Co-Design of an Electronic Patient Record-Integrated COPD Self-Management App: The My Lung Health Coach Companion

Digital self-management interventions can improve outcomes in COPD, but many are standalone applications that lack care integration, limiting usability, adoption, and sustainability. Embedding such tools within electronic patient records (EPRs) may overcome these barriers, but few COPD interventions have taken this approach.

We used a user-centred design process to develop and refine a companion application for the My Lung Health Coach COPD self-management program within the Epic Care Companion platform. First, we developed and face validated a prototype with respirologists and program managers. Next, we iteratively improved the app following focus group and stakeholder evaluations, using a Plan-Do-Study-Act (PDSA) approach. Usability was assessed using the System Usability Scale (SUS) and Likert-style ratings, with qualitative feedback analyzed thematically and mapped to design changes.

Four focus groups (n=7) and two stakeholder meetings were conducted iteratively across six PDSA cycles. Initial usability was low but improved following iterative modifications, reaching "excellent" levels. Likert ratings indicated high satisfaction with functionality and content. Thematic analysis identified key adoption enablers: readability, simplicity, supportive tone, clinician endorsement, and training. Specific modifications included enlarging text, simplifying navigation, rephrasing judgmental language, and clarifying wording. To facilitate use in a future clinical trial, a training module was developed. Integration into Epic ensured data security, workflow alignment, and future scalability.

Through iterative co-design, we developed an EPR-integrated COPD app with sustained usability improvements. Embedding patient and stakeholder feedback throughout development produced a clinically aligned and highly usable tool to complement virtual COPD self-management. This approach addresses longstanding limitations of standalone digital health tools and provides a scalable model for integrating patient-facing digital interventions into routine chronic disease care.