I started today by looking back at what I have done during my summer at Mount Sinai. I thought about my first weeks in learning about different technologies. I remembered my first exposures to health related apps and websites. I reviewed the lessons of design that I organized for future use. These were the first steps of creating a  presentation for next week.

As I looked at the design principles I highlighted as important, I decided to critique what IBDPromise looks like right now using the checklist I laid out about a month ago. I slowly stopped going back to this checklist and now I have uncovered some real questions about potential design flaws. They will not make or break what I created and it is good to question what exits. This is the apps first "usability test" and I will try to make improvements if I think they can happen quick enough or else I will leave recommendations. I will also highlight the apps successes, producing an Internal Review of IBDPromise.  

I am happy with how the home screen turned out and think the hours of back and forth (see July 8th post) trying to create a screen that balances responsibilities came through. The screen is not overcrowded yet enables the user easy access to any part of the app. In fact, when I created the site map for Milan, though there are 38 independent screens it takes at most 3 clicks to get to any of them from the home screen. The screen also is successful at presenting information while acting as this main access point and thoroughfare. 

The issues: I do not think it is clear that these graphs are "clickable." A veteran user will find this screen easy to navigate, but it is not clear that the graphs double as a route to update different statuses. This may just be due to my lacking ability to design properly on Powerpoint, but this is definitely a challenge that needs to be improved upon. This challenge only becomes more difficult with the top "How I Feel" section in which both graphs lead to separate functions of the app. I made a mock-up that splits the large rectangle background into two squares, but still, guidance is lacking. If this flaw of the home screen can be fixed, then I think we have produced a very strong product.

Moving into the app, I think the layout is sufficiently intuitive. As the creator, I am undoubtedly the most bias judge of how the app is organized, so I will simply answer the questions I wrote for myself before I began creating IBDPromise (see post June 26). First, the app has many successful "menu" screens that clearly lead to respective features. The "my meds" screen shown to my left and the "my docs" screen use the same format so a user will be familiar with the workings of both. The "more" section is a fuller screen, but still uses the same "long button with 2-3 words of text and icon" organization. These screens are not cluttered with instructions, but use design principles to show what their purpose is and where they lead. 

Next, the app is designed around the idea of giving a user the bigger picture. Every time they visit the home screen the patient will see how their inputs have been recorded and where they stand with QOL, Interventions and Resource Utilization. We can go further with this, like changing the color of the different home screen rectangular "slots" depending on the users current status, but first we should see if what we have already gets the job done. 

Finally, I think the app is well organized and dynamic. Each section is separate and there are no screens that were thrown into one section because it was unclear where it should go. The only exception to this is the "Notes" option that is present in the "My Docs" section. I can make an argument about why it fits here, but the truth is that this does not directly fit into this category and I am more relying on user-experience to remember this feature, locate it and use it. Maybe if we re-named the section My Care Resources we would help solve this identity crisis. Complimenting the design, I want to highlight how I have made the Interventions part of the app dynamic with the my care team section of the app. Enabling users to go straight from reviewing "incomplete interventions" to either call their doctor, add a note or schedule an appointment is an example of thinking what the patient needs and giving it to them. I really hope that this small gesture and simplifying design feature will make users more proactive about adressing interventions that need to be completed.

And now for Inputting information. We put a lot of thought into this part of the app because if the app is successful at retrieving information, than we have done the majority of our job. I began designing these pages, then took time off to look at survey apps that serve a similar purpose (Blog July 28th), and then went back at it. I took what I learned from survey apps as well as the other healthcare apps and applied that to the information inputs that now make up IBDPromise. I became very attached to sliding scales and whether used as in the right for number scales or used in the objective scales for SIBDQ or EQ-5D the sliding scale was the method of choice. I also tried to add color into these screens, using a red-yello-green progression to give numbers meaning and always using the same orange submit button to submit an input. I think the consistency and use of tools that are intuitive on tablet devices will lead to success for these parts of the app.

I also worked on making the information part of the apps dynamic. When inputting resource utilizations out the initial history inputs, options only appear as they become applicable. For example, first you input you have visited the hospital 3 times in the past two months and then three options of inputs appear. I really appreciated this type of design in the other GI apps I looked at and therefore wanted to replicate it. 

Now the shortcoming and this is a real shortcoming! I really enjoyed the ability to add notes to inputs on the other IBD apps. The point of retrieving information is to record the status of the user and sometimes the pre-determined scales we set up are not enough to do so. For example, yesterday when I was at clinic hours with Dr. Atreja, he had to help patients when asking SIBDQ questions. Had he not, patients would have said "I'm doing well just not really well" when a little prodding got them to decide on "below average and poor." The notes section allows us to get the real information. It helps the user feel comfortable inputting information because they understand that what they are giving is more than a number. They have the opportunity to explain that number. I believe that with the ability to add a note to each input (for official QOL questions as well as the personal metrics they decide to record) will make patients more willing and more likely to use this app. As of now we have not offered this feature and no matter how trivial it may seem, we need to decide if this is a handicap that will sabotage the apps success.  

