Spark App Launches
What would the ideal app for medical education and communication look like?
The UCSF Division of Cardiology spent three years answering that question, developing the Spark Communicator app, which launched in June 2022. The HIPAA-compliant platform is available to everyone in UCSF Cardiology through the App Store. It combines the best features of Instagram, Slack, WhatsApp, Microsoft Teams and iPhoto, all integrated into a single user-friendly format.
After logging in with their UCSF email address, Spark allows users to easily share and discuss clinical images and cases. They can communicate seamlessly with clinical teams across three hospital sites, even while each team’s members are constantly rotating. The app also allows them to curate UCSF Cardiology “news feeds” tailored to their particular interests.
“There was an opportunity to create a more education-based communication platform where all the things that happened in various silos could be combined into one app, and at the same time improve the way we communicate with colleagues who are spread out across different teams and sites,” said Jeffrey Olgin, MD, chief of the Division of Cardiology and Ernest Gallo-Kanu Chatterjee Distinguished Professor in Clinical Cardiology.
To make this idea a reality, in 2019 he and Atif Qasim, MD, MS, director of the Cardiology Fellowship Program and Echocardiography Core Laboratory, hired Jason Pascoe, PhD, an expert in mobile technology and user interface design. Dr. Pascoe’s previous endeavors included developing app-based walking tours, museum guides, and a mobile tool for ecologists studying giraffes in Kenya. As project manager, he shadowed and interviewed cardiology fellows and faculty members to learn about their needs, pain points and ideas, and also led focus groups. “The key thing was to observe and listen to our end users, so we could understand how they work and the context of their lives as well as possible,” said Dr. Pascoe.
He met regularly with Dr. Olgin and Dr. Qasim, developing and testing prototypes. Dr. Pascoe built most of the code from scratch himself, later hiring two freelancers to help out. “We tried to create a user interface structure that would feel similar to ways of doing things in WhatsApp and other apps that users were accustomed to, so they would have that feeling of familiarity with Spark,” said Dr. Pascoe. “Once they were safely in the app, we also have some innovative new things that can’t be done in other apps.”
Supporting 21st Century Medical Education
“This project initially emerged to fill an unmet educational need,” said Dr. Olgin. “The way our trainees learn now is very different from when people like me trained. Asynchronous learning is much more common, as is learning in little snippets.” For example, many cardiology fellows learn by reviewing “Tweetorials,” a thread of individual tweets on a particular topic, often enriched with hashtags, polls, short videos, and links to other online resources. In recent years, fellows also started creating WhatsApp channels to share interesting cases with one another. However, this resource was only available to those who happened to be members of the group.
There were other untapped educational resources. “On the electrophysiology attendings’ listserv, at least once or twice a week a faculty member will post an email to the group and say, ‘I saw this patient today and would love your input on how you’d handle this case,’” said Dr. Olgin. “These are primarily patient management questions, but there can be 20 to 30 messages back and forth discussing the patient, what different attendings would do, the pros and cons of various options, and what the literature suggests. Unfortunately, there are no trainees on any of these conversations, which have the potential to be a very rich learning opportunity. We wanted to put this content into an environment where anyone in UCSF Cardiology can access and learn from that discussion.”
To harness these opportunities, Spark features several education-centered features. One of them is Images, which allows users to store all medical images in a private, dedicated archive which is separate from their personal photos on their iPhone. Users can add photos to their archive by taking a photo with their iPhone, or importing them from an iPhone album or any file system. The Pen tool allows users to redact patient information as well as annotate an image by drawing circles, arrows or labels to highlight key clinical or educational features. To ensure HIPAA compliance, users are required to confirm that each image is de-identified before it can be shared with others.
Spark has several ways to catalog images, such as organizing photos in folders called Collections, and the ability to star or “favorite” particular images. They can also add searchable tags to each image – such as aortic heart disease, bradyarrhythmias or conduction disease – which can help users quickly find images.
