The General Academic Pediatrics group at Children's Hospital of Pittsburgh conducts numerous studies that require the subjects to read and review information about the study and then legally consent to participate in the study by signing a paper consent form. Seeing the opportunity to improve this process, Children's contracted Flipside to create the eConsent Manager. This online consenting system recreates the IRB (internal review board) approved legal consent forms while greatly enhancing the experience for the subjects and administrators. Flipside worked with Children's to design a system that is able to educate the subject on the details of the specific study through a number of informational animated videos. These video vignettes are collected into an every-growing library that can be utilized by future studies. An integrated glossary is available to reference difficult terms, and interactive quizzes ensure the subject understands the content. After watching all of the videos and reading the consent form, the subject can digitally sign the consent form. And should additional counseling be necessary, the subject is able to communicate with a researcher via the integrated video chat functionality. All of this can be done by the subject in the comfort of their own home, on their own computer, laptop, or touchscreen tablet.

Flipside designed a wealth of powerful features for administering study consents as well, including:

• Administering multiple studies, with separate staff (researchers / doctors) and subjects (patients) for each study
• Versioning and notifications when the content of a consent form changes and must be resigned.
• Complete audit trails for compliance requirements
• Tracking subject status and progress through the consenting process
• Storage of all data in a secure, encrypted, HIPAA-compliant manner

Flipside Media partnered with PHRQL to create Connect & Coach, an educational ecosystem based around delivering nutrition services in non-institutional settings, such as retail supermarket and independent offices. As the provisioning of healthcare services moves out of centralized hospital facilities and into the local communities, Flipside and PHRQL are supporting these service though the Connect & Coach system. Together Flipside and PHRQL created a software tool based on ScoreMD that incorporates the nutrition care process (NCP), an educational framework developed by the Academy of Nutrition and Dietetics. Connect & Coach provides registered dietitians the tools to support a comprehensive education program, including the following features and functionality:

• Integration with retailers' existing online enrolment and scheduling software, allowing patients to be seamlessly enrolled in the Connect & Coach system
• Comprehensive online patient self-assessment (including contact, demographics, health and food history, and clinical data)
• Customized reporting to meet insurer, reimbursement and billing requirements (including HCFA 1500 form generation)

In addition to the suite of features for the educator, Connect & Coach also includes a unique mobile application that allows patients to track their nutrition, exercise, and other relevant information. This information is automatically reported to the nutrition coach, where secure messaging allows for the educator to coach the patient to improved health.

The entire Connect & Coach system also has the ability to integrate with retail supermarket's point of sale data. Since many retailers gather POS data about customers through loyalty or rewards cards, this collected information can be mined in conjunction with the Connect & Coach to elucidate customer purchasing patterns. Retails can also use the wealth of collected data to send targeted promotions and coupons to customers.

The United States Bankruptcy Court for the Western District of Pennsylvania sees a high volume of cases with each case lasting a short time. In order to keep the flow moving smoothly, it is important to provide information to upcoming participants so that they know what is currently occurring in the court, and when their case is going to be coming up. The United States Bankruptcy Court contracted Flipside to create an on-site kiosk-based system to provide real-time information about the current and upcoming cases. The system included a backend server running Node.js that received data from the court's internal scheduling system in an XLM data format. The server then rendered out a high-resolution page listing the day's cases, which was displayed on a 55" HD monitor. Additionally, Flipside created interactive touchscreen kiosk interface that allowed participants and lawyers to search for their upcoming case and retrieve pertinent information.

Flipside had previously developed the EnterVue platform, which is a wireless touchscreen-based tablet screening, data collection and analysis system. The initial implementation was in pediatrics, based on content from the Bright Futures national initiative. Realizing the opportunity to expand the EnterVue platform into other content areas, Flipside partnered with Dr. Kelly Kelleher (at the time at the Children’s Hospital of Pittsburgh) to create a new content module for EnterVue. Together an SBIR opportunity through the National Institute of Health (NIH) was identified which was being sponsored by the Department of Health and Human Services (DHHS) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). A detailed grant proposal was created, submitted, and approved.

