Together is a mobile app designed to help cancer survivors transition between healthcare providers and treatment stages. Version 1 will be released for iPhone in August and focuses on facilitating communication between survivors, caregivers and providers through a secure "Care Conversation". It was co-designed over 6 weeks with input from survivors, caregivers, providers and experts to create an intuitive interface addressing key pain points around care coordination and transitions. The app leverages cutting edge design, security and data integration to provide a HIPAA-compliant personal health record and enable sharing of sensor data from devices.

1. Together
The life companion for cancer survivors

2. 1. Ubiquitous Platform
The first version of Together is on iPhone. We are building a version for web and
iPad. We plan to release version 1 to the Apple App Store in August.
● Version 1: iPhone
● Next: Web version
● Advantage of mobile first
○ Easily used at a doctor's visit (can you imagine logging into a computer in
the doctor's office?)
○ Convenient data portability
○ Identity authentication using cell number in combination with password
○ 13,000 medical apps in App Store
■ Widely used resource for health IT innovation

3. 2. Transitions
Version 1 is designed with Transitions in Care at the core. Together unites all
members of the healthcare team to help Survivors transition between specialists
and primary care providers.
We worked hard to create a HIPAA compliant tool for collaborative and seamless
communication between Survivors, Caregivers, and all multiple Providers.
Introducing the Care Conversation - the essential tool for Transitions of Care.
● HIPAA Compliant
● Enterprise - level
● Team-based communication
● Care team directed by the Survivor
● Unites Providers and Caregivers for Survivor-centered care

4. Collaborative Care
Care Conversation is a secure platform
for collaborative care. One conversation,
everyone who matters.
Care Conversation:
● Patient can invite multiple providers
into chat thread to have questions
answered and create a patient-
centered dialogue.
● Invite family, friends, surrogate
decision makers into care
conversation.

5. 3. Usability & Design
Together is designed by Survivors,
Caregivers, Providers, Professional
Designers, User Experience, and User
Interface experts:
● Standard conventions for easy-to-
understand interface.
● Makes complex communication
between patients, healthcare
providers, and family members
simple and clear.
● Final design was product of testing
by over 50 co-designers: patients,
caregivers, and providers = optimal
usability!

6. 4. Co-design
Design team:
● Survivors! We worked directly with our
team Survivor and using LinkedIn. We
received direction and input from over
20 Survivors during the design process.
● Specialists: The co-design effort included
surgeons, oncologists, dermatologists.
● Primary Care: we gathered input from
primary care providers to determine
needs and hone design.
● Family Members and Caregivers: We
canvassed, surveyed, and spoke to over
20 caregivers - professional and
nonprofessional.
Together was a joint effort by all end users:
Survivors, Providers, and Caregivers!
To determine where to start, our team
dissected the problem into
communication, medication adherence,
surveillance and monitoring. We only had 6
weeks to build the first version of Together, so
we wanted to tackle what Survivors felt to be
the biggest pain point first.
We surveyed over 20 survivors to
determine where to which piece was
essential to version 1. Our surveying and
canvassing revealed that transitioning
between providers, specifically,
communication between providers was a
huge pain point. We set out on a mission
to solve this problem.

7. 4. Co-design
Discoveries during co-design. We focused on the Care Conversation - we wanted to
optimize the Care Conversation for each end user: Survivors, Caregivers, and Providers.
● Survivor input
○ Hardest part of Survivorship: feeling alone after treatment.
○ Together needs to include family members in some conversations and not in
others.
○ Care Conversations should happen with individuals doctors and well as
groups of doctors - I choose.
● Caregivers input
○ Communication with the entire team is essential - every single doctor, family
member, and healthcare provider!
● Providers input
○ I need to be able to invite a patient into a conversation.
○ I need to be able to manage multiple patient conversations within the app.
○ Patients need to be able to include both doctors and family members in Care
Conversations.