They can post de-identified images using the Channels feature. “It’s a bit like Instagram meets Slack for doctors,” said Dr. Pascoe. In addition to sharing images to one or more Channels – for example, CCU, Echo or Interesting ECGs – they can add a description, note interesting features, or ask a question. Other users then contribute comments to the conversational thread. “People can discuss the case and ask questions, which is different from Instagram, where people mostly just ‘like’ images,” he said. Users can also choose from a number of Reaction icons – for example, teaching pearl, unicorn or classic case – and may repost threads to other Spark Channels or enhance a post’s tags.
Channels has several organizational features, including folders for My Posts and Starred Posts, as well as a section for Favorite Channels, which allows users to tailor their “news feeds” according to their particular interests. “For example, the trainees will probably mostly tune in to the ‘Interesting Cases’ channels, because they’re so busy and have so many other duties,” said Dr. Pascoe.
“These days, especially with COVID, it’s less and less common that everyone is in the same room to be able to spontaneously discuss cases,” said Dr. Qasim. “Spark allows people to share interesting cases with their colleagues across sites in a safe and HIPAA-compliant way, and to ask, ‘Hey, what do you think of this?’ The app creates a separate bank of images that aren’t mixed in with your iPhone pictures of family or friends. Another advantage is that all those cases are saved for future use, and can be easily looked up if you’re giving a presentation or are on rounds and want to show an example of something. You can also search for cases that may be similar to the case you’re seeing right now, and review a thread to see how previous cases were handled, or what people said at the time. It’s a useful way to organize cardiology content, which currently is spread out over many different systems and learning platforms.”
Another goal of the app is to lower the bar for communication. “Some people may be less likely to post things on Twitter, because the entire world can see what you’re saying,” said Dr. Qasim. “This is a smaller community of people you know, which may help people feel more comfortable asking ‘silly’ questions, or putting their nickel down on a diagnosis. We hope that will support more engagement across different levels of learners.”
“I’ve enjoyed testing the app so far, especially the Channels feature, and look forward to integrating this with fellow education!” said Aarthi Sabanayagam, MD, a clinician-educator and subspecialist in adult congenital heart disease.
Spark also addresses another challenge: how to communicate efficiently across three main campuses and health systems – UCSF Health at Parnassus, Mission Bay and satellite clinic sites, Zuckerberg San Francisco General Hospital (ZSFG), and the San Francisco Veterans Affairs Medical Center (SFVAMC). This is especially challenging when the teams of attending physicians, fellows, residents and medical students are constantly changing depending on rotation schedule, vacations, and sick days. For example, until now, a ZSFG faculty member with a patient who needed to be seen at Moffitt Hospital for an electrophysiology (EP) study would need to start an arduous chain of communications, asking his or her fellow to find out who the EP attending physician at Moffitt was and relay important clinical information.
“What should happen is that the cardiology attending at the General sends a message to their team and the EP team saying, ‘We have a patient who needs to go to Moffitt for an EP study, and here is his EKG,’” said Dr. Olgin. “One communication. Everyone who needs to see it receives the message, and there can be a back-and-forth visible to everyone, without having to relay the message.”
To help meet these needs, Spark offers several features. The Messages tab allows users to engage in private conversations with individuals or groups. It functions very much like the iPhone Messages app and includes a chronological list of conversations with the time of the most recent message and the list of people on each thread. Users can easily send messages to fixed groups, such as first-year general cardiology fellows. To send a new message, the user can also search by the recipient’s first and last name, as well as by site, section and position – for example, whether they are an attending, fellow or resident.
Perhaps the most technically complex and novel feature is Team Chats, which shares some similarities with Microsoft Teams and Slack, but is customized to the workflow of a busy, multi-site clinical enterprise whose team members are continually changing. Users can join a team by selecting the site and team name – for example, adult congenital heart disease at UCSF Health, or interventional cardiology at the SFVAMC. They can join as many teams as they like, and will receive all notifications related to those teams. Because faculty and trainees are constantly rotating on and off various services, they can easily join a team when they start a rotation, and leave a team when their assignment ends. Spark also notes when each member joins or leaves a team, so everyone knows who is currently on board.
