Making the most of mobile technology: To app or not?

Categories: Education.

But amid the hype and excitement of the “next big thing,” many hospices are spending a lot of marketing money to create an app without first considering important communication basics:

  • Who are the primary users of mobile?
  • What makes mobile devices different from a desktop computer?
  • How are mobile devices used most?
  • What do you want users to do when they connect with you via mobile?

This article helps you answer these questions. It also offers guidance for HIPAA screening of vendors and making the decision between a native app or Web app.

Who is Using Mobile

Pew Internet and American Life inarguably supplies the best data anywhere on the usage patterns and demographics of adults in the U.S.1

  • 90% own a cell phone
  • 58% own a smartphone
  • 42% own a tablet

A Closer Look at Smartphone Users

As with many innovations, adoption of smartphones is strongly influenced by age:

  • 18-29 year olds: 83% own a smartphone
  • 30-49 year olds: 74% own a smartphone
  • 50-64 year olds: 49% own a smartphone
  • 65+: 19% own a smartphone

    But education level and income are strong factors in smartphone ownership. Seven out of ten college graduates own a smartphone as compared to less than half of persons who have a high school diploma or less:

    • High school diploma or less: 44% own a smartphone
    • Some college: 67% own a smartphone
    • College+: 71% own a smartphone

    Similarly, smartphones are more popular among adults in higher income brackets:

    • Less than $30,000/yr: 47% own a smartphone
    • $30,000 – $49,999: 53% own a smartphone
    • $50,000 – $74,999: 61% own a smartphone
    • $75,000+: 81% own a smartphone

    Based on these data, developing a mobile app for your patients or their family caregivers doesn’t make much sense. At best, less than half of elder caregivers are using a smartphone, with the possible exception of those living in tech-heavy, highly educated urban centers such as Silicon Valley, Seattle or Boston. These caregivers might expect the ability to access information and learn about your organization via their mobile devices.

    Your referrers seem to be the real audience for mobile technology since they more closely fit these age, income and educational demographics. The medical profession, in particular, has been especially quick to adopt mobile technology.

    For example, Manhattan Research determined that 81 percent of doctors own a smartphone while 62 percent own a tablet. Worthy of note: 75 percent have chosen to purchase an Apple device (iPad, iPhone or iPod).2,3,4

    If you want to stay connected with your medical referrers, you need to offer mobile options for interaction.

    What Makes Mobile Different

    From a technological point of view, “mobile” refers to highly portable devices that are, essentially, mini-computers. Both tablets (e.g., the iPad) and smartphones (e.g., iPhones, Android phones) fall into this category and share seven characteristics:

    • they are small
    • they are lightweight
    • they have a touch screen rather than a mouse for input
    • they have very little room for storage
    • they serve to connect you to the Internet, where the information actually lives (aka “the cloud”);
    • they have a GPS device that enables the user to retrieve information about resources that are physically close to where he or she is at any given moment (called “location-specific data”)
    • they have cameras.

    Mobile technology is in the early stages of evolution, so there are a variety of platforms and little standardization among them. This has resulted in compatibility issues which you may have already encountered firsthand (e.g., an app for the iPhone will not work on an Android phone). Over time, things will sort out and these difficulties will be minimized. But in the interim, they need to be accommodated.

    How People Use Their Mobile Devices

    In an insightful post on his technology blog, Luke Wroblewski, author of Mobile First, rather humorously describes the four main activities performed on mobile devices:

    Explore/Play:  “I have some time to kill and just want a few idle-moment distractions.”

    I don’t see a hospice offering much that would be enticing for this type of user.

    Lookup/Find:  “I need an answer to a question now [e.g., I have a meeting at 1:00 and I can’t find the office I’m looking for].”

    Typically in hospice, people are not coming to your office. In fact, you are more likely to go to your referrers than they are to come to you. The geographic-locator benefits of mobile, therefore, are probably not as pertinent for your hospice as they might be for retailers or other professionals.

    That said, a referrer who is away from the office or at the hospital bedside may want a way to find your contact information and possibly something about your range of services. This could be accomplished very inexpensively with a specially laid out landing page for mobile devices that provides this basic information.

    Given the strong look-up activity on smartphones and tablets, your mobile Web presence should focus on content marketing, where you offer bookmarkable, online resources that make your referrer’s job easier. Such resources might include criteria for hospice eligibility, how to start the hospice discussion, and perhaps even a formulary of medications you offer through your pharmacy program.

    Check In/Status:  “Something important to me keeps changing or updating and I want to stay on top of it [e.g., stock market or baseball scores].”

    There are not many reasons why a referrer would need to check in with you so regularly. The exception is if you have electronic medical records where it might be convenient to have quick, anytime-from-anywhere access to lab results, updated medication schedules, or perhaps the schedule of nurses, volunteers or home health aides coming to the home. (For this type of access, you will need safeguards in place to ensure compliance with HIPAA, such as unique log-ins. Rather than build an app yourself, contact your EHR vendor and ask them about providing mobile access. It is best to work off of the compliance infrastructure they already have in place.)

    Edit/Create:  “I need to get something done now and I don’t want to wait until I get back to the office [e.g., make a referral].”

    Here is where mobile technology really shines for hospice.

    Using Mobile to Facilitate Referrals
    This is far and away the smartest task to mobilize. It’s where the anytime/anywhere advantages of mobile take off!

