Med-HF: Algorithm to App
Sheri L. Koshman BScPharm, PharmD, ACPR
Assistant Professor of Medicine
University of Alberta
sheri.koshman@ualberta
Disclosure
• No conflicts of interest to disclose
Outline
Algorithm
App
Heart Failure: Burden of Illness
• Over 80,000 individuals live with heart failure (HF) in
Alberta
• HF is typically progressive, characterized by frequently
hospitalization, and a large burden on healthcare
resources
• Medical management, the mainstay of treatment, is
complex and requires frequent dosing adjustment and
monitoring
• Most of these complex patients are managed in the
community.
• Tools are needed to support front line clinicians to help
improve patient outcomes
Heart Failure: Clinical Practice Tools
Heart Failure: Clinical Practice Tools
• End users:
– Capital Health Chronic disease management HF
working group (2007)
– Alberta Cardiac Access Collaborative HF clinics (2009)
– HF clinic nurses
– Pharmacists
– Alberta Health Services: Strategic Clinical Network;
Heart Failure Working Group (2011)
• Structured implementation into family practices
Oak Bay Medical Centre, Calgary
The Associate Clinic, Pincher Creek
Feedback from front-line clinicians……
Great tool, but…….
It’s not handy
I don’t know where to start
Too complicated
Overwhelming
After someone walked me
through it, I found it easy to
use
There has to be a better way……
• How could we increase ease of use?
• How could we increase accessibility to the end
user efficiently? At the bedside? In the office?
• How do we make the tools interactive?
Let’s develop an App!
How do we develop an App?
How do we develop an App?
• Strategy #1: Find someone who knows how to
make an App
– Canadian Cardiovascular Society (CCS)
• Strategy #2: Add App development onto an
existing project
– Alberta Health Services: Strategic Clinical Network,
Heart Failure Working Group
– Partner with CCS to nationally disseminate
How do we develop an App?
• First steps:
– Meeting with IT department (October 2011)
• Understand the need and scope of the project
• Determine which platform(s) to ensue
• Determine project timelines
Surprise!
We’ve never done this before.
Don’t worry…..Our programmer will
go to App school.
Lost in translation
Algorithms
App
IT
Clinicians
Clinicians
IT
Working toward a common goal
• 4 algorithms
– Refine one at a time
• All same format, increase efficiency with progression
• Standardize format for App
– Breakdown each section
• Used Powerpoint slides to communicate vision of
screens
Working toward a common goal
• Screen mock-ups
– Used to visualize and finalize format
– Multiple iterations before programming
• Review and revision without downloading
• Allowed for multiple reviewers:
– Pharmacists
– Nurses
– Physicians
• Project management
• Establish steps
• Adhere to deadlines
Working toward a common goal
• Programming
– Xcode: storyboards
– Beta-testing:
• Pharmacists
– Tech savvy
– Student
• Heart failure nurse
• Physicians
– Cardiology resident
– Family physician
– Internists
•
•
•
•
•
Lessons learned:
Very important
step
Composition of
beta-testers
important
Format matters
Esthetics matter
Transitions
matter
Graphic design was a game changer….
Administrative Processes
• The players: University of Alberta (UA) and
Alberta Health Services (AHS)
– AHS / UA Legal
– AHS Health Technology and Innovation / TEC
Edmonton
– AHS / UA administrative administration
– Canadian Cardiovascular Society collaboration
• Copyright / intellectual property rights
• Disclaimer
• Liability/insurance
Administrative Processes
• University of Alberta and AHS:
 The UA already registered a copyright for the
algorithm content (paper version)
 AHS signed a royalty-free license from UA for the
algorithms
 AHS registered a joint copyright for the mobile App
We have an App…how do we get the
word out?
• Promotion key strategies:
Launch date October 26, 2012: corresponded with the
Canadian Cardiovascular Congress meeting.
Internal communications (i.e. AHS Insite, Medical Affairs
print/online mediums, UA)
External organizations (i.e. CCS, Alberta Medical
Association, Alberta Pharmacist Association)
Calgary, South, Central Zone Twitter accounts
News release and scheduled media interviews
Feature story for AHS / UA external website
Friends, family, strangers
In the news….
Where are we now?
• Launch on iTunes October 26, 2012 (1 year
after starting)
• Downloaded in 65 countries
– 3174 new downloads
– 12,767 user sessions
– 630 active users
– 44 sec - median length of session
– 68% females
– Highest users: 25-35, 36-54 years
Where are we now?
• Lots of good feedback
• Lots of requests for other platforms
– HTML5 program complete and awaiting server
space and beta-testing
• Lots of internal requests for other Apps
The dream team….
Algorithm
App
Clinicians
IT
Project
Management
Graphic
design
Legal/Admin
How to find us
• We’re free! Download us on iTunes
• https://itunes.apple.com/ca/app/medhf/id559909558?mt=8 or search Med-HF
People Involved
Dr. Justin Ezekowitz (Cardiologist, UA)
Dr. Sheri Koshman (Pharmacist, UA)
sheri.koshman@ualberta.ca
Gerry Ison (Senior Manager-PCSD Team, AHS)
Umar Sheikh (IT Analyst-PCSD Team, AHS)
Taryn Heck
Anne-Marie Sande
Ernest Law
Dr. Mike Hannen
Dr. Scott Forsythe
Dr. Raj Padwal
Dr. Narmin Kassan
Mona Dhanda (Business Analyst-PCSD Team, AHS)
Telus Health
Chris Carvalho (Telus Health), Vivian Woo (AHS)
Monica Saromo (Robots & Pencils)