Well I hope I made a glaring point right there, and there is only one last screen for me to attack: please look to your left.

It's a great screen! It must be a great screen after all the different version I went through to get here. Why is it great? Well, it portrays information in an easy to understand fashion using both logos and color coding. It seamlessly leads to the next screen so you can "zoom" in on any particular intervention. It follows heuristics so that anyone familiar with popular apps can look at this screen and immediately understand how to utilize it. And yet, time for another improvement.

Something is missing. This screen shows what you have done :) and what you are overdue on ): but what about the actual To-Do list. What about the those procedures or tasks that are planned, are important, just haven't come around yet? What about the yellow? (that says the yellow for those of you who can't see it...)

If we are including this category of interventions in the Un-met category than this sarcastic rant is un-called for but  I am wondering which would be preferred. Should there be a third section of either "scheduled interventions" or "upcoming interventions" to separate interventions that you could/should have accomplished and those that you are planning but have not been able to accomplish yet? Doing so would allow patients to "get out of the red" it would add a gaming component because there is now a goal you can overcome and win. 

This is just an idea. We could make the met and unmet interventions expandable-collabsible so the screen does not get cluttered. This can be another question to bring forward to the focus group.

So overall, I give my seal of approval. I think the apps worst shortcomings are in actual design and I am sure a more experienced designer will be able to improve on this front. The features that are offered and the way we have organized them are a strength and will lead to a successful trial of the app. There are more sections we can consider adding: a my profile of users basic information is not included, we thought about tracking weight more than just question #7 in the SIBDQ and all the critiques mentioned above. There is room for discussion and debate on how to make improvements but IBDPromise has become a reality.

An added feature of IBDPromise is a resources section that can help patients learn about their disease. The design for this section is complete! but the content does not yet exist... We will have to build our own educational material and this is why I began looking into slidecast presentations at the end of yesterday. Slidecasting is used to deliver slideshow presentations with an audio component and may be a great tool for this "resources" section. There are many different programs available to build a slidecast and I wanted to learn about them and see if this is what IBDPromise needs.

Conclusion: slidecasting is cool. It's where slideshow meets video and is a great way to present information. I do wonder though if it is better than written materials or video. With a slidecast, we control what audio is connected to each slide but I worry that boredom may set in for the patient viewing our material. There is limited stimulus from a "still" presentation screen and the user has little control over the pace of the presentation. They can jump from slide to slide, therefore jump from audio to audio, but I am not sure if we can have it so they can navigate the audio within a specific slide. There are ways to record and make a video of the screen as someone goes through the slideshow and talks about the slides, but if we are already making a video...

So a decision needs to be made and in the meantime, here are some of the tools I found for making slidecasts:

The first slidecast generating program is "slideshare." Purchased last year by LinkedIn for nearly $120 million, this software is a leader in content sharing for professionals. Slideshare allows you to upload a powerpoint and audio file (saved as an mp3 or a few other formats) and has a simple to use tool to line up the audio properly with each slide. Recording tools such as Audacity or garageband can be used to create the initial audio file. The final product is a slideshow with each slide having specific audio "attached to it." While the use of slideshare is free, and the final product can be downloaded, I am not sure if there is a way to insert the presentation in our app.

Next is Profcast. This simple and straightforward tool makes it easy to record a powerpoint presentation with audio. The final product is a video file that can be saved in all different formats depending on the need. To use Profcast, you simply choose the powerpoint that you want to present and begin recording as you narrate the slides. The software can be downloaded for a 15 day free trial and will cost $30 to purchase for a PC (and $50 for a Mac!!).

Camtasia is the souped up version of Profcast. With Camtasia, the powerpoint that is being used is chosen and then audio can be recorded as you present. Camtasia will also allow any portion of the screen to be recorded and provides features to edit the final video. If you want to get fancy, this software allows you to embed a video of yourself talking about the slides that will appear in the corner of the powerpoint slide show. (On the one hand this takes care of my fear of boredom, on the other hand it makes the content look like Mount Sinai staff produced, which was something we decided should be avoided). With these fun features comes a fun cost of $300, though there is a generous 30 day free trial available. 

I have not written here in a few days so I figured this is a good opportunity to sum up what has been going on. For starters, this App is DONE (with the first steps...). But how did we get here?

