Appendix 2: The eGVHD App

Abstract

Blood and Marrow Transplantation Long Term Management: Survivorship after Transplant, Second Edition. Edited by Bipin N. Savani and André Tichelli. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. In our hyper‐connected world, healthcare professionals increas‐ ingly turn to Apps and other software to access medical informa‐ tion and support their decision‐making process [1]. Such tools are considered useful and reassuring for clinicians [2]. They have the potential to improve work efficiency by bringing evidence‐based medicine principles to the point of care, thereby improving the fre‐ quency, accuracy and completeness of medical documentation, even in resource limited settings [3]. The eGVHD App was designed as an algorithm‐driven applica‐ tion, or electronic tool (eTool), to help clinicians apply the interna‐ tionally recognized criteria for the assessment of GVHD [4]. The eGVHD App is not a medical tool aiming at replacing the diagnosis of a clinician, but it is intended to be used as a user‐friendly educa‐ tional tool or diagnostic aid. It presents the information necessary to assess GVHD through an electronic interface. Once the user has filled in the electronic forms, the App makes an automatic summary and informs the user on the type of GVHD and its severity accord‐ ing to the appropriate set of evaluation criteria. The eGVHD app has a consistent layout (Figure A2.1). Regardless of the type of assistance needed (diagnosing or scoring), the user navigates between nearly identical screens, which display the essential features required for GVHD assessment, sorted by organs (one screen corresponds to one organ). The user can access glossary terms/illustrations as needed and can choose whether or not to display additional detailed items (which are usually reserved for research use and do not have a direct impact on diagnosis or scoring). Once all relevant fields have been completed, the user uses the ‘calculator button’ to receive a detailed report of the information entered with an automatic calculation of the diagnosis or score. The App was designed based on a “human centered design” methodology: at each step of the development process was reviewed by IT (information technology) experts, GVHD experts and users to ensure optimal function and usability of the tool. The feedback gathered during each stage was integrated into the development of the new version of the App. The validation process occurred in three consecutive steps, in which GVHD clinical vignettes were evaluated by professionals with and/or without the App. The first phase was a local pilot testing, aimed at giving a proof of concept of the added value of an electronic tool for GVHD assessment and to provide usability feedback to support further development [5]. Once an improved version of the App was available, the generaliz‐ ability of the pilot test was extended by performing a similar workshop in a group of healthcare providers from the European hematopoietic stem cell (HCT) community at the annual European Society for Blood and Marrow Transplantation (EBMT) congress in 2017 [6]. Finally, a formal validation of the eGVHD App was done in a randomized fashion, by comparing the GVHD assessment per‐ formance of healthcare providers using the App, compared to using standard of care methods (in this control group, participants were allowed to use any method of their choice to support their GVHD assessment, except for using the eGVHD App)[7]. This demon‐ strated that the accuracy of GVHD assessment of clinical vignettes by healthcare professionals was significantly higher when using the eGVHD App. This effect was seen for both acute and chronic GVHD (cGVHD), across all severity levels (except for aGVHD grade I), all degrees of experience and professional backgrounds and without any evidence for center effect. Compared to other smaller‐scaled initiatives, which have shown successful implementation of eHealth technologies to assess GVHD in local electronic medical record systems [8] or specific research programs [9,10], the eGVHD App is now ubiquitously available for all healthcare professionals who wish to have bedside user‐friendly assistance in their GVHD assessment, to improve their expertise and/or the uniformity of their GVHD data collection, both in daily practice and in clinical trials. The eGVHD App was officially launched on AppStore and GooglePlay in February 2018 as a free‐ of‐charge educational tool for healthcare professionals (Figure A2.2) to be used on mobile devices or accessed by standard web browsers such as Google Chrome (https://www.uzleuven.be/eGVHD) from any device, including desktop computers. Its uptake in the interna‐ tional HCT community is good, with more than 4500 downloads to date over 45 countries across six continents (Figure A2.3). A critical issue to be addressed by the eGVHD App in the future is the need to allow for longitudinal data‐collection for individual patients over time. This data capture should ideally be directly transferrable to electronic medical records and allow for the evalu‐ ation of disease evaluation over time (including aspects such as disease evolution and response to treatment for instance). APPENDIX 2 The eGVHD App