Atherosclerotic cardiovascular disease is the leading cause of death in the US, and many of the risk factors and behaviors that accelerate the development of atherosclerosis often begin in childhood. In response, the National Heart, Lung and Blood Institute (NHLBI) developed new cardiovascular health guidelines for pediatric care providers. The NHLBI wanted a better way to get these guidelines into the hands of primary pediatric care providers as well as to provide more interactive assessments and recommendations. The NHLBI contracted RTI International to develop and evaluate a toolkit to support provider adoption of the guidelines, including a mobile clinical decision support app to help providers screen children for cardiovascular risk and provide recommendations for treatment.

RTI developed an initial prototype, led by technical lead and co-investigator Robert Furberg, Ph.D., but both NHLBI and RTI knew that usability was key in an already busy and fractured workflow of primary care providers. Dr. Furberg wanted to take the app to the next level of usability based on early user feedback, and though he had a strong team of in-house developers, without an experienced design team, he knew the app wouldn’t reach its full potential. This is where Little Green Software came in. Familiar with their previous work, Dr. Furberg knew the company specialized in creating apps that engage users with an intuitive user experience and polished designs. Dr. Furberg also needed a design partner who understood the unique challenges and requirements for building a true clinical application. LGS was a logical choice given their clear understanding of industry-specific security and privacy regulations that include HIPAA and a number of medical app certifications.


Design: Little Green Software started with a needs assessment of the project, and then worked closely with the RTI team to review the prototype, user feedback, and large volume of background materials. While the basic functionality of the app remained the same, Little Green Software overhauled the app’s organization, flow, visual cues, icons, colors and transitions to deliver a redesign that took the user experience and visual design to the next level. RTI’s internal development staff worked closely with Little Green Software to implement these new designs. The end result of this truly collaborative effort is a much more polished, user friendly, and visually appealing application that providers can download to their iOS devices.


Feedback from preliminary testing among twenty board-certified pediatricians from the American Academy of Pediatrics was overwhelmingly positive, and participants did not want to give up the tool once the trial was over. One of the most popular and groundbreaking features was the ability to take a child’s blood pressure measurement and plot that number against representative population percentiles. What used to be a cumbersome manual process that may have discouraged providers from taking these steps can now be done electronically through the use of a smartphone. With the ability to easily access this data via their phone, providers may be able to identify problems earlier and address them with patients in real time.