Subha Airan-Javia, MD, and Stephanie Altavilla, RN, faced the same set of choices when they set out to create apps for their hospitals.

The first was whether to buy an existing app on the open market and try to fit it into their infrastructure, knowing that there was no guarantee it would fit smoothly into the existing workflows and that they might be faced with users who were unwilling to adopt it.

Or, they could write the apps internally.

The build versus buy decision can be a difficult one. Despite the hailstorm of apps available for free or at a relatively low cost, many of those geared toward hospitals or providers can be tricky to plug into existing workflows, let alone customize.

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Building an app with internal resources requires careful planning and a need to manage a development process. But providers like Boston Children's and Penn Medicine are rising to the challenge, creating their own apps with exactly the features and functionality their staff needs.

So the next option is whether to build a Web-based or native app. Both have distinct advantages, and picking one over the other likely comes down to what you want to achieve as well as understanding your target audience.

Under the hood

In architecting its MyChildren's Mobile, Boston Children's IT and Web departments chose to build a native app that would live in Apple's AppStore and Google's Play Store.

"That was thought to be the best approach for widespread visibility and adoption from the patient and parent community," said Altavilla, the hospital's program manager for clinical informatics.

Penn Medicine opted to go the Web app way instead, with an eye on rapid cycle iterations, according to Airan-Javia, a practicing hospitalist, assistant professor at the University of Pennsylvania, director of the internal medicine residency health IT education program, who also serves as a physician liaison to the information systems department specializing in mobile health innovation.

"We knew we would be doing frequent updates and enhancements, and wanted to be able to push these out quickly without relying on people having to download an update each time," Airan-Javia said.


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MyChildren's Mobile connects physicians with patients and parents by enabling users to view their children's health records, contact clinicians directly, schedule appointments and pay for them.

For its Mobile Patient Dashboard, Penn Medicine built interfaces that sync into two EHRs and several other clinical systems including cardiology, labs, patient tracking and radiology, to extract data in near real-time.

"Whereas before clinicians would have to remember to check a patient's vitals or medication administration history, or study results the next time they had access to a computer, they are now able to do it in real-time while they are having conversations with their patients or other care providers," Airan-Javia said. "This enables providers to get the information they need immediately and make the appropriate clinical decisions based on that data in a more timely manner."

Lean, mean and unforeseen

Altavilla and Airan-Javia agreed that building an app from scratch in a timeframe within single-digit months required an agile approach to application development and project management. 

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Full-time employees were dedicated to testing on a daily basis, assessing progress, and readjusting goals as needed; all to maintain a razor-sharp focus on quality while adhering to strict timelines.

Building apps so quickly also means that hospitals – or IT shops in any industry for that matter – are susceptible to unforeseen consequences, including the need for internal policy making, dealing with uneven wireless strength, maxing out IP addresses and even cellular dead zones.

In the cases of both Boston Children's and Penn Medicine, the initial success resulted in a growing appetite for further innovations.

"They're approaching us and asking for new functionality all the time," Altavilla said.

To which Airan-Javia added: "We are continuously getting feedback to enhance our app on a regular basis. This has allowed us to continuously improve our product and innovate."