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Jeremy's Daily Blog

3 goals for summer internship
1.      Better understand roles and relationships among different members of the healthcare workforce and day-day functioning of a physician

2.      Understand the role of IT in healthcare and gain familiarity with technology tools by working with a project team

3.      Finding what role/s I would enjoy in the healthcare system 

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GOOD STUFF IF YOU CAN READ IT

6/19/2013

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I will have to apologize in advance for the incoherent nature in which I expect to be writing this post. I plan on going through the three IBD apps (GI Buddy GImonitor and myIBD) listing features that I find to be valuable, features that need to be fixed, features that should be added and explain where these conclusions are coming from. While doing so will help me develop a better sense of app design, I do not expect it to produce a very coherent blog post. When I finish working with the above apps. I will begin doing the same thing with other apps that serve similar purposes (ex. for patients with a chronic disease and/or their clinicians) and will document the findings that I see as valuable.

My Good Friend: GI Buddy

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Before I start analyzing I think it will be worthwhile to write down some initial impressions of GIbuddy that I had after working with it last week. Opening the app, I immediately liked the home-screen. It was simple to start using it as every important function was just one click away. I felt as if I was thrown into the app, yet it was designed in a way so I knew exactly where I was and how to proceed. My only source of concern was with the "lifestyle" category. Clicking on this box leads to a list of seemingly unrelated options: "IBD Impact" (ambiguous), "stress level,"  "Well-Being Check," "Life events" and "Exercise/Activities." It appeared that the makers of the app wanted to include all of these options but did not want to clutter the home-screen. They settled and threw these options into the category "lifestyle." Doing so, made the home-screen design more aesthetically pleasing, but I found that these five functions, that have important purposes, will be used less because they are hidden within the app. So the home-screen looks nice (YES!), especially with the explanatory logos and attractive color scheme, but if the "lifestyle" options are important, then a change needs to be made (OH :o(  ).

Once using the app, I appreciated how simple the design team made the task of inputting information. Whether logging symptoms, medicine schedules, meals or exercise activities; you are always choosing from a compiled list of choices. The choices are organized in simple and easy to read scroll down menus that speed of the process of finding the correct choice. By organizing the app in this way, the designers accomplished two goals. First, because the process of inputting information is easy and quick, a user will be more likely to stick with the app. Secondly, the responses from all users of the app are now uniform; making it easy for a user to track personal changes on a daily basis or easy for a clinician who sees the same entries by all of his/her patients. The one issue with these compiled lists concerns the diet input. Using the vast USDA Database is cumbersome and difficult. Because recording diet is such an important part of this app, I will continue to brainstorm on how to improve this feature.

No matter how much foresight you have, you cannot think of every possible entry a user might want to input. In fact, even if you do think of the infrequent entries, you do not want to clutter the scroll down list with options that serve little purpose to the majority of users. This is why the "other" option is so important: not everybody fits into the per-determined list! The fact that this "other" option is always last ensures that users will not resort to it and are forced to first see the provided options before creating their own. Next, the constant ability to enhance each entry with a "note" is a crucial feature. There are always underlying details that are related to even the simplest symptoms and there is always a story behind a missed meal. The notes section allows a user to get there whole story down, It makes me okay with saying I "didn't take my medication today" because I can write down why and explain my decision so I do not feel stereotyped. If I could not write down the information, explaining why I have done something wrong/right, then I may decide it is better to not write at all. (A Note on the "Notes" feature is that there appeared to be no auto correct or spell check in the text box. Especially when wanting to write a lengthy note, these lacking features in the already miniscule text box makes writing notes a cumbersome and difficult process).
See! now if I somehow gamified this post and rewarded anyone who has read this far...
Another feature that I enjoyed when inputting information is how the process seemed dynamic. For example, when recording a bowel movement under symptoms, new options appear that let me give detail to this symptom. The fact that these options are hidden until they become pertinent allows the app to look clean and simple. Had all of these options appeared from the beginning, the app would be intimidating.

