1) The document discusses an overview of medical app development presented by Erik van der Zijden of Synappz Medical Apps. It covers topics like who Synappz is, what mHealth is, the medical app development process, and current and future trends. 2) The medical app development process discussed includes discovering user needs, preparing designs and functionality, creating graphics and coding, marketing the app, and obtaining necessary certifications and validations. 3) Current and future trends mentioned include tracking more health data using mobile devices through wearables and sensors, as well as using standards like HL7 and DICOM to enable data sharing and interoperability.

1. Medical App Dev and a bit more
Seminar Medical Informatics | University of Utrecht
Erik van der Zijden
Synappz Medical Apps

2. Who am I?
Multimedia
Marketing
Techno geek
Martial Arts
MBA
BSc
Pharma
Digital Media
MSD Animal Health
1972
Video Mobile
Triumph Spitfire
Yara
Medical
Biology
Floor
Eline
Health 2.0
Global Brand Manager
Export Sales former
Yugoslavia
Innovation Manager
Erik van der Zijden
Apple fanboy
Medical Apps
Business Manager
EntrepreNerd

3. Be in your Centre

4. Synappz © 2013
Who are we?
Erik van der Zijden BSc MBA Piet Nelis DVM MBA Erich Taubert MD
One app, one life. At least.

5. Synappz © 2013
It’s the team work that makes the dream work
Jessica Seegers
Lead Designer
Mindy Broeren
Creative Operational Manager
Sebastiaan Seegers
Game Developer
Dick Coppus
Lead Developer
Jolanda Hutten
Visual Designer
Frans Kouwenhoven
Mobile Development 2GO
Sami Yilmaz
Mobile Development 2GO
Eduard Ernst
Photo & Camera Production
Rob van der Galiën
HTML5 Guru
Taha Chebli
Lead 3D Designer
Sandra Brusman
Marketing Director
Jeroen Beltman
Program Lead
Ethem Volkan Uslu
Mobile Dev Guru
Remco Bron
Web developer

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What’s IT all about?

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Meet the family

8. voidingdiary
Synappz © 2013

9. What is mHealth anyway?
Applications that will improve or
assist you with your personal health
Easy accesible advice for stakeholders. Services provided by mobile apps in
order to help users mainly in the
information and prevention area
Any software or hardware that improves the patients'
quality of life using mobile devices.
Mobile applications to educate or assist
the healthcare brance, both personal and
professional use. Health related applications who
assist patients
healthcare that is supported by
mobile devices
Health related applications for
mobile devices
Medical support using mobile devices
Health solutions delivered to
mobile devices
Synappz © 2013

10. Your opinion
mHealth and eHealth are basically the
same. Stop the semantic discussion!
Agree Disagree
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11. What’s your experience with mHealth?
None
40%
A little
60%
n=10 Synappz © 2013

12. Where lies the true value of mHealth?
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13. Where lies the true value of mHealth?
Synappz © 2013
Mobile Teleradiology
Mobile Oral Telemedicine Mobile Cervical CancerScreening
Mobile Teledermatology

14. Where lies the true value of mHealth?
Synappz © 2013

15. Where lies the true value of mHealth?
Synappz © 2013

16. Today’s chapters
What makes a great medical app?
The Med App Dev Process
Current and Future trends
Case
Synappz © 2013

17. What does make a great medical app?
0
9
Scientific Support
Safery & Security
Graph & Int Design
Easy implementation
Clear revenue model
Connectivity
n=10 Synappz © 2013

18. Ingredients for an awesome medical app
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Connect
APIs
Standards (OpenEHR,
HL7, DICOM)
Wearables
Sensor Tech
See
Interaction Design
Graphical Design
Coding
Use case
Marketing & PR
Trust
CE certification
Sector certification
Norms, Protocols
(NEN7510, HIPAA)
Encryption
Conformity Assessment
Anonymization/Pseudonymization
Believe
Validation
(Scientific) publications
Community Best Practices
Expert Co-Creation
Awards
Do Implementation Program
Training & Support
Change Management

19. Biggest challenge for implementation (you say)
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Change
6
Proven business model
2
Unknown territory
2
Territory is confusing
2
No scientific evidence
2
Healthcare Professionals
Too difficult
4
Trust
3
Costs
1
Ignorance
1
No adoption
1
Patients

20. Biggest challenge for implementation (you say)
n=10 Synappz © 2013
Physicians should stop standing on a golf course and
actually start caring about patients, by exploring new
methods of providing healthcare.
- A Respondent
“

21. How to make this stuff?
Synappz © 2013
The Med App Dev Process

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App Dev is a process, too
Discover
1
Prepare
2
Graphics ‘n
Geeks
3
Let the
world now
4
Certification
& Validation
5

23. Foto patient met iemand
die aantekeningen
maakt.
Screenshot van Patient
Journey (Jonas Piet?)
Start with the UserDiscover
1 *)
*)
Patient, healthcare professional

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Patient JourneyDiscover
1

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Alternative: PersonasDiscover
1

26. Your Problem Solving CapacityDiscover
1
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Which problemare we trying to solve here?
For iP Voiding Diary:
Paper micturation lists are old-fashioned and dirty. You can lose
them, patients do not understand waht they write down. They even
can’t be linked to a EHR.

