mHealth App Selection - Testing Process

Testing Process – Hardware Selection:

When we first explored developing a toolkit devoted to selecting mobile health apps, we knew there were thousands on the market designed to help manage scores of chronic diseases. As such, we decided to narrow our selection by choosing a health condition with a history of mHealth solutions.  We decided on diabetes management apps, as scores of apps are in use to assist patients with home care, and mHealth innovations related to diabetes are plentiful and growing.

Even after choosing diabetes apps as the subject of this toolkit review, we still found hundreds of apps to help diabetics with everything from menu planning to blood glucose charting. 

Taking it one step further, we looked at innovations in mobile diabetes management, and found a growing market of glucometers designed to sync blood glucose readings into mobile phones and devices. These reduce errors in manual entry, and are simpler for the patient.

Given the apps’ interactions between glucometers and mobile phones, our hardware selection was twofold. First, we had to find glucometers enabled to sync data with their associated apps, then we had to determine on which mobile phones to test them. 

To find our target glucometers, we created the following criteria:

  1. The glucometer must be designed to work with a mobile app
  2. The glucometer must sync data with the app (without requiring manual data entry of blood glucose levels)
  3. Start-up costs must be less than $250

We purchased the only three glucometers that met these parameters and that were available for sale in the United States. These were (in alphabetical order) the iBG*Star, the myglucohealth, and the Telcare system.

After purchasing glucometers, the second phase of hardware selection was determining which mobile devices to use for app testing. 

  • When we began testing, the iBG*Star was available only for use on the iPhone 3G, 3GS, 4 and 4S, and on iPod touch 2, 3 and 4. Toward the end of testing, an update to the app allowed for use with the iPad and iPhone 5, with a Lightning to 30-pin adapter. We tested this system using the lab’s iPhone 4S.
  • The myglucohealth system will work with most Bluetooth-enabled devices to directly link to the web portal. However, at the time of this assessment, the myglucohealth system only had an Android app. To evaluate this app, we chose the lab’s LG Optimus smart phone.
  • The Telcare system app was designed to work on both Android devices and iOS devices.  We loaded the Android app onto the same LG Optimus cell phone, and the iOS app on the same iPhone 4S. This gave us the opportunity to compare the Android and iOS apps on identical phones, taking the guesswork out of any differences in layout or display.

The following section discusses the devices tested, the assessment plan, and the testing results.

Testing Process – Software Selection:

Because of the limited number of glucometers available for sale in the US that sync with mobile apps, the software selection portion of this assessment was completed when we found the three glucometers that met our hardware criteria (available for use with a smart phone).  The apps are proprietary, created to work only with their own glucometers, making the software selection process automatic.

Testing Plan:

Our main testing goal was to evaluate diabetes apps for ease of use, quality of compiled data, and methods of data sharing.  However, because of the proprietary nature of the apps and their associated glucometers, evaluating apps alone wouldn’t be conclusive without also testing the glucometers themselves.  We tested each glucometer for BGL accuracy and ease of use.

The first evaluation was to determine if the meters measured the same blood glucose level on the same subject when performed at the same time. 

The second component of the assessment, to check the BGL accuracy of the glucometers, was performed on a fasting volunteer who, right after measuring with these three glucometers, had blood drawn for a serum glucose test performed in a laboratory.

Finally, we evaluated the connection and interplay of the glucometers with their mobile apps, and reviewed the functionality of the software. Specifically, we performed the following tasks:

  • Evaluated the ease of data upload from the device to the software.
  • Evaluated the quality of the compiled data for patient and providers.
  • Tested how both patients and providers were able to access the compiled data.