Edinburgh Napier University

  Background: Cardiovascular disease (CVD) is the leading killer globally and secondary prevention substantially reduces risk. However access to preventive programs is low, leading to development of alternative models of care.
Objective: To inform the development of a web-based preventive program integrated with primary care electronic medical record (EMR) systems, we undertook a collaborative user-centred design process and validation of algorithms to develop a consumer e-health tool, integrated with the EMR.
Methods: A three-phase process was utilised involving ten multidisciplinary clinicians and academics (Primary care physician, public health nurses and allied health professionals), two strategic design consultants, graphic designer, information technologists and nine proposed end-users. The twelve-month process included in phase 1, a literature search and competitor review, face-to-face interviews, and end-user diary studies; in phase 2 user experience strategy workshops, co-design and prototype validation activities with prospective users and a design process to generate the look and feel of the website based on the results of user feedback; in phase 3 validation and testing of the algorithms to deliver information from the EMR into the consumer portal. This work enabled deep understanding of the user contexts, producing increasingly detailed designs and prototypes.
Results: We reviewed ten related apps/websites and 15 observational and interventional studies in a half-day workshop and derived a set of core components and ideal features for the system. These included the need for interactivity, visual appeal, credible information, virtual rewards and need for emotional and physical support. The following three features were identified as essential: (i) both mobile and web-enabled ‘apps’, (ii) an emphasis on medication management, and (iii) strong psychosocial support component. Subsequent workshops (n=6; 2 x 1.5 hours) informed the development of functionality and lo-fidelity sketches of interfaces for the tool. These ideas were next tested in focus groups with patients (n=9; 3 x 1.5 hours). Based on this feedback a graphic designer iteratively developed the end-look of the website. Concurrently, the EMR was linked to the consumer portal: A written description of the final algorithms for all decisions and outputs was given to the software programmers. The validation of these outputs was then conducted by comparing the outputs from a dataset of existing patients produced by the software program and author (EH) who programmed the algorithms independently in STATA. This was an iterative process until there was complete agreement.
Conclusions: End-users of web-based CVD preventive programs have complex needs including physical and psychosocial support. An iterative development process aided the integration of these needs into the development and refinement of our web-based application for prevention of CVD.