Flipside then worked with Dr. Kelleher and the team to create a new tool called the primary care computerized assessment tool (PCCAT). Similar to EnterVue:Pediatrics, PCCAT is a touchscreen-based tablet based system designed to engage patients with screenings, provide clinicians with results, and suggest brief intervention or referral information at the point of care. The content for PCCAT was derived from the NIAAA’s “Identification of At- Risk Drinking and Intervention with Women of Childbearing Age” guide. Additionally, a number of other relevant screeners were evaluated for inclusion in PCCAT, including:

• Guidelines for Adolescent Depression (GLAD-PC)
• Patient Health Questionnaire 9 (PHQ-9) (modified)
• Youth Risk Behavior Survey (YRBS)
• Short Form (36) Health Survey (SF-36)

Due to extensive question set that was included in PCCAT’s screening corpus, advanced adaptive questioning and branching logic was developed to ensure the user always received the most appropriate and valuable questions at any time. Multiple reports were created for both the user (patient) and the physician. Longitudinal patient tracking allows for individual patients to be followed over time, with PCCAT increasing the relevancy of the system with each iteration.

Myofitness has been a provider of corporate fitness programs and private personal training and coaching services for almost 20 years. Flipside Media partnered with Myofitness to create an online portal for delivering comprehensive corporate health and wellness programs. The My.Myofitness portal provides a wide array of online tools which are tightly integrated with Myofitness's on-premises training services and continuing web-based coaching. Some features of the My.Myofitness system include:

• Detailed longitudinal tracking of employee's nutrition, exercise, and biometric data
• Comprehensive online customizable workouts
• Rich online library of workout videos
• Establishing of employee goals, daily tracking of progress towards achieving goals
• Intra-corporation challenges allow groups within a corporation to challenge each other to improve their health and wellness
• Optimized interface for mobile devices (iPhone/Android phone, iPad and other tablets)
• Integration with third-party devices and services including BodyMedia and Jawbone UP biometric devices and the SparkPeople online diet and healthy living community

For companies that provide space for employees to work out, Flipside created a kiosk-based version of the system that allows multiple employees to participate in videos-guided workouts while at work.

McKesson Health Solutions contracted Flipside to create a web-based system for managing diabetes patients within an educational program. Similar to the functionality of the AADE7 System and Chronicle Diabetes, McKesson needed a tool that could be used by diabetes educators for patient management, data collection, education documentation, reporting and analytics. Additionally, the system needed to seamlessly integrate with McKesson's existing electronic medical records (EMR/EHR) system. Flipside used the ScoreMD platform to create a customized system for McKesson called the Diabetes Self Management Training Application (DSMTapp). Many unique features were implemented including:

• Evidenced-based educational framework based on the ADA's national standard
• Customizable alerts and notification system- Based on current data in the system, notifications were created to instruct users on upcoming tasks. Alerts were created to draw users' attention to upcoming and pending events.
• Electronic referral management- As electronic referrals are initiated from within McKesson's EMR, DSMTapp receives these and routes them to the appropriate site and educator. The educator can then manage all incoming referrals.
• Data exporting and secure delivery - Flipside created export protocols based on McKesson's data structure to allow for batched record delivery on a periodic basis. Export files were securely delivered to McKesson's servers for automated processing.

Flipside Media partnered with Teredesai, McCann & Associates, P.C. to form CKD Partners, a collaboration that created KidenyTIES (treatment, intervention and education system). KidneyTIES is an online tool for supporting all aspects of a chronic kidney disease (CKD) education program. Built on Flipside's ScoreMD platform, KidenyTIES allows nurse practitioners to manage patients in all stages of kidney failure, and ensure that they are in the best possible condition to begin dialysis. Patients are quickly imported into KidenyTIES from existing electronic medical records (EMR/EHR) system using HL7 and continuity of care documents (CCDs). The process for each patient's access placement is documented in a unique timeline, giving caregivers the information to ensure the patient is prepared to begin dialysis. Education is documented in the prescribed six sessions, using the educational frameworks defined by the National Kidney Foundation or customized to the user's program. A built in scheduling calendar coordinates all aspects of patient care. And detailed education reports are designed to meet the needs for submission to insurance providers for billing and reimbursement.

