StrabisPIX: Assessing strabismus from patients’ smartphone photos

strabismus smartphone
(Lapina/Shutterstock)

New smartphone-based diagnostic tools are enabling consumers to take their temperatures, diagnose simple skin conditions and much more. As advanced smartphone imaging puts more and more capabilities in patients’ hands, it’s no surprise that clinicians and numerous digital health startups are leveraging them.

As a case in point, the Department of Ophthalmology and the Innovation & Digital Health Accelerator (IDHA) at Boston Children’s Hospital have co-developed a smartphone application for patients with strabismus, or misalignment of the eyes, to securely capture and transmit photos of their eyes to their providers.

The StrabisPIX App, a HIPAA-compliant photo messaging platform piloting this month, will enable clinicians to remotely monitor and assess eye alignment before and after corrective surgery. In doing so, patients may be able to avoid unnecessary follow-up visits by interacting with their provider, remotely and on their schedule.

A mobile design challenge

Working with ophthalmologist David Hunter, MD, PhD, the IDHA development team sought to understand the complex process of capturing the nine diagnostic positions of eye gaze. While simple to conduct in clinic, this routine diagnostic test presented numerous design challenges when creating a self-guided app for a patient’s smartphone.

After testing a variety of instructional diagrams and written directions, the team designed a guided tool that takes patients through the complex workflow of posing for and capturing the nine diagnostic images: eyes up, down, left, right, straight ahead, etc.strabismus assessmentFor providers on the other end, it was important for images to be captured at a consistent distance and presented uniformly. Through the use of camera guide overlays, patients are instructed to frame their eyes within a blue box, enabling images to be captured and cropped for consistent display in the provider’s dashboard.

A familiar experience for patients

strabismus assessmentWe wanted patients to feel a familiarity while navigating StrabisPIX. To achieve this, the app’s navigation and technical features were designed to be consistent with popular social networking and content apps. And since both adults and children are treated for strabismus at Boston Children’s, the app uses simple instructional diagrams.

After patients complete their image capture, they can securely send the images with a message to their clinician for review.

Clinician- and workflow-friendly

On the provider end, the images are linked to a patient profile and automatically resized for ease of viewing and diagnostic assessment, giving clinicians and support staff a one-page view of any patient who is active in the system. When a new set of images comes in, the provider is notified, and the app confirms that the new submission has been reviewed and then indicates whether the patient has received a timely response. Doctors can follow and compare a sequence of images submitted by the same patient over time.

We were concerned that doctors and staff might be burdened with many questions about how to use the app. To handle this in advance, we built in a suite of self-help tools that will let families resolve most questions with a single tap.

Innovating with mobile: a scalable strategy

By building the StrabisPIX app, we have also created an infrastructure to support future clinical and research specialty use cases. Three attributes were key:

  • Accessibility: The patient app was designed to be compatible with iOS and Android devices and will soon be available via the App Store and Google Play. Access is restricted to approved patients at Boston Children’s, but the eventual goal is for it to be used by other practices and hospitals. The provider dashboard is integrated with Boston Children’s IT infrastructure for easy, secure access using hospital credentials.
  • Scalability: Mastering the complexity of capturing eye gaze images allowed us to build the technical infrastructure to support almost any form of image capture in the future.
  • Patient-friendly interface: The design, language and imagery are familiar, simple to use and accessible for all users.

The ubiquity of smartphones among patients and families makes them a key platform for innovative care delivery. As a large care delivery organization, Boston Children’s is uniquely positioned to support the future of mobile innovation. Long-term, we plan to expand from ophthalmology to other clinical specialties needing a secure way for patients to send images to their provider.

murphy_matthewMatthew Murphy is Innovation Lead with the Innovation & Digital Health Accelerator (IDHA) Program at Boston Children’s Hospital. For more more information on StrabisPIX or the IDHA Digital Core, send us an email.