mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App

Abstract

Background: The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler.

Objective: This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use.

Methods: The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders.

Results: DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients' vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed-days saved.

Conclusions: The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges.

Keywords: COVID-19; Telegram service; app development; clinical care; continuity of care; digital health; hospital-at-home; mHealth; mobile app; mobile health; rapid development; remote care; virtual care.

Figure 1

Rapid Application Development process.

Figure 2

Overview of the Singapore General Hospital COVID Virtual Ward (SGH CVW) workflow.

Figure 3

Registration for DrCovid+ via FormSG. FIN: Foreign Identification Number; NRIC: National Registration Identity Card; SGH: Singapore General Hospital.

Figure 4

Dashboard for verification and confirmation of enrollment. NRIC: National Registration Identity Card.

Figure 5

Welcome message on DrCovid+. SGH: Singapore General Hospital.

Figure 6

Reminder push message for vital signs submission. SGH: Singapore General Hospital.

Figure 7

Vital sign updating form on FormSG. NRIC: National Registration Identity Card.

Figure 8

Clinician dashboard for patient's vital signs tracking. BP: blood pressure; HR: heart rate; I/C: in charge; NRIC: National Registration Identity Card; SPO2: oxygen saturation.

Figure 9

(Test message) Interface for drafting tailored messages.

Figure 10

(Test message) Interface for scheduling tailored virtual meetings. NRIC: National Registration Identity Card; SGH: Singapore General Hospital.

Figure 11

Example of a tailored message on Telegram services. SGH: Singapore General Hospital.

Figure 12

Example of a scheduled ZOOM meeting on Telegram services. SGH: Singapore General Hospital.