And some other comments on the app. At the bottom of the screen there is a "tool-bar" that makes navigation of the app quick and easy. The activity section for quick review and editing of the information posted in the app is a simple but crucial feature that brings the app together. Logging in different information seems a bit distant until I am able to see the whole picture with this feature. I also enjoyed the additional information that the app has links to and the "community" section. These unnecessary additions make the app feel more friendly. I think that because the app seems to go out of it's way to be helpful, I am more drawn to use it. One big complaint about the app is that is continuously "syncing" which means I am stuck and frustratingly waiting to be able use it.

Overall: solid app and I can't wait to beat it!

ON and ON to: GI Monitor

PictureGI Monitor Home-screen
The screen shot of GI monitor has some immediate improvements from the GI Buddy home-screen. Using descriptive pictures, more options fit into the home-screen while the high level of aesthetics is maintained. It is important that GI Monitor still uses some level of text to explain each section. Together, the text and the picture, are able to effectively convey the purpose of each option. The increased amount of links on the home-screen will make it easier for patients to utilize all of the options GI Monitor has to offer.

Time for some Devil's Advocate.

While it is easy to see from the GI Monitor home-screen what capabilities the app provides, will this correlate to a proper and fuller use of the app? GI Buddy got to the point! I knew I should fill in my symptoms; in GI Monitor the symptoms are split up and the "custom symptoms" makes me create my own instead of selecting from the compiled list in GI Buddy. I knew I should make an entry about my medication; in GI Monitor that is only one of many options so the importance of doing so may gets diluted within all my other choices (also, you should really be able to add new medications from "missed meds" section! But I digress). I knew I should enter what I have eaten; in GI Monitor my diet has the same presence in the app as bowel movements and stress level! Now maybe I am being too nit-picky. Patients will use the app how they want to use the app... If they think it is important to record their missed meds and diet, then they will. If they want to record their bowel movements, stress level and pain level then it is even easier now!

My conclusion here is that it is really up to the designers. There can even be a compromise where Diet and Meds take a more prominent role while sharing the home-screen with the many different categories that fell under "Lifestyle"
for GI Buddy. Overall, I am more fond of the GI Monitor set-up because the home-screen "command and Control center" feels more complete.

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Tell me about your Bowel Movements
GI Monitor is an innovator when it comes to detailing inputs. Instead of rating pain, stress, etc. with words, GI Monitor uses an intuitive raking system with color coded numbers. It is much easier to differentiate  pain using a scale of 1-10 then deciding between: sorta painful, painful and very painful. Similarly, detailing bowel movements is incredibly simple. The color scheme makes the screen both appealing and functional. A user can very quickly add a lot of information about their bowel movements.
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Rating systems on a 1-10 color coded scale
BUT WAIT, THERE'S MORE!
GI Monitor adds perks for it's users that have the potential to build a stronger fan base and leave users with a sense of belonging, Fist is the prominent position on the bottom left hand corner of "Questions for Doc." In GI Buddy this feature is hidden in the "More" tab of the app and I assume is therefore seldom used. Placed where it is, this simple feature accomplishes a lot. First, it enhances communication between a patient and their doctor, the main purpose of the app, by helping patients prepare more effectively for their appointments. Secondly, it shows me that the designers of the application really had the users in mind when deciding what should be offered and how it should be presented. This is a really important lesson to internalize before we begin working on our own application!

The other perk that is so crucial to the success of GI Monitor (it has nearly 850 ratings on the itunes store which means a lot more downloads...) is its "socialize feature." GI Monitor created a community and virtual support network amongst its members. This "Focused Facebook" creates commitment and belonging to the app for its users. The continuous posts on this forum, at about every 10-15 minutes, means users are continuously opening to app to see what's going on. As they feel connected to the app and are opening it more often, they will also use the app for its intended purpose of tracking their disease. Like my post on gamification, when using the app becomes less of a responsibility and more part of an enjoyable routine, the app is successful.
Some other observations when considering GI Monitor design: The app often has the edit button on the bottom left hand corner going against the convention of the usual top right position so I am sure it often missed. Lesson: use conventions! The news section is just another great "let's go out of our way to provide this" perk; it wont appeal to everyone but it will definitely enhance the experience of some and is out of the way so it won't serve as a distraction. The report/graphing function is awesome! while the white box on the bottom of the screen has a bit too much going on to make it a functional summary, The QOL gauge is a really effective display by incorporating colors into the number scale.

