m-health Design and Evaluation Yuri Quintana, Ph.D. Division of Clinical Informa8cs BIDMC and Harvard Medical School TM An Academic Division of the Dept of Medicine at Harvard Medical Faculty Physicians at BIDMC, Inc. 3/5/15
2 mhealth Opportunities mhealth New horizons for health through mobile technologies Global Observatory for ehealth series - Volume 3 WHO ISBN 978 92 4 156425 0 http://www.who.int/goe/publications/goe_mhealth_web.pdf
3 mhealth Opportunities Source: mhealth New horizons for health through mobile technologies Global Observatory for ehealth series - Volume 3 WHO - ISBN 978 92 4 156425 0 http://www.who.int/goe/publications/goe_mhealth_web.pdf
4 mhealth Systems
5 Design And Evaluation Framework DESIGN Stakeholder Engagement Use Cases Idea8on & Innova8on Formal Requirements Itera8ve Design User Incen8ves People- Centered Design IMPLEMENTATION Integra8on with Systems Training Evalua8on User Support Real Time Data Analy8cs User Feedback Revision of Requirements DEVELOPMENT Agile Development SoJware Documenta8on Design for Testability Interoperability Security & Compliance Usability Tes8ng Tes8ng Methodologies SUSTAINABILITY Governance Models Financing Models Interoperability Plan Outcome Measurements Return on Investment Privacy & Compliance Plan Source: Yuri Quintana, 2015.
6 Design And Evaluation Framework Source: Kumar S, Nilsen WJ, Abernethy A, Atienza A, Patrick K, Pavel M, Riley WT, Shar A, Spring B, Spruijt-Metz D, Hedeker D, Honavar V, Kravitz R, Lefebvre RC, Mohr DC, Murphy SA, Quinn C, Shusterman V, Swendeman D. Mobile health technology evaluation: the mhealth evidence workshop. Am J Prev Med. 2013 Aug;45(2):228-36. doi: 10.1016/j.amepre.2013.03.017. PubMed PMID: 23867031; PubMed Central PMCID: PMC3803146.
7 Design And Evaluation Framework Source: Kumar S, Nilsen WJ, Abernethy A, Atienza A, Patrick K, Pavel M, Riley WT, Shar A, Spring B, Spruijt-Metz D, Hedeker D, Honavar V, Kravitz R, Lefebvre RC, Mohr DC, Murphy SA, Quinn C, Shusterman V, Swendeman D. Mobile health technology evaluation: the mhealth evidence workshop. Am J Prev Med. 2013 Aug;45(2):228-36. doi: 10.1016/j.amepre.2013.03.017. PubMed PMID: 23867031; PubMed Central PMCID: PMC3803146.
8 Designing People-Centered Healthcare Systems Source: Quintana Y, Lorenzi NM, Shani M. People-Centred Healthcare systems: opportunities and challenges. In: Global People-centred ehealth Innovation Forum. London: British Medical Journal Group. Satellites. 2011:18; 17-24.
9 Planning for Integrated Solutions Source: Why Collabora;on Solu;ons Fail [Infographic] Noreen Seebacher Oct 13, 2014 hxp://www.cmswire.com/cms/social- business/why- collabora8on- solu8ons- fail- infographic- 026808.php SoJChoce.com Study Working Hard or Hardly Networked, responses of250 IT managers &750 line- of- business employees who were asked about the effects typical UC and collabora8on rollouts
10 Usability Testing Across Platforms Source:http://www.actualinsights.com
11 User Interface Design Considerations Simple Screen Design - Linear Naviga8on Most used features must be simple to use Avoiding feature creep and cluxered design Design for Seniors font size, color, naviga8on Need to follow evidence- based user design principles Need formal process for itera;on between user requirements, wire framing and usability tes;ng
12 Understanding Usage Patterns Source: Van Noorden R. Online collaboration: Scientists and the social network. Nature. 2014 Aug 14;512(7513):126-9. doi: 10.1038/512126a. Erratum in: Nature. 2014 Aug 21;512(7514):243. PubMed PMID: 25119221.