27. Make an App Definition Statement
Synappz © 2013
iP Voiding Diary is:
The authority for digital voiding diaries. During a predefined period it
registers and interprets peeing- and drink patterns in an easy way.
iP Voiding Diary is used by people who worry or want to know more
about their bladder behaviour, and it is being read and/or prescribed
by the physician.
‘Reporting that makes you understand your own bladder health’.
Discover
1

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What does the app have to do?Prepare
2
Need
Sandy wants to know whether urine loss is
normal
Consideration Compare with friends, media, Dr Google.
Pain points Taboo, not easy to find, subjective info.
Functionalities
Measure time/volume/intake/loss
Compare with norm
Present in an easy way
Share outcome

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Which buttons do what?Uitwerken
2
You want to make this
Land
Fly
While the user wants this
Prepare
2

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Which buttons do what?Prepare
2

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Which buttons do what?Prepare
2

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A Blueprint (like expensive architects make)
For: 2go-mobile
Date: May 30, 2011
Document version 1.0
1. General
1.1 App Definition Statement
iP is the authority in the field of digital registration and interpretation of the
urinating- (micturition) and drinking pattern, and urine loss. It’s a simple to use
app which is used during a predefined period. Actions are linked to the results of
the data measured. The app will be used for people who worry and/or want to be
informed about their micturition pattern and urine loss.
iP will increase patient compliance and interpretability. The data can be
aggregated, thus results can be communicated more effectively with EZIS/HIS
(hospital and general practitioners information systems).
1.2 App Store Description
• Simple and clear input of urinating pattern.
• Input liquid intake using clear icons.
• Easy input of ‘events’ such as pain, incontinence and urge.
• Visualizing subjective incontinence volumes and urges.
• Input of (self created) events.
• All input linked to day and night.
• Specific day and night visualization in reporting
• Clear reporting, understandable for all.
• Print report to PDF and send to healthcare professional.
1.3 Personas
Patty is 35, married and has two kids, one son of 3 and a daughter of two months.
Patty has a part-time job as a marketing assistant. A job she likes a lot. She is
also pretty busy dealing with her household and sport. She enjoys life.
!
Functional Design iP • Confidential • © 2011 AppOriginal
3. App Functionality
3.1 Graphics
• PNG format
• iPhone 3G/3GS: 480x320 screen; iPhone 4: 960x460 screen
• Create ‘classic’ and ‘retina’ graphics.
• All visuals will be supplied by AppOriginal
3.2 Splash screen
- Splash screen will be supplied by AppOriginal.
-Default.png: 480x320
-Default@2x.png: 960x460
3.3 Screens: Highest Level
On this level, the Login Screen, Home Screen and Overview can be found.
1C. Overview1A. Login 1B. Home
!
Functional Design iP • Confidential • © 2011 AppOriginal
Patty, however has a problem: she loses urine and goes a lot to the toilet to pee.
Patty is not willing to accept this behavior, and starts searching for solutions. She
is pretty active on the internet and wants to keep control about her own
healthcare. She did not discuss her ‘issue’ with her physician.
1.4 From needs to functionalities
Need
Wants to know
whether urine
loss is normal
Wants to know
if anything can
be done about it
Wants to feel at
ease
Wants to
communicate
story to doctor
Consideration
Compare with
friends, info in
media, Google.
Googling,
searching for
solutions and
possible to
Asks herself
whether
something is
wrong
How do I
convince my
doctor about my
problem?
Pain points
Taboo, info not
easily available,
not specific
enough for her,
no objective
Google: too
much info, not
specific, trust in
doubt.
Physician: taboo
Incomplete
picture of the
problem, needs
help to make the
diagnosis.
Complaints and
too variable and
she finds it
difficult to
explain.
Functionalities
Time/micturition
volume/intake/
loss
Compare to
norm presented
in
understandable
General info
about micturition
patterns.
Comparison to
norm, presented
in an
understandable
way.
General info
about micturition
Digital
communication
with care giver.
Objective
representation of
micturition
patterns.
1.5 Key indicators for interpretation
Number
• Number of micturitions/24 hours
• Number of micturitions/night
Volume
!
Functional Design iP • Confidential • © 2011 AppOriginal
3D. Add Own Event to Pee
- User can define their own Event category.
-Variables: Event Name (free text), Icon (some 25 icons), More info (free text).
-Own Event appears on top list 3C.
3.6 Screens: Event Level
In the Events Users can add events during the CYCLE. Users van experience pain,
urine loss or urge during a non-specific time period. In V1.0 of the app only these
three events will be displayed.
4A. Event 4B. Add Event 4C. Event ‘Pain’
!
Functional Design iP • Confidential • © 2011 AppOriginal
Prepare
2

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Battle of the platformsPrepare
2

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Battle of the platformsPrepare
2
read.bi/10CqyJb

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Your audience decidesPrepare
2

