From idea to reality: how I designed the Digital Care Program framework
S02-E03 (5 February 2023)
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With a bit of effort, I wrote the third episode of this newsletter, keeping my commitment to publish it every other Sunday. Today I am talking about a project I have been very busy with and am very proud of: the digital care programs I designed and developed with the Paginemediche team.
Digital Care Program 101
I met Roberto Ascione, founder, and CEO of Healthware, between 2013 and 2014, and we became friends. At that time, I had just founded Stamplay, a platform to connect online services and automate business processes without developing software. Stamplay was acquired in 2019 by Claris (a subsidiary of Apple), and the product is now called Claris Connect.
In 2014, I began discussing with Roberto the idea of creating a no-code platform composed of modules that could be assembled to develop personalized healthcare programs. We talked about this idea several times over the years until he asked me to join Paginemediche in 2021, and we then had the opportunity to work together.
Last year I began to give concrete form to the ideas we had discussed. In this process, as design thinking teaches us, the starting point is always to narrow the scope of action and identify one or more problems to solve.
Defining the problem
One of the fundamental activities in the relationship between patient and physician is the exchange of information.
The physician needs to acquire a lot of information from the patient to make a diagnosis, decide on a treatment, and evaluate the outcome. This information involves symptoms, measurements, and diagnostic tests, which, in most cases, is not easy to acquire efficiently:
patients have a hard time communicating their symptoms,
reports are still delivered to patients on paper and DVD,
it is sometimes necessary to monitor parameters such as blood pressure or blood sugar on an ongoing basis, and medical devices connected to a smartphone are still too few and too expensive.
The result is that physicians often find themselves making decisions in the presence of deficient or incorrect information.
At the same time, patients need information on how to:
effectively prevent a disease,
manage therapy and any side effects,
perform monitoring of vital parameters,
live with the limitations imposed by many medical conditions,
and so on.
Transferring this knowledge correctly takes time that doctors, even the most helpful and empathetic ones, do not have. The result is that we all resort to alternative sources. At best, it is a patient association, but it is much faster to use Google or join some Facebook group in most situations.
I asked myself two related questions using How Might We questions:
How might we help physicians provide patients with information on managing the disease?
How might we help patients provide physicians with accurate data about their health status?
The result of this inquiry is a framework for physician-patient collaboration, which we call the Digital Care Program.
A modular system
A Digital Care Program consists of modules to collect data (Questionnaires, Vital Parameter Monitoring, and Notes) and a module to provide recommendations and educational materials.
Questionnaires are an excellent tool for collecting information in a structured way and turning it into rating scales. In clinical practice, they are referred to as COA (Clinical Outcome Assessment), which the FDA defines as “a measure that describes or reflects how a patient feels, functions, or survives.” They are divided into four categories:
Patient Reported Outcome (PRO)
Observer-reported Outcome (ObsRO)
Clinician-reported Outcome (ClinRO)
Performance Outcome (PerfO)
At Paginemediche, we designed a Digital Care Program to care for psoriatic patients in collaboration with Apiafco. We created a smartphone version of the DLQI (Dermatology Life Quality Index), a questionnaire filled out by the patient and used to measure the impact of the disease on their quality of life. The program was announced during the Frontiers Health Italia conference in Rome last year.
Periodic monitoring of vital parameters, namely blood pressure, heart rate, respiratory rate, and body temperature, is necessary for many diseases. Today, taking these values is very easy through digital sphygmomanometers, which can be connected to the smartphone via Bluetooth for automatic data acquisition and storage.
Paginemediche has developed two DCPs that provide remote monitoring activities: one dedicated to Covid-19 and one dedicated to heart failure patients. The Telecare app offers the ability to connect many devices to the smartphone, view the data collected, and share it with the treating physician.
In the future, it will also be possible to include periodic monitoring of any biomarker.
Sometimes it is helpful for the physician to have more qualitative information as well, so we have added the ability to include text notes and an elementary five-value Likert scale.
To provide educational materials to patients, leveraging my experience as a University professor, I chose to use the microlearning teaching framework, which consists of administering the content to be learned in pills that can be consumed in minutes. Each pill can contain text, images, audio, and short videos. The patient can answer a questionnaire to measure her level of learning.
Depending on the results of the questionnaires, the content can be reintroduced to the patient to improve memorization over time.
Connecting the Bricks
Digital Care Programs are designed as a collaborative tool to make communication between patients and physicians easier. The modules I have briefly described are designed to work together and to be combined in complex workflows.
a general practitioner could enroll a patient in a preventive Digital Care Program that involves periodic monitoring of values such as cholesterol or triglycerides;
the app would alert the patient when it is time for checkups, perhaps at a pharmacy (some checkups are now done with a drop of blood) or by asking for a home blood draw instead of going to a testing center;
once the results are obtained, the patient can upload the reports to the app;
in the presence of an abnormal value, the app could generate an alert for the physician and, at the same time, could trigger recommendations to quickly explain to the patient what to do to manage the out-of-normal value;
finally, the physician could schedule a chat or video consultation with the patient to give specific directions, ask for more tests, and eventually prescribe a therapy.
All within a single app that is highly convenient to use.
How DCPs can be used
When designing Digital Care Programs, I didn’t think I would develop such a flexible framework. We did several simulations, and by combining different building blocks, we created prevention programs, disease awareness projects, and chronic patient support programs. Probably, with a few modifications, we could use them to implement clinical trials.
Some of the applications of the Digital Care Programs will soon be visible in the new Paginemediche mobile app, which will undergo a substantial update in the coming weeks. I don’t want to brag, but I don’t think I am exaggerating when I say that it will probably be the most sophisticated digital health application on the Italian market.
Such a complex project requires a collective effort and the talents of many people. In my (extraordinary!) product team:
Francesca Sgambato (still in her twenties…) managed all product management activities, working with me on feature definition, developing user stories, working alongside Luca on design, managing interaction with the development team, and running hundreds of tests;
Luca Casamassima (only 22 years old…) designed the UX and UI, developing dozens of tables and meticulously detailing every single flow and edge case of Telecare, the first mobile app in which the Digital Care Programs framework was implemented for heart failure management and Covid-19 patient monitoring;
Lia Alimenti led user research activities to ensure that the application was easy to use even for the elderly.
Alessandro Sbenaglia, CTO of Paginemediche, coordinated a multidisciplinary and tireless team of mobile, front-end, and back-end developers.
Interesting and inspiring readings
Recently, I discovered the poet Rupi Kaur and bought her first book, Milk and Honey (affiliate link). Overall, I liked it because of how she describes situations and emotions, although the simplicity of the text is the subject of much criticism. Rupi Kaur’s poems are probably the fruit of our time, easy to share on Instagram, and immediately understandable. At the same time, they are polarizing: many love them with a fan’s passion for a celebrity, while others hate them. This poem for example is certainly not a masterpiece but it says so much in a few words.
i want to apologize to all the women i have called pretty before i’ve called them intelligent or brave i am sorry i made it sound as though something as simple as what you’re born with is the most you have to be proud of when your spirit has crushed mountains from now on I will say things like you are resilient or you are extraordinary not because i don’t think you’re pretty but because you are so much more than that
Thanks for taking the time to read this episode of my newsletter: I hope I’ve been helpful. If you think my sketchbook might interest someone else, I’d be glad if you shared it on social media and forwarded it to your friends and colleagues.
See you in a couple of weeks 😊