8. 5. Innovation
Together is an innovative mobile application that leverages cutting edge design,
data security, data handling, and data integration.
● Design
○ Trendsetter!
■ Design is in-line with conventions of iOS 7 - release Fall 2013
○ Data entry - complex medical history entered easily into the application
○ Simplifies the complex communication between multiple people using
intuitive social media-style conversational user interface and design
● Data Security and HIPAA Compliance
○ Together gives every patient, caregiver, and provider a HIPAA compliant
method for team-based communication and data exchange!
○ This is not easy!
○ Two factor authentication - leading edge user verification
○ Every user has a HIPAA compliant secure data cloud
○ Image data is not stored on the device (not in users camera roll!)
○ HIPAA-compliant Personal Health Record!

9. 5. Innovation
● Data Handling
○ Enterprise-level platform
○ Literally every one of the 14 million survivor could stream Fitbit or Misfit
wearable sensor data or send/receive 23andme genomic data to our
database without handing issues - huge innovation in true Big Data
Personal Health Record architecture
● Data Integration
○ First application that enables a patient to share commercial wearable
sensor data with their healthcare provider! (not in demo but will be in
App Store release!)
○ Turn key device integration
■ Home monitors: blood pressure, glucometers
■ Wearable devices: Fitbit, Misfit, Jawbone
■ NOTE: Fitbit integration underway with 1-2 more weeks to
implement patient dashboard proposed in initial submission
● This feature will be enabled in Version 1.0 released to App
Store in August

10. 6. Interoperability
● HL7 Compatibility
○ Data is structured into CDA Personal Health Monitoring Report
■ Personal health monitoring information
■ Measurements captured by devices
■ Narrative information
■ Graphs generated by user of device
○ Data output is CDA Unstructured Document
■ Images and other unstructured documents such as scanned docs
○ Platform is Enterprise-level and designed for large hospital and clinic use
with EHR compatibility
● Blue Button
○ Development in early stages
○ Advantage is our existing HL7 data compatibility
○ Blue Button implementation: goal of September 2013

11. 7. Adaptable and Customizable
Together is built on the Medable HIPAA-compliant platform that is designed for
customization.
● The frontend and backend architecture are designed for accessible
enterprise-level customization - users such as Mayo Clinic and MDAnderson
● Hospital/Clinic Customization
■ In less than 1 week, Together can be customized and integrated
into existing clinical and hospital ecosystem
● User Customization
■ Current version is customized to user: patient versus provider
● Patient next version: diagnosis-specific customization
● Provider next version: customized to speciality in future
version

12. 7. Adaptable and Customizable
Together is built on the Medable HIPAA-compliant platform that is designed for
adaptability.
● Evolving patient needs and preferences
○ Survivor controls data access
■ Changing members of care team is easy from providers to caregivers
● Changes in healthcare system
○ HL7 and standardized architecture enables interoperability and
adaptability in a changing ecosystem: changes in clinic/hospital EMR
● Device adaptability is key element of backend architecture
○ Turn key device integration
■ Home monitors: blood pressure, glucometers
■ Wearable devices: Fitbit, Misfit, Jawbone
■ Fitbit integration underway with 1-2 more weeks to implement
patient dashboard proposed in initial submission

13. Thank you for a life changing experience!
Thank you to the awesome teams at the Office of the National Coordinator, the National
Cancer Institute, Health 2.0, and Medstartr! This was life and company- changing
experience! We are now on a mission to build the best technologies for Survivors!
Since May 28, 2013 we have made incredible progress, had a ton of fun, and made
friends!
○ New Friends and Colleagues
■ Over 150 people we met with incredible experiences, stories and missions!
○ Partnerships and Relationships
■ Leaders in Survivorship: Kerry Trout - Patient Navigator at Mason General
Hospital, Molly McDonald of The Pink Fund, Susan McHugh Cancer Coach
■ Leaders in Caregiving: Lauren Tarrant of Help FInd Care
■ Misfit wearables, CEO Sonny Vu
■ Rebecca Skloot author of The Immortal Life of Henrietta Lacks
○ Press and PR
■ Blogtalkradio! Thank you Dr. Just! More than 10 press features and articles
about Together
○ Funding
■ Over $7000 dollars raised