Accepted for/Published in: JMIR Formative Research
Date Submitted: May 29, 2019
Date Accepted: Apr 13, 2021
Date Submitted to PubMed: Apr 21, 2021
Utilizing Lean software development strategies to improve global eHealth initiatives: viewpoint from a basic emergency care app.
ABSTRACT
Background:
Health systems in low- and middle-income countries (LMICs) face considerable challenges in providing high-quality, accessible care. Simultaneously, however, they have seen unprecedented growth in cell phone and internet technologies which has resulted in mounting interest in the potential of eHealth in these locations. However, few apps or software programs have gone beyond the testing phase, most downloads are never opened, and consistent use is extremely rare. This is believed to be due to a failure to understand and address user needs.
Objective:
Feedback from World Health Organization (WHO) Basic Emergency Care (BEC) course participants requested a mobile adjunct to the complex primary survey. Our team undertook the task of developing this solution through a community-based participatory model in an effort to meet trainees reported needs and avoid some of the above failings. Owing to familiarity with their elements and ubiquity in medicine, we used a well-described Lean software development strategy to complete this task and eliminate waste.
Methods:
From September 2016 through January 2017, the BEC App was roadmapped and developed at UCSF in California. When a prototype was complete, it was piloted in Cape Town, South Africa and Dar es Salaam, Tanzania - WHO BEC partner sites. Feedback from this pilot shaped continuous amendments to the app before subsequent user testing and study of the effect of use of the app on trainee retention of BEC course material.
Results:
We were able to rapidly build and iterate a user-centered app directed at LMIC healthcare workforce using a familiar and readily available framework. Our solution had minimal direct costs and resulted in a robust infrastructure for subsequent assessment and maintenance which is familiar to the global health and medical communities and allows for efficient feedback and expansion.
Conclusions:
We believe that utilizing Lean software development strategies may help global health advocates and researchers build solutions utilizing a familiar process with buy-in across stakeholders that is responsive, rapid to deploy and sustainable.
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