In addition to the practical functionality of the KidneyTIES system, CKD Partners worked with Carnegie Mellon University (CMU) to develop powerful analytics for nephrology programs. Based on the analysis from years of collected patient data, we created the Dialysis Scorecard™, an evaluative metric of a patient's readiness for dialysis. Additionally reports calculate the impact education has on the progression of each patient's disease, including whether or not education played a role in delaying the start of dialysis.

As a result of the cutting edge functionality of KidneyTIES, the product was awarded the American Society of Nephrology Innovators Place award for 2013.

The University of Pittsburgh Medical Center (UPMC) the Diabetes Institute (UPDI) is one of the largest diabetes education programs in the nation, with dozens of education locations serving hundreds of patient each year. In order to manage, track, and report on this population, UPMC needed a single enterprise-level solution that meet the national American Diabetes Association (ADA) requirements. UPMC contracted Flipside to create a system built on Flipside's existing ScoreMD platform. Flipside worked with the experts at UPDI and also met with many UPMC diabetes educators to create the Chronicle Diabetes system. Based on national standards with a focus on quantifying the diabetes education process, Chronicle allows educators to manage their patient populations, track clinical, assessment and health history data, and create valuable population reports. Additionally, the UPMC program coordinator can manage and administer each of the sites in the program. The coordinator can also generate program-wide reports, which are required for maintaining their ADA recognition.

Recognizing the opportunity to offer this powerful tool to a national audience, UPMC worked with the American Diabetes Association (ADA) to provide Chronicle as ADA's official diabetes self management education (DSME) system. Launched at the national ADA Scientific Sessions, Chronicle was adopted by hundreds of educators, quickly becoming the standard for ADA-recognized DSME programs.

Carnegie Learning is a leading publisher of innovative, research-based math curricula for middle school, high school, and post-secondary students. Founded by cognitive and computer scientists from Carnegie Mellon University in conjunction with veteran mathematics teachers, Carnegie Learning uses a blended approach to education, with a textbook and web-based software (called Cognitive Tutor) for each subject. Carnegie Learning contracted Mind Over Media in collaboration with Flipside to implement a new interface for their Middle School Math online software. Flipside utilized Carnegie Learning's existing content to develop web-based interfaces for many aspects of the Middle School Math online portal. This included creation of interfaces for expandable education modules, student dashboards, and innovative navigational motifs. These features combined to provide the students with a fun, engaging, and feature rich learning environment. Flipside worked in tight collaboration with Carnegie Learning's developers to ensure that the interfaces integrated with the back end Java-based education delivery system in a seamless fashion.

The American Association of Diabetes Educators (AADE) contracted Flipside to create a new online tool that built upon the success of the previous NDEOS and AADE7 IMPACT systems. This new tool, AADE7 System, was developed to give diabetes educators acrossAmerica a single system for managing patients, documenting services, and collecting all of the data required for diabetes self management education (DSME) accreditation. AADE7 System leverages Flipside's ScoreMD platform as a proven platform for rapid development. The system includes patient communication tools and allows patients to complete initial assessments online prior to their DSME visit. Complete patient records are maintained, including demographic, health status, goal setting, clinical data and medications. The FDA's Orange Book medication database has been integrated for quick and standardized data entry. Powerful reporting features allow administrators to mine their program's data to extract detailed information. AADE7 System launched in 2009 at AADE's national conference, and within the first year almost 1,000 educators had signed up and entered nearly 30,000 patients into the system.