Don't Forget about myIBD

PicturemyIBD Home-screen
myIBD is a great app to review last. On the one hand, the simplicity and design of this app blows the previous two apps out of the water. On the other hand, myIBD seems like an incomplete application in which the developers released a "rough draft" while they are finishing the real final version. For us, this just means there are a lot of "what-to-do" and "what-not-to-do" lessons.

The home-screen. It is clean.

I think it is the black background with the vibrant colored and round edged icons that make this homes-screen so appealing. It is all encompassing but not crowded. It is full with information but only a brief summary, It accomplishes the goal of leave nothing out but include nothing extra. It had set the standards for home screens, making the first step on inputting information intuitive and simple.

Because I can, I would like to complain about one thing. It is a bit depressing that the icon for mood is a rain cloud. I beleive emotions are  contagious and this icon is creating a subliminal message that you are in a downer mood. At a closer look I think there is actually a heart behind the rain cloud, but it really does not come out well and though this is a small critique I think it would improve the app.

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The high quality design is not limited to the home screen; clicking on any of these icons leads to a similarly clever design. To the right is a screen shot taken after clicking on mood. Throughout the app, inputting information is as easy as a slide or a click. The convenience this provides makes the app more practical. Additionally, at the bottom of each screen shot there is the same "add a note..." box that protrudes out as if it asking to be clicked. If a user feels restrained from the limited predetermined answers they are given to choose from they can add a note to personalize their response. The system that myIBD has created makes the users task simple and quick while not creating any restrictions.

An issue: myIBD is too dependent on icons and fails to use text to convey a message. In this screen shot, the icons at the top of the screen are supposed to represent the activity tracker, fatigue, stress and General Well-being. The icons are too none descriptive and I see no way to realize and remember which goes to which. Knowing the identities of these options becomes important when you click on "history" from the home-screen to view a summary of your information.

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As seen in the screen shot to the left, it is difficult to decipher what information was inputted for the categories of stool, food and mood. This an example of over-reliance on icons and a few descriptive titles would increase the usability of this feature. Too much of a good thing...

Another issue with myIBD is that there is no shortcut within the app that will bring you back to the home screen. GI Buddy and GI Monitor both had a tool bar at the bottom of the app that provided easy access back to the home-screen (as well as other important pages within the app). It was a bit frustrating when playing with the app and having to work my way back to the home screen instead of clicking on a simple shortcut. 

There are two kinds of people, those who finish what they start and so on
But we really are done! I have learned about the importance of a home-screen. It should be appealing, act as a central point in the app that defines and leads to the important features. Also, there should always be easy access to the home-screen for the user. I learned about building an interface for users to input information. Instructions are bad. Nobody reads them. A descriptive image with one or two explanatory words can suffice as instructions if used effectively. Once the user is inputting information, the task should be easy for them; a result of the designer thinking ahead. Options should be on an easy to scroll list so only a few are seen at a time, and when possible- ranking systems using the established conventions of number rankings works well. Using the conventions of colors when ranking different information is also an effective tool to convey a message and there should always be an options for the user to personalize their response with a note. The user should feel liberated not constrained by your design. In sum, don't just build an app by putting features together. If you think about what the user will be doing on your program, and construct an app with the user in mind, these ideas should come naturally.
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    Jeremy Rosh is a rising Junior studying finance and pursuing a pre-med track at the NYU Stern School of Business. Searching for ways to combine the disciplines of medicine and business, he is working this summer on project to simultaneously  improve the quality of care that patients receive while driving down costs. Embracing the summer atmosphere and as an energetic and curious twenty year old, Jeremy cannot wait to see what he will uncover during these next few months.

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Division of Gastroenterology, Icahn School of Medicine at Mount Sinai
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