    Imagine your referrer is at the bedside, in the exam room (or on the golf course!). When the discussion with the patient and family results in a decision to go with your services, the referrer can simply tap your logo on the home screen of his or her smartphone and be taken to a HIPAA-compliant referral form. Of course, you need to have the technology in place to assure the appropriate HIPAA safeguards, but with the right protections, you can remove barriers so referrers can choose you no matter where they are. [See section at bottom on HIPAA Compliance).

    Because mobile technology includes touchscreen capabilities, the doctor can also tap/check a certification statement and then use his/her finger to sign on the phone. The software is now available to deliver you a signed Physician Order for treatment.

    In these busy times, it’s often the hospice which is the “easiest to refer to” that gets the referrals — and it doesn’t get much easier than tapping the screen.

    So Should You Develop an App?

    Clearly the answer is “yes” if you are looking to connect with referrers. And the simplest, most on-target app would offer your referrers just-in-time look-up references (e.g., hospice criteria, how to start the hospice conversation), and the ability to easily accomplish repetitive activities such as making a referral. You can add other features on top of these, but such extras (e.g., video tours of your hospice house) would be very expensive relative to the actual likelihood they would be used on a repeated basis.The more important question is whether to create a “native app” or a “Web app.” Research from noted usability experts, the Nielson Norman Group, provide some valuable insights in this regard.5

    Native App
    This is a very limited program that you download from iTunes if you have an Apple device or from Google Play if you have mobile devices running on the Android operating system. Referrers who have a Windows phone will download their apps from the Windows Phone Store.

    Each platform has its own licensing regulations and coding languages. Thus, for dissemination, you will need to develop three distinct apps (one for each store). This makes native apps very expensive to develop and difficult to update if you want to make changes. Even the smallest change will require revisions on three different files.

    Web app
    This is a regular website that can detect the size of the screen where it is being viewed and adjust the layout of the pages to look good on whatever device is used. The viewer accesses the Web app via the browser on his or her smartphone or tablet (e.g., Safari, Google Chrome), so there is no need to download anything. As a developer, you simply make one “responsive design” website and referrers can view it from any device, including a regular desktop computer.

    The Pros and Cons of Each
    A native app is more expensive to develop, but includes features that may be important to you:

    • It utilizes all the phone’s functions (e.g., GPS locator, the camera). Do you need these functions for the app you have in mind?
    • Once you have downloaded it, you do not need Internet access to use it since all the programming exists “natively” on the device. Do your referrers typically work in remote situations where Internet access is not available?
    • A native app may run a little bit faster than a Web app, but this is only an issue of concern with fast-paced activities such as games, or with very large files like videos. Are there functions you are planning to include that depend on split-second speed? Are any large files on your app truly necessary?

      The benefits of a less-expensive Web app include the following:

      • There are no licensing fees and no approval processes to go through. Lead time is less during development as you only need to make one version of the app (versus three for the native app).
      • Updating or adding features is simple. You only need to make the change once.
      • Referrers on a desktop computer can access your referral form, hospice criteria, etc. If these materials were built into a native app, you would need to build them yet again on a website if you wanted referral sources to also have access to them from their desktop computer.

      In Summary

      As you consider developing a mobile app, be very clear about your target audience and your objectives for leveraging this medium. Make sure the app will also accommodate what we know to be important functions:  quick look-up and accomplishing repetitive tasks. And if your app will include access to protected health information, you’ll want to be sure it’s HIPAA-compliant.
      Consider a native app if:

      • You can afford from $4,000 to $8,000 for development;
      • Your referrers work in an environment that does not have Internet access;
      • You don’t mind that your referrers will be unable to access your resources from their desktop computer (or you are willing to build a separate website for desktop users);
      • Your desired features require phone functions like GPS or a camera, or very large files; and
      • You do not anticipate needing to update or make changes often.

      Consider a Web app if:

      • You only want to invest from $2000 to $3000 for development;
      • Internet access is generally available in your service area;
      • You want referrers to be able to access your resources from any device, including a desktop computer;
      • You do not need to include large files or draw upon the phone’s special functions (GPS or camera); and
      • You want the option to update the site regularly.   


      Ensuring HIPAA Compliance

      Whether you go with a native app or Web app, it will be prudent to contract with a developer well-versed in HIPAA compliance. Here are a few questions to pose during the vetting process:

      • What Internet Service Provider (ISP) do they use and does it specialize in hosting HIPAA sites?
      • In terms of a security breach, what special protections do they have in place? 
      • Will you be able to get a log of who has accessed information from the app? (This is a HITECH requirement.) 
      • Does the developer/hosting service carry cyber liability insurance in the (hopefully unlikely) event of a breach?

      And of course, you will want to have the developer sign a Business Associate Agreement 



      Tasha Beauchamp is the Webmaster and research scientist for Elder Pages Online, LLC. She has been creating digital marketing resources for hospices since 2001. This article was originally published in NHPCO’s NewsLine, Fall 2014.


      1. Pew Internet and American Life Project (January 2014) Mobile Technology Fact Sheet (Retrieved on 6/28/14).

      2. Manhattan Research (2012) Taking the pulse: How has the physician mobile landscape changed in 2011? (Retrieved on 7/8/14).

      3. Manhattan Research (2012) Taking the pulse: New study reveals physicians’ device and digital media adoption rapidly evolving (Retrieved on 7/8/14

      4. Horowitz, Brian T. (May 6, 2011) 75 Percent of Physicians Prefer Apple iPad, iPhone: Survey (Retrieved on 9/1/12).

      5. Budiu, Raluca (2013). Mobile: Native apps, Web apps and hybrid apps (Retrieved on 7/8/14).


      Leave a Reply

      Your email address will not be published. Required fields are marked *