Estimating the Cost of Building a Health App: ITRex Experts Weigh In Share: ITRex Date Published 1 January 2023 Categories Blog Reading Time 27-Minute Read Healthcare app development costs depend on the solution’s functionality, type, technology used, and compliance requirements. Having doubts about whether your mHealth application idea has potential, and unsure if it’s worth its high healthcare app development costs? The good news is that customers are willing to download and use medical apps. Let’s take a look at statistics. Samsung Health app hit 3.15 million downloads in September 2022, while the Indian COVID-19 contact-tracing and self-assessment solution, Aarogya Setu, surpassed 100 million downloads within 40 days since its launch. Leading mHealth solutions in the Google Play Store worldwide in September 2022, by number of downloads The global mHealth app market was valued at $38.2 billion in 2021 and is expected to reach $105.9 billion by 2030, steadily growing at a CAGR of 11.8%, as more medical organizations use health app development services to expand their business. Are you interested in joining this venture but feeling hesitant because you don’t have enough information on the amount you will need to invest? This article explains the five major factors that influence the total cost of developing a health app and gives real-life estimates from our portfolio. In the end, our pre-sales team shares practical tips on how to minimize your expenses in the process. You can find more insights on the factors affecting the development cost of software solutions, independently of the industry, in this comprehensive guide on our blog. This article also details the steps our team takes to help you with cost estimation. 5 key factors affecting the cost of developing a health app To get an accurate estimation of how much it will cost to develop a health app, you need to assess your idea against the following five factors: Target user base (patients vs. medical professionals) Type of the healthcare app you are looking to build Features you are going to implement Innovative technologies your mHealth app will rely on Compliance and certification requirements your product will have to meet Let’s explore these factors in more detail. Factor #1: Target user base (patients vs. medical professionals) A healthcare app can either serve patients or healthcare personnel. mHealth applications for medical professionals Applications of this type include healthcare solutions that serve doctors and nurses. Such apps facilitate the processes around healthcare delivery and enable medical personnel to communicate with patients. It’s critical that these apps are HIPAA compliant and utilize strong encryption methods. Medical apps for healthcare professionals help medical staff with the following tasks: Perform clinical diagnosis, as they support doctors in clinical decision making by sorting data and facilitating communication with other professionals Consult and monitor their patients remotely Store and manipulate patient data, such as medical history, prescriptions, appointments, etc. Manage billing and streamline the invoicing process Health apps for patients These solutions aim to support the general population in leading a healthy lifestyle and delivering better medical outcomes. This type of mHealth apps helps patients to: Search for doctors, schedule, and reschedule appointments Monitor their chronic conditions and alert doctors if their condition deteriorates Get initial diagnosis based on their symptoms Cope with mental health issues Factor #2: Type of the healthcare app you are looking to build As some people tend to confuse mHealth apps with fitness and wellness software, we want to draw the line between these solutions. Healthcare applications discussed here use personal data for medical purposes and therefore need to be compliant with the corresponding country’s regulations. If you want to build a fitness app, you can check our recent article on sports app development costs. Also, if you are looking to develop a patient engagement solution, check our detailed guide on expenses associated with implementing patient engagement software. In this section, we list common types of health apps, describe their functionality, and assess their development costs. Note that all cost estimates in this section are valid only under the assumption that a medical app operates on a single platform, doesn’t use any advanced visualizations, such as gamification, and doesn’t employ any innovative technologies mentioned in “Factor 4.” E-prescription medical apps This type of healthcare software allows doctors to prescribe medication, monitor prescription history, cancel and renew prescriptions. The functionality of such apps depends on governmental regulations. In some countries, such software lets users communicate with a pharmacist of their choice to place an order and arrange for a pickup. ScriptSure is one example of this health app category. It enables users to send their e-prescriptions to pharmacies and safely print prescriptions when needed. This software links to an integrated database with prescription drugs and vitamins together with their directions for use. An e-prescription medical app can cost you from $40,000 to $80,000 on average. Appointment scheduling health apps These healthcare apps let patients schedule doctor appointments, receive reminders, and view and cancel their bookings while automatically notifying the clinic. Such software typically has two tiers: a patient-facing side and the functionality used by medical professionals. Doctors also use appointment management applications to alter their schedules and receive notifications of new bookings and reminders about existing appointments. Some scheduling apps allow patients to send relevant information from their medical history to doctors upon request. SimplyBook.me is booking software for medical centers. It extracts appointment data from various channels, including Instagram, Facebook, and Google maps. The vendor can also integrate SimplyBook.me into a clinic’s website if it’s constructed with a popular website builder, such as Wix and Joomla. The licensing costs vary from $0 for 50 appointments per month to $49.9 for a premium subscription. The price you will pay for an appointment-scheduling health app starts from $20,000–$30,000. Telehealth solutions Telehealth practice has gained popularity since the COVID-19 outbreak. These health solutions allow doctors to carry out online consultations via mobile and web apps. These apps can be rather extensive and include linking to the hospital’s EHR system, invoicing and payment options, in-app video conferencing, patient dashboards, file transfer, e-prescription, and patient monitoring, among other features. Boston-based Amwell developed a comprehensive HIPAA-compliant telehealth solution that gives patients access to specialized professionals 24/7. Healthcare organizations can register their professionals for a subscription fee. Doctors can access the app directly from their native EHRs, and it can be linked to billing and claims systems. This platform offers primary and urgent care along with telepsychiatry. Amwell already has over 2,000 medical facilities subscribed to its services. It would cost you between $50,000 