Chronic obstructive pulmonary disease (COPD) is a common condition among primary care patients and it is currently the fourth leading cause of death in the United States. COPD is still often diagnosed late and may be under- or even untreated even when it is recognized.
There are many guidelines and care recommendations produced by both national and international organizations to supplement limited COPD-focused training by providing updated information. The COPD Foundation released their Pocket Consultant Guide (PCG) in 2007 as a practical tool to assist clinicians at the point of care, especially primary care clinicians managing the diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD).
Over the years, the PCG has been supplemented with a mobile app that allows the clinicians to enter patient-specific data in their smartphones or tablets for guidance to next steps of diagnosis or management of COPD.
Can you tell us the story behind your mobile app? Where did the idea for your app come from? What served as your inspiration for the app?
The Pocket Consultant Guide (PCG) was first designed as a 4" x 6" tri-folded pocket card containing essential information from expert-approved COPD guidelines used to diagnosis and treat an individual with COPD. The user-friendly card includes a list of common symptoms and scales, steps for diagnosis of COPD, a chart of commonly used formulations of drugs for the treatment of COPD and recommended therapy for each severity domain of COPD. In 2013, a mobile app version of the PCG was created for iPhone users only. The updated app will include an Android version and more interactive features for users that will make the PCG an effective tool in the diagnosis and management of COPD.
How did you build the content that's contained in the app? Does the information in your app come from evidence-based resources, such as scientific literature, peer-reviewed articles and case studies?
All information on the app is from evidence-based sources, including a team of experts in the field who have worked to create the material for the app. The original version was designed in collaboration with the National Lung Health Education Program and New York-Presbyterian Healthcare System. The COPD Foundation has convened an advisory board to ensure that the newest version of the PCG is accurate and contains the most up-to-date information available.
The PCG is designed to incorporate best practices and serve as a short summary to guide major clinical decisions during visits to the office, emergency department or hospital. It is the work of the authors with input from many health professionals who have reviewed and commented on its content.
More information on what is included in the updated version of the app can be found here: https://journal.copdfoundation.org/jcopdf/ArticleType/ArticleView/ArticleID/1156
What impact has your app had on clinical practice so far? We'd appreciate if you could share some stats on how frequently your app is used worldwide.
Since its launch in 2013, the iPhone version of the app has been downloaded more than 16,000 times by healthcare professionals around the world. Approximately half of all users are from the United States and Canada.
Most patients with COPD are cared for in primary care but evidence suggests that the majority do not receive care based on available guides, guidelines or in the case of GOLD, strategy documents. The aim of the app has always been to provide information in the simplest format. At this point, while we can report the number of times the app has been uploaded, it’s difficult to determine the extent of the impact. As we launch the next version, we hope to provide a wealth of info that will increase the app’s use and impact, including links to inhaler directions, the interactive chart, depression and anxiety scorers and exacerbation predictors. We hope to track the use of these going forward.
What are the tools and technologies used to build your mobile app (both cloud- and client-side)? Was it native or cross-platform development? Did you consider other technologies?
The newest version of the PCG app has been developed for both iOS and Android devices. Though the functionality of the PCG app is clientside, we are using a content management system (CMS) on the backend to manage the content within the app. The use of the CMS enables us to release updates without relying on the end user to have to manually update the app in the traditional way. This makes it more efficient for us to roll out certain content updates and more efficient for the end-user to receive those updates. Though functionality changes will still require an app update by the end user, many content changes will not. We briefly looked at emerging technologies such as Progressive Web Apps for the PCG but felt we needed something more traditional and proven for the PCG target audience.
What were the main challenges you had to overcome when developing your app? Could you please single out the biggest technical challenges, product challenges, marketing challenges, and support challenges?
The biggest challenge was finding time to bring together all members of the advisory board to develop the content of the app. As noted above, the team includes leading experts in the field and the demands on their time is tremendous. The team’s many different stakeholders all realized the value and importance of the PCG app. They each brought different ideas and perspectives to the project and one of the biggest challenges was ensuring that all their concerns were addressed in order to ensure that we had the most effective app possible.
Could you single out the 3 biggest mistakes you made when developing the 'COPD Pocket Consultant Guide' app?
We would like to think we didn’t make any mistakes in our development strategy, but it is too early to tell as the app hasn’t yet been released to a large audience. However, we did learn from the development effort of the prior version. The first was not providing an Android version, which alienated a portion of potential users, and the second was not using a CMS on the backend to more efficiently manage the app content. However, at the time of the first development effort, the option to deploy a content management system to manage the content within a native mobile app was not available or at least not available to be deployed efficiently. We recognized we needed a more efficient process for managing the static content within the app, so this time deploying a CMS was a more realistic option.
When it comes to medical apps, sooner or later the issue of data protection and security always comes up. How do you make sure that user data is secure?
Data is not stored in the app, meaning there is no personal information that could potentially be jeopardized.
What's next for your app? Are there any new features, functionalities, or upgrades planned for future updates?
The updated app will include an Android version and several new features, including videos of inhaler use, screening tools for anxiety and depression and various tools to assess the patient's physical and mental health status.
We are excited about the technologies and what they might hold for the healthcare and the future of medicine. What do you think this technology-driven, human-centered future holds for mobile health and how do your app plan to contribute?
Mobile health holds tremendous possibilities to enhance the quality of care patients receive and the speed at which information is provided. We believe that over time, this updated PCG app will greatly improve the care provided to individuals with COPD.
Much like telehealth, mobile health has the potential to bring new levels of care to those unable to access direct medical care, including people who are homebound for whatever reasons, people lacking transportation or other resources and individuals living in rural America. In rural parts of the country, for example, COPD rates are significantly higher and this technology will enable healthcare providers in those communities to provide more effective and efficient care to individuals with COPD.
Could you share some word of advice with other mobile app developers? What steps they should follow in order to make a successful app?
First and foremost, it is critical to ensure that all stakeholders are part of the design and implementation process as this ensures that the final product will achieve the goals you originally envisioned. Second, the timeline you establish must be practical and realistic. People are busy and have demands on their time and unexpected challenges will come up during the process. Leave time to account for these challenges so that you are not rushing to complete the project when it may not be ready.