Proceedings of the 8th Australasian Workshop on Health Informatics and Knowledge Management (HIKM 2015), Sydney, Australia, 27 - 30 January 2015 Evaluation of Cross-platform Development Tools for Patient Self- Reporting on Mobile Devices Hyung Jin Kim1 Sudara Karunaratne1 Holger Regenbrecht2 Ian Warren 3 Burkhard Claus Wunsche 1 Department of Electrical and Computer Engineering University of Auckland, Auckland, New Zealand, [email protected], [email protected] 2 Department of Information Science University of Otago, Dunedin, New Zealand, [email protected] 3 Department of Computer Science University of Auckland, Auckland, New Zealand, [email protected], [email protected] Abstract to empower health consumers to better manage and monitor their health, e.g., by proving self-reporting tools. Western societies are aging rapidly and novel solutions A recent survey found that 75% of physicians believe must be found to make healthcare more effective and that patient self-tracking is tied to better health outcomes affordable. One step towards this goal are mobile (Manhattan Research 2013). Self-reporting provides applications for patient self-reporting. The tools healthcare professionals with improved monitoring data, provide healthcare professionals with improved whereas patients benefit from a reduced number of doctor monitoring data, whereas patients benefit from a visits and improved diagnosis and interventions. So far reduced number of doctor visits and improved diagnosis self-tracking data is obtained primarily using low-tech and treatment. In order to make self-reporting tools as methods, such as patient handwriting the data accessible as possible they must be affordable, easily (Manhattan Research 2013). accessible, and easy to use. Smartphones are an ideal In order to make self-reporting tools effective they platform for patient self-reporting tools, but must be affordable, accessible, and easy to use by both development is made complicated by the lack of patient and doctors. Smartphones are an ideal platform standardised operating systems and development for patient self-reporting tools, since they are frameworks. In this paper we evaluate popular cross- readily available, already in widespread use, very platform mobile application development tools. They affordable (< 50 US$ for entry level Android devices), are evaluated against a generalizable simple patient and many patients are already familiar with their self-reporting application scenario called interface. It has been demonstrated that “Feelometer”. We show that PhoneGap is currently smartphones are able to deliver health improvement one of the most suitable technologies for that purpose. interventions to traditionally hard-to-reach It creates applications of similar look and feel as populations (Agarwal & Lau 2010). natively developed applications. However, memory Development of mobile applications is made usage and application startup time are worse than for complicated by the lack of standards associated with natively developed applications and not all necessary healthcare applications, and the lack of standardised functionalities for telehealth applications are operating systems and development tools. In order to supported. maximise usefulness a self-reporting tool should run on Keywords: cross-platform development, mobile all common mobile phone operating systems. A web- applications, patient self-reporting, mHealth based interface might appear to be an easy solution, however, is not practical since it limits access to certain 1 Introduction mobile phone functionalities and would only be available The healthcare systems in many developed countries are when an Internet connection exists. under pressure due to an increasing number of elderly Over the past few years several cross-platform people and more chronic diseases affecting them (World development tools for mobile applications have emerged. Health Organisation 2006, Machlin 2009). One approach In this paper we evaluate popular cross-platform mobile to make healthcare more effective and more affordable is application development tools by using as example a ____________________________ simple patient self-reporting tool called “Feelometer”. Copyright © 2015, Australian Computer Society, Inc. This Section 2 reviews current popular cross-platform paper appeared at the 8th Australasian Workshop on Health development tools for mobile applications. Section 3 Informatics and Knowledge Management (HIKM 2015), summarises previous work evaluating cross-platform Sydney, Australia, January 2015. Conferences in Research and development tools and mobile applications for self- Practice in Information Technology (CRPIT), Vol. 164, reporting. Section 4 presents a requirement analysis, Anthony Maeder and Jim Warren, Ed. Reproduction for which is used to motivate the design and implementation academic, not-for profit purposes permitted provided this text is of our solution presented in section 5 and 6, respectively. included. We evaluate different implementations of our application 55 CRPIT Volume 164 - Health Informatics and Knowledge Management 2015 in section 7. We conclude our research in section 8 and 2.1.1 RhoMobile Suite give an outlook on future work in section 9. RhoMobile is a set of products for cross-platform development, consisting of Rhodes for application 2 Background development, RhoConnect for remote integration with Mobile applications can be developed in three servers, RhoHub for application deployment and different ways (Smutny 2012): RhoGallery for application management. Rhodes is Native apps are written for the target platform created using a single code-base written in HTML, using the programming language and tools that are JavaScript and CSS and uses native applications to supported by the platform. For example, native improve end-user experience. Rhodes is open source Android apps are written in Java while native and can be used via a browser with a hosted Integrated iOS apps are written in Objective-C. Natively Development Environment (IDE) or locally with developed apps are fast and reliable and have standard IDEs. Applications can be compiled into access to all of the device’s features. The look Java bytecode for Blackberry or into Ruby 1.9 and feel of native apps also provides a familiar bytecode to be used in all other platforms. One major experience to the users of the platform. The disadvantage of RhoMobile is that it is not very well drawback of writing apps this way is that the documented compared to other tools. Ruby is also a app is made to only work on the platform it is language that we have never used before and as such it written for. would be expected there would be a learning curve. RhoMobile also does not have access to the device’s Web apps are generally a condensed version of a web page to fit on a small screen. This means that Accelerometer which is a useful feature for the they will run on any modern mobile browser “Feelometer” application scenario. regardless of platform. They are built using web 2.1.2 PhoneGap technologies such as HTML5, CSS and JavaScript. Because web apps are not distributed by the app PhoneGap is a mobile application development frame- store and are instead hosted on a server, updates work, which enables development using web-based can be deployed more easily without an update languages such as JavaScript, HTML5, and CSS3. download from the app store. However, web apps Native device capabilities can be accessed via plug- lack the ability to access native device features, ins. PhoneGap applications are hybrid: the UI is limiting the amount of functionality they can have. rendered via web views, but the applications have access to native device APIs and are packaged as apps Hybrid apps are a compromise between web and for distribution and not accessed through the web. The native apps. These apps are developed using web underlying technology behind PhoneGap is known as technologies and then embedded into a native Apache Cordova. PhoneGap is free and openly licensed container. The HTML content is rendered by the under Apache 2.0. device’s browser while the native container The PhoneGap Build service allows uploading of provides access to native platform features. These web-code to the Adobe cloud service to be compiled apps are quicker and cheaper to build than native into targeted mobile OS implementations such as iOS, apps and only a portion of native code needs to be Android, Windows Phone, Blackberry 7, webOS and re-written to make the app work on a different Symbian. platform. They also support a wider range of Reported disadvantages of PhoneGap are that the device functionality than web apps. The drawbacks free developers’ license has limitations, that the of this approach are that the reuse of the user generated code is not as fast as native code, and that it interface means that apps will not have the native does not support the Cappuccino Web Framework for look and feel unless native UI code is written for creating advanced Web applications. each platform. Hybrid apps also suffer in performance compared to native apps because they 2.1.3 DragonRad run on the device’s browser. DragonRad is a database driven cross-platform 2.1 Cross-platform Development Technologies development tool with a unique twist. Using a drag- and-drop GUI for application development, DragonRad In recent years a number of cross platform development tools have emerged. Academic projects facilitates integration and synchronization of database