The Special Olympics of PA (SOPA) contracted Flipside to create an online tool that can be used by SOPA administrators, coaches, volunteers, and athletes (collectively referred to as "delegates") to manage all of the data for these groups. An initial version of the SOPA Web Based Delegate Management Software (DMS) was launched in 2004 and adopted by all of the county-based SOPA programs. The DMS allows permission-based internet management of all delegates in a SO Program. It facilitates the effective organization of thousands of delegates information, positions, and requirements. Since its launch, Flipside has maintained and supported the DMS, while continuing to expand and improve the system to meet the evolving needs of all of the SOPA programs. As of 2010, there are over 50,000 delegate records in the system.

Some key features of the SOPA Web Based Delegate Management Software include:

• Permission based access model
• Secure, centralized data for thousands of users across the state
• Customizable reports generated as printable html, PDF, or Excel format
• Ad-hock data searching and reporting, with multiple pre-defined reports:
  • Delegate Report by Position
  • Certified Coaches Reports
  • Program Information Report
• Mailing labels printable based on the results of delegate searches

The American Association of Diabetes Educators (AADE) and the University of Pittsburgh Medical Center (UPMC) contracted Flipside to create an online tool that can be used by diabetes educators to gather, collect, manage, and report patient data. The National Diabetes Education Outcomes System (NDEOS) was built by Flipside and deployed to a number of UPMC offices in western and central Pennsylvania. It is currently in use by over 25 educators and over 2,000 patients. After the launch and operation of NDEOS, AADE contracted Flipside to create a new-generation diabetes management system for national use, dubbed AADE7 IMPACT. At AADE's 2006 national conference AADE7 IMPACT was launched to the national audience. After seeing the groundbreaking product, the keynote speaker Newt Gingrich (founder of the Center for Health Transformation) expressed the importance of the new AADE7 IMPACT as a tool educators can use to help reform the current health care system into what he termed as "a 21st century intelligent health system." Within the first year after launch 795 educators had signed up and over 3,000 patients were using AADE7 IMPACT.

Some key features of NDEOS and AADE7 IMPACT include:

• A secure, password-protected web environment for use by patients, educators, and administrators that complies with HIPAA security and confidentiality requirements.
• Advanced features and functionality that can accommodate all of the major web browsers on Windows/PC and Mac platforms, on both high-speed and dialup connections.
• Advanced data sorting, viewing, querying, and reporting.
• Daily secure data syncing and importing from AADE's private Windows-based database server.
• Multiple user access levels, which allow for the defining of data access rights.
• An easy to use system, with embedded tool tips and contextual help, ensures that even users with little computer experience can quickly learn to use the system.
• Automated password resetting of lost passwords

The American Association of Diabetes Educators (AADE) contracted Flipside to develop a media-rich online education tool to provide diabetes information to users. The ABCs of Diabetes Education (ABCDE) is divided into a number of modules, with each module containing live-action video, an extensive educational presentation, an interactive case study discussion, quizzes related to the educational content, and downloadable resources. All video was shot by Flipside on-location at a local hospital with selected actors. Post production, editing, and voiceover recording was done at Flipside's studio. The content was produced in Adobe Flash format, and incorporated into a SCORM 2004 conformant web infrastructure.

Dr. Aletha Akers of Magee-Womens Hospital contracted Flipside to create an educational program to help parents of teens talk to their children about sexual topics. The Talking with Children About Sex (TCAS) content was written by Dr. Akers and would be delivered to parents (or guardians) of teens while the teen was meeting with their primary care physician. Flipside created a web-based delivery platform to administer the program, which included a pre and post questionnaire for the parent as well as 15 minutes of animated educational material. Flipside worked with Dr. Akers to narrate the animated segments, and partnered with Nathan Mazur (scaredofbees.com) for the static graphics. All of the animations were created in Adobe After Effects. The program was delivered from wireless laptops in the doctor's office, and all data was collected centrally. Data from the study was submitted to the researchers on a regular basis.

The American Association of Diabetes Educators (AADE) contracted Flipside to create an online tool for AADE's new national Diabetes Education Accreditation Program (DEAP). In order for DSME programs to receive reimbursement from Medicare and other third-party insurers, the program must receive accreditation, which requires tracking a wealth of information about the program. The DEAP portal was designed to allow DSME programs seeking AADE accreditation to register and submit the required data. Tools were incorporated to allow AADE administrators to manage the entire accreditation process. The DEAP portal was also integrated with AADE7 System so that programs that are using AADE7 System are able to import the required data into DEAP in a seamless manner.

