Get Inspired Jerry Lieveld 15 Jul 2014
User stories are great, aren’t they? All these happy users praising your product and service. Ok, sometimes they’re slightly scripted since they are marketing tools after all, but this story is different. It’s straight from the heart, and that’s why we like it so much.
This is the story physician Tripp Bradd wrote himself and emailed us. He wanted to make a mobile app for his family practice to engage patients with their mobile devices. He clearly describes his quest to find the right tool to make a mobile app and how he finally, to his great relief, found AppMachine. He also describes every step he took to make and publish his app. Please read Tripp Bradd´s journey into the app world.
Tripp Bradd, MD
April 21, 2014
Engaging patients to take better care of themselves is a goal we, as physicians, embrace as a foundational goal of good care. At Skyline Family Practice, we’ve had a lot of success with engaging our patients with their mobile devices, QR codes and use of a knowledge base.1,2 Earlier this year, I started looking for a way to create an app that would be specific to our practice. It just made infinite sense to engage our patients in this way. What follows is my journey into the app world…
Adapting to the needs of our changing patient demographics is something most practices naturally do. Likewise, using the media channels that our patients use frequently makes sense. In 2013, mobile devices passed PCs to be most common Web access tools. By 2015, over 80% of handsets in mature markets will be smart phones.3 Our patient demographics are changing with regard to how they use computing platforms. In our practice, the post-baby boomers are now becoming a larger part of our practice. These folks in Generation X and Y are using their mobile phones for more and more of their primary computing.4 To give you an idea of the scope: By 2014, there will be more than 70 billion mobile app downloads from app stores every year.3
Not being a programmer, the prospect of coding for a mobile app across different mobile platforms was something foreign to me. My former partner had actually created a pediatric drug dosing app which did help me overcome my fears in that I realized it could be done. But, he had been programming for years and, in fact, started working at IBM at the age of 16!
Getting the Android SDK (software development kit) and getting the basic building blocks to begin coding for an Android app was a daunting prospect for me. Likewise, for Apple devices, coding in XCode and creating the software certificates , various bundles as part of gauntlet of processes to submit an app is not for the faint of heart. I tried. Besides, to submit the final app bundle to Apple requires a MAC (you can’t do it on a PC). I even went to the point of buying a MiniMac to do the iOS app development. Wow, what a daunting and meticulous process! Sorry but my brain was not wrapped around this nor did I have the time to learn how to do this!
My first step was to find a web service that would allow me to create an app. There are plenty of choices out there. Having a programmer or company build an app could cost several thousand dollars, so free or least expensive were important criteria. In no particular order I looked at AppMakr, AppArchitech, and even venerated Adobe (plus others). All of these services had the ability to create apps.
I finally settled on AppMachine. As it turns out, this service was recommended by one of my patients who knew I was looking. He had created an app through them for a local municipality. What follows were the steps to making our app.
Before you read further, consider downloading our free app so you can understand the process.
This app would include educational documents and video delivered through a mobile phone directed to that group of people who do use apps. Additionally, it had to have some kind of connectivity with office staff and allow access to our webportal.
Having built websites and our knowledge base, I was familiar with some rules that many use.1
• KISS – Keep is short and simple. Although some of the educational content is long, most of the actual text sections are not long.
• Not too many ‘layers’. Most of the content can not be too many screens away from the home screen. Although the app has navigation arrows, having
• Not to have too many menu items per screen. Patient will scroll but not having to scroll allows quicker access to the content
All of the webservice app creators use some sort of visual interface to create your app (so called ‘building blocks’). Interestingly, AppMachine uses visual building blocks (picture). These blocks can be moved around just as just as you might do so with a building block set but you do so by using a mouse. There are various blocks (of code) that do different and common mobile app functions. These functions include:
• Information content – text and
• URL link (web links)
• Facebook (timelines) and Twitter (tweets or buzzwords)
• Photo, video and points of interest
• Submenus (which lead to other blocks)
• Contact, calling and emailing blocks
• And many others
A previewer app that lets you see how the app will look and perform is available in the app stores. A previewer also available on the website which allows you to see how the app looks on a mobile phone you design and before you decide to finally submit your app.
It is a good idea to have other programs so you can develop the content before creating some design building blocks. Although, AppMachine had the various icons (some of which I used) and title bar pictures (see picture), I frequently used Adobe Photoshop to create my own. For some of the linked web pages I created, I used Adobe Dreamweaver. However, creating text content can be as simple as typing in the content area on their website or copy/pasting from Wordpad (or other similar text editor). Video rendering was mostly done by Camtasia Studio (although Adobe Premier is good but not quite as intuitive).
