device to authenticate. To make this happen, our developer needed to adapt around the existing workflow of these two technology partners.
- OS upgrades
We confronted the realities of dealing with Apple OS upgrades. Because an upgrade occurred mid-project, our app needed to work with Apple OS4 as well as the newer OS5.
- Hardware variations
We had to work with multiple types of hardware, and we had to find ways for the app to work with multiple configurations such as the iPad and SMS text messaging.
- Patient data integration
Our plan for patient data integration was thwarted when Google Health (our planned data repository) was discontinued. Changes happen. Even large, stable companies cancel products, and we have had to adapt to this reality.
- Performance issues
Although our design team had outstanding ideas about data visualization (e.g., screen pinch and zoom timelines for data), some of those ideas were beyond the reality of processor/computing capacity at this time.
- Vendor issues
Apple hardware is elegant, but we did have challenges working with Apple, including a very limited discount for nonprofits and research projects, as well as having to go through their application review process with a limit of only 100 provisions for testing.
Technology successes we can identify at this point include:
- We predicted that participants would want to use their own phones for the project, which turned out to be the right call. Not everyone wants to give up their plain old cell phone for a smartphone. In order to accommodate these users, we incorporated SMS text messaging into the app, and all patient participants received iPads that can be used for both ODL data collection and data visualization.
- The popularity of the iPad and the other devices we offered to the cohort have resulted in great user compliance and lots of enthusiasm for the project.
- We have been able to integrate data via the effective APIs available from Withings and Fitbit.
- The device makers realized that multiple people in a household will use the Withings scale, and the log in allows additional names and tracking capabilities. Similarly, iMedic8 can handle additional users.