The University of Pittsburgh School of Nursing (UPSN) contracted Flipside to create a secure web portal for administering screening tools and collecting data. The portal was being used as part of a multi-year program called Reproductive-health Education and Awareness of Diabetes in Youth for Girls (READY-Girls) that was being administered at the Children's Hospital of Pittsburgh. The system allowed for an administrator to manage a rolling admission of study participants in a de-identified manner. Each participant could then securely log into the portal and completed an extensive baseline survey that was customized to the individual participant. An administrative dashboard allowed the study administrator to monitor the progress of participants, and send out notifications when it was time to do follow up surveys. All of the survey data was collected in a standardized manner and provided to the researchers for monthly importation into SPSS.

The University of Pittsburgh Medical Center (UPMC) contracted Flipside to develop a diabetes education portal with extensive tracking, data collection, and patient communication capabilities. UPMC was beginning a project called Rethinking Eating and Activity (REACT) to determine the difference in efficacy of video education delivered via a DVD versus web-based delivery. The Moodle framework was used for the web-based portion of this project to allow for rapid development. Flipside converted this Moodle framework to meet the unique needs of the project. Communication tools were developed to allow program managers to interact securely with project participants. At the portal, participants viewed educational content that had been extracted from the existing DVD and converted into a web-friendly format. Existing paper-based literature was reproduced and incorporated into the portal. A food and exercise logging and tracking application was built to allow participants to record their daily progress. Weekly interactive "to do" lists ensured that participants stayed focused on the prescribed tasks. All of the collected data was available to program managers in real time so they could monitor the participants' progress and intervene when appropriate. The results of this study were published in ADA Diabetes Care and presented at the 71st Scientific Sessions.

Steps to a Healthier PA Fayette County (StepsPA) contracted Flipside to develop a turnkey kiosk system that included screening and education components. As part of an initiative by the Department of Health and Human Services, StepsPA was created to promote healthier lifestyles on a local and community level. Flipside incorporated the ADA's diabetes risk assessment and Flipside's own TEACH:diabetes educational videos into a system that could be quickly deployed at various locations. Flipside utilized SeePoint kiosk hardware and partnered with Prime Computer for delivery and installation services.

Mount Aloysius College contracted Flipside to create a system that would allow the researchers to determine the effect that "framing" has on diabetes education. For example, is it more effective for education to be delivered (framed) in a way that scares or shocks the patient (e.g. showing the results of poor foot care) or is it more effective to encourage the patient (e.g. highlight the benefit of proper foot care)? Flipside worked the researchers to develop educational videos with different framings, and then created touchscreen software that would randomize the study participants and place them into a study group. Each patient used the touchscreen kiosks to complete a baseline evaluation of his or her knowledge and understanding of diabetic foot care. The kiosk then presented the patient with a number of framed diabetes education videos. Finally, the patient completed the evaluation questions a second time. The patient also came in for three, six, and 12-month follow-up touchscreen evaluations to gauge retention and change of knowledge. All of this was remotely administered on the internet-connected kiosks and the data was gathered centrally on Flipside's secure servers.

The Department of Pediatrics at Ohio State University contracted Flipside to create touchscreen-based that can be used to collect patient registration information while in the waiting room. Working with Dr. Deena Chisolm, Flipside used its ScoreMD platform to create a tool that allowed novice computer users to use a touchscreen kiosk to:

• Verify the demographic and billing information that was contained in the office's EHR
• Answer health history questions
• Complete a number of risk assessments, which were then scored
• Complete a satisfaction survey

All of the information was gathered each time the patient came into the office, and the resulting reports were immediately generated and printed out for use by the office staff. A paper about the system was published by Dr. Chisolm et al., with the conclusion being that Flipside?s ScoreMD system was well accepted by both the patients and the staff, and showed potential for improving efficiency in clinical office settings.

