Developing a concussion assessment mHealth app for certified Athletic Trainers Design and Development of mHealth Applications S81 Scott McGrath, MS Biomedical Informatics Doctoral Candidate University of Nebraska at Omaha Twitter: @McGrathSPro

Disclosure Our group has no relevant relationships with commercial interests to disclose. Lead author’s (Scott McGrath) spouse contributed to this work as a 2nd author (Melanie McGrath) AMIA 2017 | amia.org

Learning Objectives After participating in this session the learner should be better able to: Apply the Center for eHealth Research (CeHRes) roadmap in the formulation, planning, and development of mHealth apps. Identify why rural ATCs are a desirable target for mHealth and telehealth applications. AMIA 2017 | amia.org

Outline Introduce ATConnect, our mHealth telehealth app Review the CeHRes holistic roadmap for mHealth app development AMIA 2017 | amia.org

Concussions: Scale of the problem 1.6-3.8 million concussions occur from sports and recreational activity in the United States annually1 Concussions account for 5-9% of all sports injuries, which often translate into visits to the emergency room2 From 2001-2009, there has been a 62% increase in non-fatal traumatic brain injuries1 Studies have shown Certified Athletic Trainers (ATC) increase the rate of detection of concussions and lower the rate of injury3 However, coverage is a problem, 30% of public secondary schools in the United States have no ATCs and 24% of sporting events have no medical coverage4 AMIA 2017 | amia.org

Coverage gaps in Nebraska AMIA 2017 | amia.org

ATConnect proposed flowchart AMIA 2017 | amia.org

mHealth app based solution Sports Concussion Assessment Tool (SCAT3) ATConnect Parent/Coach Initialize case ATC Retrieves & Completes assessment AMIA 2017 | amia.org

Roadmap for eHealth development http://www.ehealthresearchcenter.org AMIA 2017 | amia.org

Contextual Inquiry – Define the problem Specify the healthcare problem (ATC coverage) What are the different challenges to this problem? Categorize the challenges (efficiency, effectiveness, timely, safety, etc.) Prioritize the elements of the problem Identify Stakeholders (ATCs, Coaches, Athletes) Invite key stakeholders to discuss the problem What roles do stakeholder have? Addendum Construct a preliminary budget with developers and build mock-ups AMIA 2017 | amia.org

Value Specification – Meet stakeholders Focus Group (ATCs, medical software developer) Have stakeholders rank the 10 E’s of Eysenbach: Efficiency, Enhancing quality of care, Ethics, Extending scope of care, Evidence Based, Empowerment, Encouragement, Education, Equity, & Enabling Capture user requirements from stakeholders How can stakeholders contribute? AMIA 2017 | amia.org

Design – Building the app App development Cognitive walkthrough Persuasive design Persuade & motivate without being coercive Prototyping Usability Testing Expert testing Target group testing Addendum iOS & Android development and beta testing planning AMIA 2017 | amia.org

Operationalization – Marketing the app Business Model Internal product Offered to the public Planning and actions for: Dissemination Adoption Integration AMIA 2017 | amia.org

Summative Evaluation – Reflection mHealth uptake Usage behavior Profile of users User motivation mHealth impact Impact on health delivery Impact on patient health & well being AMIA 2017 | amia.org

Future work Continue to develop ATConnect Revise app to include newly released SCAT5 protocol (released April 2017)5 Integrate feedback from targeted users Conduct a pilot program Seek grants and funding to build the components originally envisioned for the app Conduct a study to evaluate impact and uptake of the mHealth app AMIA 2017 | amia.org

You can find me at: smcgrath@unomaha.edu Thank you! You can find me at: smcgrath@unomaha.edu @McGrathSPro

References [1] Broglio, S. P., Pontifex, M. B., O'Connor, P., & Hillman, C. H. (2009). The persistent effects of concussion on neuroelectric indices of attention. Journal of neurotrauma, 26(9), 1463-1470. [2] Lincoln, A. E., Caswell, S. V., Almquist, J. L., Dunn, R. E., Norris, J. B., & Hinton, R. Y. (2011). Trends in concussion incidence in high school sports a prospective 11-year study. The American journal of sports medicine, 39(5), 958-963. [3] Fletcher, E. N., McKenzie, L. B., & Comstock, R. D. (2014). Epidemiologic comparison of injured high school basketball athletes reporting to emergency departments and the athletic training setting. Journal of athletic training, 49(3), 381. [4] Kutcher, J. S., McCrory, P., Davis, G., Ptito, A., Meeuwisse, W. H., & Broglio, S. P. (2013). What evidence exists for new strategies or technologies in the diagnosis of sports concussion and assessment of recovery?. British journal of sports medicine, 47(5), 299-303. [5] Echemendia, R. J., Meeuwisse, W., McCrory, P., Davis, G. A., Putukian, M., Leddy, J., ... & Schneider, K. (2017). The Sport Concussion Assessment Tool 5th Edition (SCAT5). Br J Sports Med, bjsports-2017.