Implementation of a Personalized Digital App for Pediatric Preanesthesia Evaluation and Education: Ongoing Usability Analysis and Dynamic Improvement Scheme
Authors: Connelly Yaron , Lotan Roni , Brzezinski Sinai Yitzhak , Rolls Dan , Beker Amir , Abensour Eilone , Neudorfer Orit , Stocki Daniel 
Published: April 2022

Background
Preanesthesia evaluation is a basic practice preceding any surgical procedure, aimed at tailoring individualized anesthetic plans for patients, improving safety, and providing patients with educational knowledge and tools in preparation for the surgery day. In the last 2 decades, eHealth and mobile health (mHealth) settings have gradually replaced part of the face-to-face encounters as the platform for preanesthesia communication between doctor and patient, yielding a range of benefits as demonstrated in recent publications. Nevertheless, there is a lack of studies examining the effectiveness of surgical mHealth apps focusing on the pediatric preanesthetic setting and addressing their usability among families.

Objective
This study describes a dynamic approach for the development process of GistMD’s preanesthesia mHealth system, a mobile-based educational and management system designed for the pediatric setting.

Methods
The study was conducted in 4 departments at a 1500-bed quaternary, academic medical center in Tel Aviv, Israel. During the study period, the link to the preanesthesia system was sent via SMS text messages to families whose children were about to undergo surgery. The system included preanesthesia questionnaires, educational videos, downloadable instructions, and consent forms. Continuous collection and examination of usability data were conducted during the implementation term including responsiveness, effectiveness, and satisfaction indicators. The information collected in each stage was used to draw conclusions regarding potential usability gaps of the system and to plan product adjustments for the following period.

Results
During 141 days of implementation, the link to the GistMD preanesthesia management system was sent to 769 families, and product-fit actions were implemented during this term: (1) changing text message scheduling for addressing learnability and accessibility, resulting in a significant increase of 27% (χ21=12.65, P<.001) in view rates and 27.4% (χ21=30.01, P<.001) in satisfaction rates; (2) reducing the number of screens to increase efficiency and operability, leading to a significant decrease of 8.6% in cases where users did not perform any activity on the system after logging in (χ21=6.18, P=.02); (3) conducting a patient-focused campaign in 2 departments aimed at addressing memorability, leading to significant increases in 8 of the 12 usability indicators.

Conclusions
Our results indicate that mHealth product-fit decisions originating from theory-based approaches and ongoing usability data analysis allow tailoring of the most appropriate responses for usability gaps, as reflected in increased use rates and satisfaction. In the case of the preanesthesia management system in the pediatric setting, increased usability conveyed important benefits for patients and families. This work suggests a framework and study methods that may also be applicable in other mHealth settings and domains.