13 Global Design Considerations Cultural and language customiza8ons needed Health literacy needs to be considered
14 Healthcare IT Enterprise Considerations Poor or no integra8on of health IT systems Privacy, Security and Compliance concerns Too much data to users, Not enough smart filtering System needs to generate the metrics of evalua8on Lack of trained healthcare workers for dealing with m- health implementa8on and opera8ons
Drug information Drug interactions Multiple user profiles Evaluation Profile sharing via of Mobile Medication Systems email Sharing across multiple devices Figure 1. Screenshots of the mobile medication management applications included in the assessment. Source: Phansalkar S, Zachariah M, Seidling HM, Mendes C, Volk L, Bates DW. Evalua8on of medica8on alerts in electronic health records for compliance with human factors http://mhealth.jmir.org/2014/1/e11/ principles. J Am Med Inform Assoc. 2014 Oct;21(e2):e332-40. doi: 10.1136/amiajnl- 2013-002279. JMIR Mhealth Epub Uhealth 2014 Apr vol. 229. iss. 1 e11 p.3 (page number not for citation purposes) PubMed PMID: 24780721; PubMed Central PMCID: PMC4173170. http://www.ncbi.nlm.nih.gov/pubmed/?term=24780721 XSL FO RenderX 3/5/15 15
16 m-health Evaluations of Medication Adherence Global case studies demonstrate that mhealth solu8ons for NCD management are feasible..but.. there is lixle evidence about the costs and savings of these technologies Source: dx.doi.org/10.1145/2093698.2093868 A review found 18 of 29 mobile systems using text messaging improved medica8on adherence. Nega8ve studies tended to have more basic and repe88ous content with a simple medica8on reminder, while posi8ve studies delivered a variety of educa8onal and mo8va8onal content with tailored or personalized SMS Source: dx.doi.org/10.1111/jan.12400 Diversity and mul8modal reminder methods should be considered to increase usability for seniors Source: www.ncbi.nlm.nih.gov/pubmed/?term=25099993
17 Road Ahead Need to design for global users and marketplace What are the design requirements and adapta8ons? Need to integrate solu8ons with health system What are the best prac8ces to do this? Need to have more formal outcome evalua8ons What are the methods to design and evaluate? More training is needed to effectively design, implement, evaluate, and sustain m-health initiatives
Thank you! Yuri Quintana, Ph.D. Director, Global Health Informa8cs Division of Clinical Informa8cs BIDMC and Harvard Medical School yquintan@bidmc.harvard.edu TM An Academic Division of the Dept of Medicine at Harvard Medical Faculty Physicians at BIDMC, Inc. http://www.hmfpinformatics.org 3/5/15 18
References Health literacy http://www.nlm.nih.gov/medlineplus/healthliteracy.html mhealth in an mworld - Delloitte Center for Health Solutions http://www.deloitte.com/view/en_us/us/industries/life-sciences/2545b66b8dc4b310vgnvcm2000003356f70arcrd.htm mhealth Competence Center - Barcelona http://www.mobilehealthglobal.com/catalogue/ Mobile Health Tools Make Big Impact by Jonathan Spalter http://mobilefuture.org/mobile-health-tools-make-big-impact/ Deloitte 2014 Global health care outlook https://www2.deloitte.com/content/dam/deloitte/global/documents/life-sciences-health-care/dttl-lshc-2014-global-health-care-sector-report.pdf Emerging mhealth: Paths for growth http://www.pwc.co.nz/healthcare-industry-sector/publications/emerging-mhealth-mobile-health-from-patients-payers-and-providers/ The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature http://www.ncbi.nlm.nih.gov/pubmed/22534082 Economic aspect of medication adherence using mobile medication reminder in French Health System http://www.medetel.lu/download/2014/parallel_sessions/presentation/day2/economic_aspect_of_medication.pdf Adherence to medication among chronic patients in Middle Eastern countries: review of studies http://apps.who.int/iris/bitstream/10665/118131/1/17_4_2011_0356_0363.pdf?ua=1 Experiences in mhealth for Chronic Disease Management in 4 Countries http://www.ghdonline.org/uploads/piette2011-experiencemhealth4countries_1.pdf A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence. http://www.ncbi.nlm.nih.gov/pubmed/24689978 Evaluating User Perceptions of Mobile Medication Management Applications With Older Adults: A Usability Study http://mhealth.jmir.org/article/viewfile/mhealth_v2i1e11/2