Creating the search words is done by using METATAGS. Metatags are in the unseen part of most webpages and allow the search engines such as Google and Bing to search and index webpages. Likewise on the App stores, having metatags allow potential users to find your app.
Apple requires you to apply for a developer’s account. Apple approves every app according to a set of technical, content, and design criteria. They want to make sure it works as it should and does not contain any objectionable language or material. So it’s a good idea to be aware of all of Apple’s requirements. Apple’s approval process can take up to two weeks. This took longer for me (patient care took priority). Applying for the Google Play Store is much less daunting. Both require fees (Apple $99/year and Google Play $25/year). The app service technical staff were helpful during this phase.
You’ll also be asked to design splash screens (the screens that show on start up of your app). Again, you can see what I did but creating a splash screen can be done with most graphics editing programs. I use Adobe Photoshop but any graphics editing program will do. You’ll also need to create the icon which will represent the picture of your app. You will also need to take screen shots of your app. You can do this with the previewer provided.
Now you are ready to submit your app. I found support to be very helpful here. They were responsive and did some ‘hand holding’ to explain the process.
This is also when you will need to pay for the services. The pricing is reasonable since to pay a programmer or development company could cost many thousands of dollars.
Getting feedback the app before release is critical. I asked my adult children and their spouses to ‘road test’ the app along with our staff and few select tech-saavy patients. Having someone check on such things as the ease of use, layout and content selection and even simple things like checking spelling is important.
Need to change your content – No problem!
Versioning with most apps means actually changing the code and then uploading the new version to the stores. This is much more involved and time-consuming. Appmachine uses a content management system. This means that when you make a change in the app on the website (whether it be to add ‘block’ or change the wording or links in the blocks), you can do this easily. Then save and publish. Since we went live with your app, I’ve changed and republished our app over 100 times!
Being able to notify patients of events for the practice or the community is a useful thing. Push messages (also called push notifications) can get an important or time-sensitive message to your target population (your patients). We recently notified all of our parents about the sports physicals we coordinate at our local hospital. Being judicious is important. Too many messages sent could cause your patients ignore the messages or, worse yet, remove the app.
In the world of big data, analytics allows for ‘fly by wire’ development or alteration of apps to better target and engage the audience. Here is a screenshots of the analytics of our app since launch in mid-March. Google Analytics can also be done which will give you even more information.
By seeing how people interact with the app historically, I have been able to change the app to better fit the app for patient engagement.
My experience from start to initial version and submission to the App Store took me just under one month working on this in a piecemeal fashion when I had time and energy. Even being in full time practice, it probably took probably less than 25-30 hours. This would depend on the complexity of the app you would create.
Since our app launch, we have had incredible acceptance and excitement from our patients. It has been surprising to see how many patients have used our app. From 82 years old down to older teenagers, the spectrum of demographics has been mind boggling. We’ve encouraged them to share the app with friends and family. Although our intent is not to grow our practice, the app has even attracted patients who like to use technology to improve their health. It has always been about our patients and how we can engage them to take better care of themselves. Now in 2014, we have mobile technology to do it better! So can you!
About the author:
Tripp Bradd, MD (a.k.a. Floyd Bradd, III, MD, FAAFP) has been using health IT since 1982. Skyline Family Practice, a practice that he founded in 1994, was the first to use an integrated EMR (electronic medical record), billing and scheduling program in his region of northwestern Virgina (United States). Having a website for the practice since 1995, he helps other doctors who use McKesson Practice Partner Electronic Medical Record Software collaborate on-line with the “EMR Village” (http://emrvillage.com) and is a co-owner of Caduceus Digital Systems, LLC (http://www.caduceusdigital.com), a software company. He is a board member for PPRNET (http://www.musc.edu/pprnet), a practice based research network using data extracted from practice EMR’s across the country. He was appointed to and served on the Quality Measures Workgroup of the Policy Committee of the Office of the National Coordinator for Health IT (for CMS/HHS) since 2009.
1 “Gartner: Top 10 Strategic Technology Trends For 2014.” Peter Hugh Forbes 10/14/2013
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2 “Generations X and Y Lead the Way in Today’s Digital World” – Results of Forrester Research, Sarah Perez, September 22, 2010
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3 “QR codes in the medical practice: A Virginia practice finds the ‘sticky factor’ that engages patients, spreads information, and boosts efficiency”, Morgan Lewis, Medical Economics, June 25.2012
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4”Develop You Own Practice Intranet”, Tripp Bradd, MD, Fam. Pract. Management, 2003 Feb, 10(2)37-40
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