Purpose: 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. Patients and Methods: 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. Results: 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. Conclusion: 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. Plain Language Summary: Chronic obstructive pulmonary disease (COPD) is a common condition that makes breathing difficult and often leads to emergency room visits and hospitalization. Good self-management, which includes understanding the disease, medications, and strategies for daily life, can help people with COPD stay healthier. However, many people do not have access to programs that teach these skills, and existing digital tools are often separate from routine care. Our team developed My Lung Health Coach (MLHC), a free, evidence-based program that connects people living with COPD to trained educators for personalized education and support. To strengthen this program, we also designed a companion app that is built directly into the electronic patient record system used at our hospital. This integration makes the app secure, sustainable, and easier to use in day-to-day care. We worked closely with patients, caregivers, and healthcare professionals to test and improve the app through several design cycles. Participants told us what worked well and what needed fixing. Based on their feedback, we made changes such as enlarging the text, simplifying navigation, using supportive language, and creating a training module. Usability scores improved from poor to excellent after these changes. This work shows that when patients and clinicians are included throughout the design process, it is possible to build digital health tools that are practical, acceptable, and aligned with real care workflows. Our next step is to test the app in a clinical trial to see how it can improve health and quality of life for people with COPD. Keywords: COPD, digital health, electronic health record, self-management, app
Farrer et al. (Sun,) studied this question.