Download PDF
CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(04): 803-810
DOI: 10.1055/a-2148-8036
Case Report

Buy or Build: Challenges Developing Consumer Digital Health Interventions

Barry G. Saver
1   Swedish Family Medicine Residency Cherry Hill, Swedish Health Services, Seattle, Washington, United States
,
Jenna L. Marquard
2   School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States
,
Jeremy Gummeson
3   Electrical and Computer Engineering, University of Massachusetts Amherst, Amherst, Massachusetts, United States
,
Joanne Stekler
4   Division of Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, United States
,
James M. Scanlon
5   Swedish Center for Research and Innovation, Swedish Health Services, Seattle, Washington, United States
› Author Affiliations Funding CONDUIT-HID was funded by a grant from the Agency for Healthcare Research and Quality (grant no.: R18 HS018461). USE-MI was funded by a grant from the National Institute of Mental Health (grant no.: R01 MH109319).
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Digital health interventions offer opportunities to improve collaborative care between clinicians and patients. Designing and implementing digital health interventions requires decisions about buying or building each technology-related component, all of which can lead to unanticipated issues.

Objectives This study aimed to describe issues encountered from our “buy or build” decisions developing two digital health interventions over different timeframes, designed to use patient-generated health data to: (1) improve hypertension control and (2) measure and improve adherence to HIV-related medications.

Methods CONDUIT-HID (CONtrolling Disease Using Information Technology-Hypertension In Diabetes) was developed during 2010 to 2015 to allow patients receiving care from a multispecialty group practice to easily upload home blood pressure readings into their electronic health record and trigger clinician action if mean blood pressure values indicated inadequate control. USE-MI (Unobtrusive SEnsing of Medication Intake) was developed from 2016 to 2022 to allow entry of patients' HIV-related medication regimens, send reminders if patients had not taken their medications by the scheduled time(s), attempt to detect medication ingestion through machine learning analysis of smartwatch motion data, and present graphical adherence summaries to patients and clinicians.

Results Both projects required multiple “buy or build” decisions across all system components, including data collection, transfer, analysis, and display. We used commercial, off-the-shelf technology where possible, but virtually all of these components still required substantial custom development. We found that, even though our projects spanned years, issues related to our “buy or build” decisions stemmed from several common themes, including mismatches between existing and new technologies, our use case being new or unanticipated, technology stability, technology longevity, and resource limitations.

Conclusion Those designing and implementing digital health interventions need to make numerous “buy or build” decisions as they create the technologies that underpin their intervention. These “buy or build” decisions, and the ensuing issues that will arise because of them, require careful planning, particularly if they represent an “edge case” use of existing commercial systems.

Keywords

digital technology - hypertension - medication adherence - patient participation - consumer health informatics

Protection of Human and Animal Subjects

The studies were performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and were reviewed by the University of Massachusetts Medical School and Swedish Health Services Institutional Review Boards.




Publication History

Received: 01 February 2023

Accepted: 30 June 2023

Accepted Manuscript online:
04 August 2023

Article published online:
11 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany