Monday, July 28, 2014

Who wants better mobile apps?

Who doesn't?

Since I arrived at Duke almost one year ago I've had many opportunities to share my vision for mobile technology in healthcare. In particular, I've had numerous conversations with budding developers and entrepreneurs asking for advice on how to produce a successful health app. While the real answer is probably something along the lines of: "It's complicated ...," there are several pieces of advice I can offer with a high degree of confidence. In other words, if a developer doesn't do these things, the chance of a successful app is slim.

Without further ado, here are my Core Tenets for Mobile App Development:

1. Start with the problem

This is first for a reason. Despite seeming blindingly obvious, it's one of the most prevalent mistakes I encounter. Technology moves quickly, and often in the wake of a new technology release (HealthKit comes to mind ...) there's a surge of interest to create something quickly to capitalize on the excitement. While there's some merit to this "see what sticks" strategy, the majority of these apps will fail to gain traction. The few that do gain traction were often already in the works, and are simply a reimplementation of the idea with fresh technology.

Instead of chasing the latest technology fad, take some time to look around and identify a need, taking into account your timeline and resources. If it's something you're passionate about or that will have a direct impact on your own health, even better. You're far more likely to be persistent if it's personal. If you're still having a hard time finding a problem to solve, either you're in the wrong field, or you need to ...

2. Involve the experts

Unless you're a healthcare provider creating an app for your own use (which happens from time to time), enlisting the help of a domain expert to assist or advise is an absolute requirement. Anecdotally, neglecting to do this is the second most common mistake I find when reviewing new app concepts. This error is typically the result of a developer or entrepreneur from a non-healthcare field who sees an opportunity in healthcare, yet either doesn't understand the importance of this expertise, or doesn't understand how to break into the academic ivory tower to reach these content experts.

I'll be the first to admit that physicians at large academic medical centers (AMCs) are not easy to reach. And even if they were, it's not easy to know who among the thousands of physicians would be willing and able to help. There's not an easy fix for this, although many AMCs are establishing centers of innovation that serve to connect innovators within an institution to interested innovators and entrepreneurs on the outside. Through the Duke Institute for Health Innovation (DIHI) we're attempting to accomplish exactly that through regular "office hours" and forums open to the local startup and business communities.

3. Integrate. Integrate. Integrate.

While all three tenets are important for practical reasons, integration is one of my passions. According to IMS Health statistics from October 2013, there were 43,000 health/nutrition/fitness apps in the App Store. How many of those do you have on your phone? How many do you use regularly?

In a highly scientific poll conducted at the 2014 mHealth@Duke Conference this past April, I asked the audience to raise their hands if they had 1 health/nutrition/fitness app on their devices that they used regularly (i.e., once per week). About 70% of the audience of about 200 self-selected mHealth aficionados raised their hands. 2 apps? About 20% remaining. 3 apps? Down to 10 people. 4 or more apps? Only the conference organizer still had his hand in the air.


Should we be surprised that further saturation of this market with one-off apps consistently yields more busts than booms? Yet, integration in the current market is hard. Many popular fitness services offer convenient APIs, but integration with EHRs remains elusive. Hence my excitement about the HealthKit and Google Fit announcements. These technologies will enable a new generation of consumer-centric apps.

Of course, consumer-centric apps are only half the story. Providers also want apps that increase efficiency while enabling them to spend less time on the computer and more time with living, breathing patients. This problem - enabling provider-centric apps in healthcare - is one I'm actively working to solve, and I hope to have more to announce later this year.

Next steps ...

If you've taken into account these three tenets while planning your new app, you're well on your way. Of course, you still need to target the right audience, ensure that it's easy to use, make sure it's visually appealing, market appropriately, etc., etc., but you already know about those. Over the coming weeks I'll further expound on each of these three tenets, but in the meantime I welcome your thoughts and ideas. The world of mobile healthcare is still young, and we have much to learn from one another.

Monday, July 7, 2014

Wear did my Glass go?

Oh, it’s right here, on my desk:

Glass is gathering dust ...  bonus points for those of you who can positively ID the other objects on the desk.

Unfortunately, this is where my Google Glass has been sitting for essentially all of 2014.  I will occasionally turn it on to check out the latest software updates.  It’s also still paired with my iPhone, so it will happily chime when I get a personal email, but other than that, it’s been a novelty at best since I became a Glasshole Glass Explorer in 2013.

However, the promise of wearable technology like Glass still boggles my mind: instant and seamless information retrieval, personal data monitoring for all (i.e., the quantified self), and that trendy cool factor (uh … except Glass.  Definitely not Glass).

In healthcare, there have been some truly innovative ideas and initiatives related to Glass as well as the application of stock functionality that is no less exciting.  Wearable Intelligence has demonstrated an exciting workflow complete with EHR integration in collaboration with Beth Israel Deaconess Medical Center, which is made possible by a custom version of Android.  Pristine has developed a compelling telehealth solution now in use in the healthcare setting.  And Duke’s own Selene Parekh is excited about the potential to improve orthopedic surgery standard of care in disadvantaged countries.

Yet despite all that … it’s still Glass.  You know, that weird-looking thing on your head with all-morning battery life and awful image quality that requires the user to look up and into the distance whenever something on the (admittedly pretty cool) display calls your attention.  I completely understand the promise and appeal of Glass, and sincerely appreciate what Glass has done to move the entire industry forward with respect to wearable technology, yet despite all the exploration, I never quite found … it.

Which is why I’m truly excited about the next generation of wearable technology, starting with the launch of the first Android Wear devices today, the LG G Watch and the Samsung Gear Live.  I'm not going to review these devices or provide a point-by-point comparison.  The reason I'm so excited about this next crop of devices is because they promise many of the benefits of Glass without being Glass.  Quick and hands-free access to information?  Check.  Integration with your phone?  Check.  Custom apps?  Check.  All-day battery life?  Check.  Mass FBI-worthy paranoia?  Um ... no.  $1500 price tag?  Try $200.

Things are just getting started.  With a (hopefully) stable Android platform and a likely iWearable right around the corner, the time for mass consumption of wearable devices is almost here.  Just as smartphones truly took off only after an app ecosystem was introduced, smartwatches never had a chance until the threshold for app development became low enough.  2014 will be remembered as the year that happened (I do like my Pebble, though - way ahead of its time).

So what does all this mean for healthcare?  Glass development will likely continue for limited use cases like those described above, but watches will open up more opportunities simply because they're more socially acceptable.  For these to succeed, apps and workflows must be integrated into the EHR - the single source of truth.  Here at Duke, we're in the process of creating such a framework, which I'll discuss in a future post along with my philosophy on EHR integration.

The only constant in technology is change.  Those who are pragmatically prepared to adapt and adopt the latest innovative technologies with a minimum of effort are going to be richly rewarded with the best opportunities to enhance patient care, further research goals, and streamline clinical workflows.  I can't wait to see what the rest of 2014 brings.