Who made the app for that? Tale of 3 app developers

They were working in their day jobs, but tinkering and programming on the side. If only their smartphones could perform certain functions, they reasoned, life would be easier. So each one created what has come to be known as an app.

For some, app development has turned into a second career. For others, it simply gave their hobby of programming a new focus and direction.

In a March report, Boston research firm Yankee Group said revenue from smartphone applications is expected to top $11 billion by 2014, even though approximately 80% of the apps on the market are free. Many developers offer free apps as a test drive for paid apps. Mobile research firm Chetan Sharma, located in Issaquah, Wash., estimates that by 2012 there will be an average of 50 billion app downloads per year.

This from an industry that most people had never heard of until March 2008, when Apple released its software development kit for the iPhone, letting anyone create and upload apps to a smartphone. Apple launched its first "app store" in July 2008, and smartphone makers have followed with their own kits and stores.

But because Apple and the others have made it so easy to put apps on the market, those who got there early face new obstacles. Michael Schneider, who left his law career in 2008 to pursue app development in the health and wellness market, said getting a new app written about or reviewed used to be easy. But with hundreds of new apps hitting the market each month, it's harder to get noticed. And those that want to earn a living from app development must continually update existing apps or create new ones to stay relevant.

Who are these app developers? American Medical News talked to three who have established themselves in the health and medical area. One is an American physician who put up apps well before they became popular. Another is a Swiss doctor who is torn between app development and a clinical career. And then there's the Dutch doctor who feels physicians should take a leading role in using technology for education. While many Americans are pursuing app development, the non-Americans featured were chosen either because their apps are routinely recognized as some of the best or most downloaded medical apps available or because of their work in advancing mobile medicine.

An American pioneer

Like many students, Gregory Moore, MD, an obstetrician-gynecologist from Richmond, Va., dreamed of making a name for himself by inventing an amazing medical procedure. Little did he know he would achieve his "mini celebrity status" with something he pursues on the side that has nothing to do with a new procedure.

When the Windows Mobile platform launched in 2002, Dr. Moore thought developing an app would be a way to combine his interest in obstetrics, his day job and his hobby of computer programming. After spending $1,000 on the software development kit and a few hundred hours writing a program geared toward pregnant women, he soon declared the project a failure.

"People just weren't into smartphones then," he said. Very few people downloaded the app, making the return on investment of time and money not worth it.

Once smartphones entered the mainstream a few years later, he created apps for other ob-gyns. Then he noticed more and more patients walking into his office with smartphones in their hands. He later determined that "the real market is with patients, not with doctors."

He rewrote his old Microsoft Mobile app for the iPhone platform, calling it iPregnancy. It helps mothers-to-be track stages of development. With an initial average of 150 downloads per day, Dr. Moore was shocked at how successful it was. It routinely makes it to the list of top 50 selling medical apps. It sells for $4.99, but Dr. Moore has plans to develop a light version for free to spark more interest. "Patients come in and say, "Hey, I have your app.' And that is very cool," he said.

But it's tough to run a practice while trying to make a name for yourself in app development. Other developers have similar apps that try to "one-up" iPregnancy. "Then I feel compelled to one-up them, and you have the leapfrog effect. It's a tremendous amount of pressure," he said. "I don't have a lot of free time these days."

A student developer

As a medical student in Bern, Switzerland, Dr. Pascal Pfiffner said he was always looking for ways to make information more accessible and convenient. Before the iPhone, he, like many physicians and students, carried around a Palm Pilot. Dr. Pffifner's Palm was customized to contain the most commonly used reference tools he needed as a student.

When he bought his first iPod Touch (the first generation iPhone was not available in Switzerland), which is basically an iPhone without the phone, Dr. Pfiffner began to transfer one of his most-used reference tools -- the eponyms database -- to a Web-based app that would work on the iPod Touch. The experience was one he enjoyed, and one that later would make him question his goal of entering clinical care.

He went on to create an iPhone version of the eponyms database, which is offered for free in the Apple app store and routinely tops lists for most downloaded medical apps. He later developed a free medical calculator, the MedCal, which also landed on iPhone's most downloaded medical application top rankings. His latest app, KidneyCalc, is for physicians who treat kidney patients. Because this app is targeted to such a small audience but took more effort to develop, it sells for $4.99.

After medical school, Dr. Pfiffner entered an immunology and bioinformatics PhD program. But he thinks he may prefer to help other physicians in clinical care by developing technical tools.

"I really enjoyed the contact to patients during medical school, something I'm definitely missing," Dr. Pfiffner wrote in an e-mail to American Medical News. "On the other hand, I also enjoy developing apps, and it's good to see that people seem to like them and they help them get their jobs done."

Dr. Pfiffner said current time constraints -- including student lab work -- keep him from developing other apps. "Having the privilege to fully focus on app development sounds tempting. The final decision has yet to be made, however."

Pushing for others to develop

Dr. Pieter Kubben, a senior resident in neurosurgery at the Maastricht University Medical Center in the Netherlands, says digital assistance shows the greatest promise for keeping doctors up to date on how to do their jobs.

Dr. Kubben is a physician who not only writes medical software but also pushes for more development of mobile tools physicians can use by researching their effectiveness. His passion for mobile health technology began even before the iPhone was developed.

In 2002, during Dr. Kubben's medical clerkship, he traveled to the U.S. and Canada to see how mobile computing was used in medical education and in accomplishing clinical tasks. He was intrigued by what he saw but concluded that the technology was too expensive. Building on prior programming experience, he duplicated some of the same apps in a free, open-source environment, which earned him two international awards.

Once the iPhone was launched, Dr. Kubben saw great potential in its ability to provide a robust, inexpensive way for physicians to carry a variety of functionalities from multiple applications all in one device.

He has three apps: NeuroMind, SLIC and Safe Surgery, all offered free. NeuroMind, for students and residents, contains anatomical images, differential diagnosis, scoring systems and a text version of the WHO Safe Surgery checklist. SLIC is a clinical decision support system on the grading and surgical treatment of lower cervical spine injury. Safe Surgery focuses solely on the WHO Safe Surgery Checklist. All the apps are free.

"I sincerely believe that the medical profession needs people who are able to bridge the medicine-IT gap," Dr. Kubben said in an e-mailed response to questions from American Medical News.

With more than 700,000 articles indexed in PubMed each year, he said, "One could literally say that there is more than meets the eye when it comes to educational resources."

Dr. Kubben said digital assistance can be the answer, but physicians need to take the lead. He has done much research on the Web 2.0 idea -- using social media -- and how it relates to medicine. He was recently named editor of Neurosurgery 2.0 for Surgical Neurology International, an open-access digital journal.

"Our mind and intellectual capacity has not grown in the same rate as the amount of knowledge we have to deal with. But at the same time, patients request us to provide the best care possible," Dr. Kubben said.

Whatever tool the physician needs, chances are there's an app for it. Or there will be -- soon.