I began designing the app using the powerpoint tool-kit last week. While this took some getting used to, Powerpoint gave me a lot more autonomy than Codiqa allowing me to format each screenshot exactly how I would like it to look. Hyperlinking different objects on the page made a seemingly functioning app. What we have now only lacks the back-end  for data collection...

This process of creating the app reminded me of my Freshman year writing seminar. My days were full of drafting and re-drafting. Creating something I liked and then working on improvements. Before I was satisfied with a screenshot, I first made four to five alternate versions so I could compare different options. Finally, once satisfied, I would get feedback on the current version and scrap slides as I started again. Hard work does pay-off and I am very happy with how the app looks now. In addition to producing an app, I picked up an immense amount of knowledge in creating powerpoints; a skill that I know will be invaluable for the future. For example, today I taught myself how to create the square icon buttons that are present on the iphone home screen. Manipulating different tools that powerpoint offers allows anything to be created and though this was probably an excessive challenge for myself (I did use these for the "more" section which may be better named "resources") it gave a great sense of accomplishment when I succeeded.

So looking back, what have I accomplished for the app?

It is more than just design. While I have definitely come up with some intuitive screenshots working with my team, I am sure when we send this to a professional there will be major changes. I embrace these changes and am happy that design that I have put together will serve as the backbone. I have made decisions on how a patient should be interacting with the app. What functions are important and what should be left out. How should different sections of the app work together to give an overall picture of health. What is the logic flow of each part of the app. Working meticulously on designing this app I was forced to concentrate and critique each feature. With the knowledge of what we are attempting to accomplish, I was in a position to focus the design towards the overall functionality. So I think I have added great value to the app and now have a vested interest in its success. I really believe the app is a first step in making a difference and will have to practice great patience until the results of the clinical trial are completed!

Today I continued working on Powerpoint. I have completed the other screens and will begin tomorrow with the "Official QOL" portion of the app. Looking at the different survey apps will help with this task as I think about a best way to organize this. 

But really,  sometimes I am just so surprised with the kind of work I am doing. I came today to continue producing screenshots on powerpoint, but first wanted to fix up Friday's home screen. When putting the screen together, I put little thought into what colors I should use. I decided that now would be a good time to sit down and choose a color scheme for the app. Unfortunately for me, matching colors was never a strength, so I did what one should always do when they're lost: Google It! The screenshot to the left is an app I ultimately downloaded that generates color schemes on demand. There were many applications and websites available to serve this function and now I just have to  copy from the colors given to me. Add matching colors to the skills I picked up this summer!

And then I continued to put together screenshots. While these screens take much longer to make then working on Codiqa, I am just abut done with the non QOL screens. The goal is to be done by Thursday so I can review and perfect on Friday and after today I am in a good place for the week. I am becoming more efficient at using powerpoint tools from formatting pictures to setting up hyperlinking throughout the slideshow. Tomorrow I will finish the intervention screens and then begin QOL metric screens. These will be harder to complete as I will have to make more design decisions. I will also play with more survey apps on the iPad to see if and how the design changes depending on the platform being used. Using the Codiqa function of switching from an iPhone and iPad view will serve helpful with deciding how to change the app depending on the screensize. 

And there she is! 

Using the new iOS images and powerpoint, I was able to get one step closer to the home screen that I want. Even as I write this, I can see places for improvement, but overall I am really happy that I was able to create something like this. This one screenshot took a few hours to create but as I worked, I became more efficient on utilizing different Microsoft Office tools to produce what I want. Now that I have a template screen completed, I will be able to work quicker on producing the remaining designs. 

The next function to explore is how to link different parts of the screenshot to new slides (and keep the giant web of links that I am going to be creating organized). The Goal: by next friday I want to have the entire app outlined on a dynamic powerpoint file. I will use both my hand sketches as well as the condiqa outlay to guide me as I complete this. 

One step closer!

I had a change of heart of what to work on today. Instead of exploring other app building tools, I am going to explore survey apps. A lot of what IBDPromise is about is data extraction. The purpose of building the app is to make it easy for patients to record their symptoms. I am hoping to come up with new ways to approach this goal by replicating apps that to collect data. 

What I found as I started this search was really interesting. There are many free survey apps that pay you to fill out their ready made surveys. While I haven't found a gold mine (it's $0.05-$0.25 a survey) in just this research I racked up earnings of about $1.45!

My first finding is that all of these apps only ask one question per page. The surveys contained anywhere from 4-20 questions, and each had  a different way for the user to proceed. 

In the app on the left, the green bar on the top tracks how much of the survey has been completed. As I went through surveys on this app, I found submitting information to be simple and straightforward. After selecting my answer, I could always look to the top right corner to get to the next question while the green bar gave me an idea of how much more I had to go. In the app "datafield" I created my own survey to investigate the different types of data entry that are available. The sliding scale that is shown has a bubble that explains what each position represents. I was hoping to use a similar feature for our app when asking the SIBDQ. For this app, there was no progress bar and I think that makes it more difficult to use. The last screenshot is a third app that includes a percent completion in its "progress bar." I liked this design the best as it produces the feeling of a "location," which is an  important notion in design.  

