CONNECTED HEALTH CONFERENCE • Boston, MA • October 25-27, 2017
Health apps seem to be everywhere, with new ones popping up all the time. Check out the infographic and learn about several keys to success, for human-centered design. Next, see human-centered design in action, with the case study that follows. This post was inspired by an article featuring our very own Dr. Joseph C. Kvedar, Engaging Healthcare App Design: Reflections from the Field.
IN ACTION: ePAL Cancer Pain Management App
ePAL is a cancer pain management app developed by Partners Connected Health for the palliative care clinic at Massachusetts General Hospital. Whether it's caused by the disease itself, by diagnostic procedures or by the treatment provided, pain is a major source of distress for cancer patients. Alleviating this pain can dramatically improve their quality of life.
The Challenges and the Stakeholders:
Feeling overloaded by work volume and conflicted by demands on their time.
Concentrating too much on information needed to make technical decisions related to cancer treatment.
Feeling "unheard" or "unseen" as individuals living with cancer and suffering pain.
Receiving care in infrequently schedule 10-minute consultations.
Feeling self conscious about sharing their true pain experiences to avoid burdening their care team.
The first step was to identify the stakeholders whose involvement was critical to designing a successful app solution and creating appropriate incentives to engage them. In this case, the two most important stakeholders were patients and providers.
Creating a shared awareness and understanding of the patient’s pain was achieved by p prompting the patient to assess and rate their pain three times a week. The app also incorporated alerts to allow better communication with the care team, and algorithm-based decision support and educational resources were added for the patient.
The alert system immediately notifies the care team if the patient reports a pain score of 8 or higher (on a scale of 0–10), reports new pain, or has any other significant treatment issue. Upon receiving an alert, the care team responds to the patient within an hour.
These powerful self-management incentives for the patient had to be balanced against the risk of increased workload for the care team. This was done by virtue of the app's functionality. By allowing patients to manage less complex issues via the app, additional clinic time can be redirected toward patients with more complex care needs.
This entire solution depended on establishing and maintaining a level of shared trust among the stakeholders, as well as between them and the app. Initially, physicians helped to instill trust by recommending the app to their patients. Trust is being continually reinforced by the level of empowerment felt by the patients using the app. Recognizing this, ePAL was designed to allow patients the flexibility to report severe pain without initiating a care team response should they choose.
ePAL's clinical trial is still in progress, however early results suggest that patients are reporting their pain at least twice per week and that its communication feature is not being abused, but utilized in response to real need. Patients are also reporting fewer instances of pain spikes, and say they feel more comfortable reporting pain accurately. On the provider side, clinicians are reporting reduced demands on their time.
The clinical trial was initially designed to run over an 8-week period, after which patients were scheduled to stop using the app. Surprisingly, patients have petitioned for continued access to the app beyond the study period, demonstrating not only the success of the app but also that ePAL is fulfilling a real unmet need.