“There are many other communication platforms out there, but many of them have limitations and don't function the way we need for medical teams that have many different levels of providers coming and going each month,” said Dr. Qasim. “Real-time communication is essential for clinical teams. Our app takes away the need to have to find out who is on call for a service or need. Instead, you can just message an entire team – like the cardiac catheterization lab – to talk about the cath schedule for the day.”
“The best feature of the Spark app is being able to send out a message to a defined group, such as the Cardiology Inpatient Service at San Francisco General to the Electrophysiology Consult Service at Parnassus, without having to look up who is on call and manually texting multiple individuals,” said Adam Lee, MBBS, a cardiac electrophysiologist based at Parnassus.
When members join a team, they can access previous conversational threads to get up to speed about a particular patient or topic. “When you first join a team, you see the top level of the current conversations, which you can judge by the subject fields,” said Dr. Pascoe. “You can also easily take a look at what people have been discussing.”
Because some members may want to follow a particular patient or topic even after their rotation ends, if they star a particular conversation, they can continue to participate in that thread even when they are no longer on that team. “People will continue to receive notifications from their starred Team Chats, but will no longer hear about other topics until they rejoin that team,” said Dr. Pascoe.
As the director of the Cardiology Fellowship Program, Dr. Qasim is particularly interested in how Spark could help trainees build a sense of community. For example, both trainees and faculty can use their profile section to post a photo of themselves, describe their clinical and research experience, and some of their academic and personal interests. “It incorporates aspects of social media and Facebook, where you can easily look people up,” he said. “Every two to four weeks, trainees rotate to a new service and have to work with complete strangers. This could help people connect with the greater community. It also makes it easier for someone to write to someone like Dr. Mel Scheinman to say, ‘I’m the resident on Cardiology A. Our team wanted to ask you this electrophysiology question.’ Whereas you might not message him out of the blue and know his area of expertise, unless someone explicitly told you.”
Designed to Scale
About 20 people helped to beta test Spark, and the plan is to have universal adoption among more than 200 users, including all UCSF cardiology faculty and fellows, as well as residents and medical students who are currently on a cardiology rotation. “Spark will not necessarily replace all the other tools we use for clinical communication, but ideally it will harmonize the way we interact with our colleagues and trainees around educational and patient management discussions,” said Dr. Olgin.
To his knowledge, Dr. Pascoe said that there are no other apps like Spark which integrate all these features and are tailored to cardiologists’ workflow. “This is a work in progress, and we’re very interested in what people think of it, and their ideas of what they’d like to see changed or added,” he said. Users can give input through Spark’s Feedback channel, by messaging him through the app, or by sending him an email.
“With the feedback we receive, we’ll make additional adjustments,” said Dr. Qasim. “With anything in education or product development, you need to continually iterate to make sure it stays relevant.”
Spark was designed with the ability to scale. “We’re hopeful that trainees with other UCSF programs, and eventually other institutions across the country, will be able to use Spark,” said Dr. Qasim. “It’s nice to have one platform that allows you to communicate with providers in your field, and also to see what’s going on in terms of education. This app collates a lot of different sources of information into one.”
Even though Spark addresses a huge unmet need, Dr. Qasim is not surprised that nothing quite like it has been developed until now. “We created this app from the ground up, after many hours of focus groups across different groups of fellows and faculty,” he said. “Each feature has been purposefully built to be most useful for the clinical and educational environment. It takes a massive amount of effort and resources to create something like this. You’ve got hundreds of people at companies like Facebook and Apple who work on just one aspect of one app. It’s a daunting task. My hat is off to Jason and the small team he created. Our division has been very fortunate to have the funds, resources and foresight to design and create Spark. We’re all trying to find solutions for how to communicate in a safe, effective manner, and this is something that people have been yearning for.”
- Elizabeth Chur