The American Orthopaedic Society for Sports Medicine (AOSSM) contracted Flipside to create a touchscreen-based questionnaire and data collection system to be used in multiple offices throughout the country. AOSSM needed to use a number of pre-existing questionnaires in the system, including the SF-36 and others. Patients used the system complete a questionnaire at baseline, and at three, six, and 12 month follow up intervals, thereby building a longitudinal record. Participating doctors could then enter into the system information related to the patient's impairment, surgery, and recovery over the next year. Flipside built the system using its ScoreMD platform, utilizing a number of touchscreen hardware devices including wireless touchscreen tablets and stand-along kiosks. The system operated in 10 offices across the country and collected data into a central repository on Flipside's secure application server. The AOSSM researchers were able to view live collected data, generate summary reports, and download exports of the data for later import into statistical analysis programs.

A certified personal trainer contracted Flipside to develop an online suite of tools targeting the personal training industry. This web-based system, called Body-Quest, is a commercial product offered to professional trainers to assist in their daily client and data management needs. Every subscribing trainer can create a profile for each of their clients and use Body-Quest's integrated tools to guide and document their daily workouts. The system's tools include fitness assessments, exercise libraries, progress trackers, and report generators. Customized workout templates can be created, and integrated video ensures that each exercise is being done correctly. In addition to traditional desktop PC access, Body-Quest also includes a mobile interface to allow streamlined entry of data as well as the viewing of instructional videos on iPhones and other mobile devices.

The University of Pittsburgh (Pitt) contracted Flipside to create a touchscreen-based questionnaire and data collection system to be used in multiple offices throughout western Pennsylvania. Laptops running the custom STEPUP software application are used to track, register, screen, assess, and report on patients. Additionally this system included a study recruitment tool that integrated with the office's existing patient database. STEPUP allows the educator at the office that is running the program (called a preventionist) to send invitation letters to eligible patients and then track their progress through the program. When the patient meets with the preventionist, the patient completes the STEPUP screener, which includes questionnaires for type 2 diabetes risk factors, lipid risk factors, Framingham risk assessment, metabolic syndrome identification, and non-fasting and fingersitck results. The system assesses and evaluates all of the collected data and creates a patient-specific report. All of the data that is collected is stored locally on the laptops and once a week it is synchronized with a central server. This sync process transfers the collected data to the central database, generates and emails status reports to the researchers, and updates the software on the laptop with any newer versions.

Children's Hospital of Pittsburgh (CHP) contracted Flipside to create a wireless tablet touchscreen-based screening, data collection and analysis system for use in CHP office waiting rooms. The questions to be asked were based on the Bright Futures national initiative, but were highly customized for this implementation. Flipside used its ScoreMD platform to create the Interactive Wellness System (IWS, later branded as EnterVue:Pediatrics) that allows children's parents to answer a battery of questions about their child while in the waiting room. The data was collected and analyzed locally, and two reports were instantly printed. The patient report gave information to the parent gave information to the parent about their child and the doctor report gave information to the doctor that could be used when subsequently meeting with the patient.

Mount Aloysius College contracted Flipside to create a diabetes education web portal that provides secure, private education to high school students who have diabetes. Over the course of the 18-month program, students would log into the education portal on a weekly basis and receive educational content. After reviewing the content, the student answers a few brief questions to gauge understanding. Additionally, prior to the start of the project, school nurses and some other school personal received basic diabetes education, which was made available to them via the portal. All of the administration of the system was done via Flipside's central servers, and all data is automatically gathered for the researchers.

Mount Aloysius College contracted Flipside to create a diabetes education web portal that provides secure, private education to high school students who have diabetes. Over the course of the 18-month program, students would log into the education portal on a weekly basis and receive educational content. After reviewing the content, the student answers a few brief questions to gauge understanding. Additionally, prior to the start of the project, school nurses and some other school personal received basic diabetes education, which was made available to them via the portal. All of the administration of the system was done via Flipside's central servers, and all data is automatically gathers for the researchers.