While the app datafield did not have a progress bar, there were a lot of other great features we can replicate. This app used visual aid to make the questions and answers more clear. This addition makes inputting information easier, making the process go faster (as it takes less effort on my part) and in turn will make me more likely to complete the survey. I is important to pick up on tools like these because the success in IBDPromise depends on minimal user effort when putting in information. 

Sorry for the stream of conscious but there is one last point I want to highlight. All of these apps showed consistency. The layout of each page was the same and there was therefore no need to re-orient once moving through the app. I have been playing with a lot of different designs for IBDPromise and I will have to settle on one template design for all the questions that will exits continuously throughout the app.

AND IT'S DONE!

At least until tomorrow... Linking the last "back button" to the correct screen made me feel light like a feather. The wireframe of IBDPromise has taken form and my reward was jumping around through the different screens. There are still touch-ups and perfections to be made, but it feels great see a product. We still need to make decision about the pages that have links on the bottom (My Doc, My Meds, History and More) and I am sure that fresh eyes, mine or anybody else's, will be able to make a lot of positive critiques. Just as a note: I could not create all of the features that I wanted using codiqa; and though I started doing so late, I tried to write these moments in the app to help remember. This usually involved formatting or finding new ways to link to the next screenshot. 

Now that this is complete, I will make of list of other websites and tools for building applications so I can begin exploring and reviewing tomorrow. Experiencing Codiqa for the past two days will help me compare the other options that exist. I hope Codiqa lives up the the competition or else I guess it is back to the drawing boards... 

In the meantime, I am just going to use this space to brainstorm on what criteria I would value in these tools. 

First is speed. Speed is the reason I chose to use Codiqa over appnotch. Codiqa let me drag-drop, copy and delete with no down time. This was crucial as I explored different features and wanted to weigh different options against each other. With appnotch I frequently found myself waiting for the software to load and the wait aggravated me. I began losing focus while waiting, and was much less productive while using it. 

Second is freedom. I am not really sure how I am going to rate or quantify this, but the ability to give each page of the app a personal touch is important. I can't compliment codiqa because that is all I have played with thus far (sorry codiqa, u really are awesome!), but I can complain about it (hehehe)! With codiqa it was very hard to format a page. The only way to put functions side by side was using the grid feature and I found this very difficult to control. I also could not re-size items or align them as I wanted. I am a big fan of symmetry or evenness on a page and this was hard to accomplish using codiqa. 

Other categories to think about will be breadth of the features available, can I build I template on my own or do I have to choose from a ready made list, is there a good "test" feature so I can check and track my work, etc... Codiqa really was great software. Looking forward to seeing what else I can find!

I have almost completed the wireframe on Codiqa today. I have made temporary compromises on certain design features to get to where I am but seeing the dynamic representation makes this worth it! I still have to decide how I want to put in the official QOL metrics (SIBDQ, EQ-5D and Morisky-8) so I guess I saved the best for last... If you log into the codiqa website, you can see the design so far.

Next, we need to decide what the pages for "My Doc," "My Meds," "History" should look like/what features they should offer and brainstorm any additional features we want to add under "More." There is almost a computerized version of IBDPromise; mid-day tomorrow, this first round should be complete!

So today started just like Friday. I sat down ready to start producing screen shots; though this time I was ready for the software to be a little difficult to work with. After experimenting some more with my different choices (and again looking at some new ones like balsamiq) I decided to move forward with Codiqa. This quick and easy to use software provides me with the most options in an aesthetically pleasing environment. Realizing there is not one ideal software to work with, I figured it would be best to invest in designing with one instead of losing time playing on each software. 

My issue is that I cannot create an exact replica of what I drew on paper using Codiqa. I tried manipulating different functions and even began reading about code so I can create my own designs (when I tried using these I found out you can only enter your own code once you begin a subscription account), but at best I am only creating something that resembles what we want. 

So I will continue at this for 1-2 more days, using Codiqa to "transcribe" what I have on paper and we can then decide if if the mock-ups are satisfactory or not. As I do more work on the Codiqa website, I am able to work quicker so I should be able to complete the entire wireframe within the next two days. My hope is that Codiqa will get us to a good place and then with a little coding on our part, we can make the complete product. I am beginning to wonder if I should began investing serious time in learning simple computer languages. This would be worthwhile if coding  knowledge ends up taking a large role in this project. 

Hope everyone enjoyed their respective seminars, conferences and workdays!