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.

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