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Your audience decidesPrepare
2

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Your audience decidesPrepare
2

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Android fragmentedPrepare
2

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HTML5 versus NativePrepare
2

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HTML5 versus NativePrepare
2

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Battle of the platforms
Ask yourself:
How ‘complex’ is my app on the interaction?
How inportant is it that all runs smoothly?
Do I use sensitive information?
Do I want to use the built in sensors?
Which devices do my users have?
What’s my budget?
If native and multiplatform: which first?
Prepare
2

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The way to Fabulous WealthPrepare
2

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Business Modeling (yes, we made one, too!)Prepare
2

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Who are your Competitors?Prepare
2
See
Believe
TrustDo
Connect
See
Believe
TrustDo
Connect
Competitor A

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Year 1 Year 2 Year 3 Year 4 Year 5
Population
Prevalence of condition
# Patients (pot. mrkt)
Penetration
# Users
Price App
Gross Margin
Minus Apple Margin 30%
The way to Fabulous WealthPrepare
2

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Year 1 Year 2 Year 3 Year 4 Year 5
Population 2.000.000 2.100.000 2.200.000 2.300.000 2.400.000
Prevalence of condition 5% 5% 6% 6% 7%
# Patients (pot. mrkt) 100.000 105.000 132.000 138.000 168.000
Penetration 1% 2% 3% 4% 5%
# Users 1.000 2.100 3.960 5.520 8.400
Price App 0,89 0,89 0,89 0,89 0,89
Gross Margin EUR 890 EUR 1.869 EUR 3.524 EUR 4.913 EUR 7.476
Minus Apple Margin 30% EUR 623 EUR 1.308 EUR 2.467 EUR 3.439 EUR 5.233
% mobile phone?
% platform?
% apps use?
Trends?
The way to Fabulous WealthPrepare
2

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Making ArtGraphics ‘n
Geeks
3

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Geek stuff: CodingGraphics ‘n
Geeks
3

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Online Marketing - nobrainerLet the world
know
4

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Offline Marketing - Necessary?Let the world
know
4

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Don’t forget
App Store description
App Store Optimization
Press Releases
Video
Promo codes & Sneak Peeks
Let the world
know
4

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Policies - Friend or foe?Certification
& Validation
5

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When CE? The story of the scaleCertification
& Validation
5
Diagnose
Measure
Treat

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When CE? The story of the scaleCertification
& Validation
5

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MEDDEV tree (it doesn’t get better than this)Certification
& Validation
5

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Privacy & Security
Use of Patient ID?
Data Storage Location?
Encryption?
Back-Up Management?
Recalls?
Certification
& Validation
5

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The wonderful world of ABBRVTNS
HL7 (Health Level 7)
• Worldwide standard.
• Connects healthcare systems and make them speak ‘the same language’.
• Open source and free to use, though pretty complex.
• New: HL7-FHIR for cloud-based applications and mobile devices.
• Not compatible with older versions of HL7. Available in September?
Certification
& Validation
5
CDA (Clinical Document Architecture)
• Based on a HL7 module.
• Template-based for sharing complex documents.
• XML formats (readable in browser)
• Example HL7-CCD (Continuity of Care Document), for transfer patients.

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DICOM (Digital Imaging and Communication in Medicine)
• ISO standard.
• Medical images and workflows (PACS).
• Image + metadata = DICOM.
• Need specific DICOM viewer, or WADO (Web Access DICOM Objects) functionality.
• App that is DICOM-compliant? Need ‘DICOM-conformance statement’
Certification
& Validation
5
The wonderful world of ABBRVTNS
HIPAA
• ******

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A solution?Certification
& Validation
5

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So what’s happening and what’s next?
Current & future trends

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Current & future trends

62. Track everything
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63. Track everything
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64. Track everything
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65. Track everything
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66. Track everything
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67. Track everything
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68. Track everything
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69. Track everything
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70. Track everything
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Track everything

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DIY sensors

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Star Trek in reality

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Star Trek in reality

75. The future of mHealth in numbers
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0
350
700
1050
14001400 bln
500 bln
Total
mHealth
By 2015, 30% of
all smartphone
users will have
used mHealth
applications
Services
46%
Device sales
30%
Paid downloads
14%
Transaction
8%
Advertisement
1%
Share of mHealth revenue source of
total mHealth market opportunity
Global Mobile Health Market Report 2010-2015 (Research2Guidance)

76. Yes, we are open for internships
Synappz © 2013
Connect
APIs
Standards (OpenEHR,
HL7, DICOM)
Wearables
Sensor Tech
See
Interaction Design
Graphical Design
Coding
Use case
Marketing & PR
Trust
CE certification
Sector certification
Norms, Protocols
(NEN7510, HIPAA)
Encryption
Conformity Assessment
Anonymization/Pseudonymization
Believe
Validation
(Scientific) publications
Community Best Practices
Expert Co-Creation
Awards
Do Implementation Program
Training & Support
Change Management

77. Erik van der Zijden
erik@synappz.nl
06-109 301 40
@ErikvdZ
synappz.nl