When designing mobile health (mHealth) applications for persons with multiple sclerosis (PwMS), patient stakeholder involvement is crucial to identify user interface (UI) and experience (UX) issues that can affect usability and accessibility. PwMS can experience impairments in cognition, fine motor functioning, and vision, which can impact adoption of mHealth. This research highlights the specific needs of this population when designing accessible interfaces for remote clinical interventions, as evidenced through the development process of the Thought Reframing Worksheet in Managing My MS My Way (M4W), a novel mHealth-based fatigue self-management application. Patient stakeholders (n = 10) completed think-aloud procedures with a low-fidelity prototype development in Figma. Action points for identified UI/UX issues were implemented in the high-fidelity prototype. After deploying the high-fidelity version through React Native Expo, expert-led cognitive walkthroughs (n = 3) were conducted, with process flow errors and significant design consistencies identified and addressed. The next steps for usability testing, including a heuristic evaluation and field testing, are detailed. The final version of M4W will be an accessible mHealth application that reflects the needs of users with cognitive, fine motor, and visual impairments.

Objective: To illustrate the need for wider implementation of the CancelRx message by quantifying and characterizing the inappropriate usage of new electronic prescription (NewRx) messages for communicating discontinuation instructions to pharmacies. Materials and Methods: A retrospective analysis on a nationally representative random sample of 1 400 000 NewRx messages transmitted over 7 days to identify e-prescriptions containing medication discontinuation instructions in NewRx text fields. A vocabulary of search terms signifying cancellation instructions was formulated and then iteratively refined. True-positives were subsequently identified programmatically and through manual reviews. Two independent reviewers identified incidences in which these instructions were associated with high-alert or look-alike-sound-like (LASA) medications. Results: We identified 9735 (0.7% of the total) NewRx messages containing prescription cancellation instructions with 78.5% observed in the Notes field; 35.3% of identified NewRxs were associated with high-alert or LASA medications. The most prevalent cancellation instruction types were medication strength or dosage changes (39.3%) and alternative therapy replacement orders (39.0%). Discussion: While the incidence of prescribers using the NewRx to transmit cancellation instructions was low, their transmission in NewRx fields not intended to accommodate such information can produce significant potential patient safety concerns, such as duplicate or inaccurate therapies. These findings reveal the need for wider industry adoption of the CancelRx message by electronic health record (EHR) and pharmacy systems, along with clearer guidance and improved end-user training, particularly as states increasingly mandate electronic prescribing of controlled substances. Conclusion: Encouraging the use of CancelRx and reducing the misuse of NewRx fields would reduce workflow disruptions and unnecessary risks to patient safety.