and $200,000 to develop a custom telehealth app. Remote patient monitoring apps This type of medical app gathers patient data outside the medical settings through sensors. Doctors use this data to monitor the patient’s well-being and sometimes even to perform remote diagnoses. Patient remote monitoring solutions can also alert healthcare providers if the patient’s condition suddenly deteriorates or any abnormalities are detected. This is especially useful for the elderly and people recovering from surgery or trying to manage a chronic condition at home. MedM offers a sensor- and smartphone-agnostic platform for patient monitoring. It already has over 600 medical sensors in its integration portfolio and can measure 18 health parameters. The app can also consolidate data with Google Fit and Apple Health. Such healthcare solutions can cost from $50,000 to $100,000. Symptoms checker mHealth app These healthcare applications help users identify their illnesses based on a list of symptoms and point them to the closest medical center to confirm the diagnosis. One example of such software is Ada. According to the app’s website, clinical studies proved that it’s the most accurate symptom checker app. It contains information on 1,500 diseases. In addition to diagnosing services, Ada can find available practitioners in close proximity to the user, and suggest treatments that you can do at home. If the AI-powered disease detection engine is already available, it will cost approximately $20,000 to implement a symptom checker app. If you need to build the engine from scratch, the costs will increase to $70,000–$100,000. Medical diagnosis software The previous mHealth app type is meant for patients, while medical diagnosing software is more complex and is intended for healthcare professionals. It helps doctors gather and analyze data from patients’ IoT sensors and EHRs, and share it — anonymously — with colleagues asking for feedback. Medical diagnosis software may also include AI models that can process patient data and generate intelligent recommendations. Human Dx is a medical community software that aims to build the world’s collective medical insights. It helps solve different medical cases and gives trainees the opportunity to practice their reasoning skills. The price tag for a basic medical diagnosis app starts at $60,000–$80,000. Medical billing application This category of mHealth apps automates billing procedures. It allows patients to make secure payments and receive virtual receipts and supports accounting departments in invoice tracking. Billing applications can also integrate with the clinic’s EHR system and insurance providers, and support discount options and credit payments. Simplepractice is an example of a powerful medical billing solution. Users can easily sign into the application and pay for healthcare services. The software also allows patients to search for doctors, schedule appointments, and receive reminders. Additionally, the application offers a telehealth platform, enabling users to consult doctors remotely and make payments online. The cost of typical medical billing applications ranges from $40,000 to $90,000. Factor #3: Features you are going to implement The number and complexity of features will have a large impact on the total cost of medical app development. But it will also give you a competitive edge if you manage to deliver functionality that actually covers the needs of your target audience conveniently. Let’s see which basic and advanced features you can incorporate into your health application. Basic features Patient profile creation and login. Users must be able to create and manage their accounts. If the app is used for appointment scheduling, you might consider asking users to fill in extensive forms that will help doctors prepare for the appointment. If both patients and doctors use your mHealth app, keep in mind that the information presented in a physician’s profile will differ from the patients’. Doctors will include their education, experience, qualifications, etc., anything that makes them trustworthy in the patients’ eyes. Don’t forget to implement an easily accessible password recovery option that allows users to regain access to their accounts using an email or a one-time PIN code received via an SMS. Adding registration and login features can add around $3,000–$5,000 to your healthcare application price. Notifications and reminders. Depending on the purpose of your health application, you might want to notify users of upcoming/canceled appointments and inform them when their lab results are ready. You can also remind patients to schedule a follow-up appointment and take their medication on time. While sending around notifications, make sure your app is not overly intrusive and the alerts are not overbearing. This feature can cost around $1,000–2,000. User communities and forums. This functionality empowers patients to connect and motivate each other, resulting in better health outcomes. If your mHealth app targets doctors and nurses, you can offer a professional networking option where healthcare employees can exchange opinions and ask for advice. Connecting an existing web-based community forum will add $800–$2,000 to the total costs of building a health app. A deeper integration would start from $10,000 to $15,000. Geolocation. With this feature, your app will offer a range of location-based functionalities. For instance, it could compile a list of hospitals and healthcare providers in the user’s vicinity. Another example is having a patient’s location visible to the ambulance crew in case of an emergency. This feature will add $5,000 to your healthcare app development costs. Appointment scheduling. A scheduling system is typically synchronized with the calendars of both doctors and patients. It allows patients to book and alter appointments on the go, and enables doctors to confirm or decline visitations. Such a system can perform other time-sensitive activities, such as sending appointment reminders. Implementing this functionality will cost approximately $8,000–$10,000. Alternatively, you can integrate an existing scheduling solution for around $1,500. Payment gateway. With this feature, users can pay for medical services, purchase medication, and make insurance payments. It will be more convenient for your customers if you can offer several payment methods, such as Payoneer and PayPal. You can also give an option of credit card payment. For this feature, expect to pay around $3,000 per method. Advanced features Here is a list of more complicated features that will help you deliver a competitive offering. Collecting data from wearable devices. This implies that your mHealth app can integrate with IoT devices, and aggregate, and analyze the data they generate. This functionality enables users to monitor their health parameters, such as blood pressure and heart rate. A recent study shows that 80% of the surveyed consumers are willing to wear fitness and health technology. Enabling people to link your health application to their favorite gadgets will increase their engagement. Also, it gives doctors more information on their patients and allows them to make data-driven decisions on treatment options. The costs here depend on the number and type of IoT sensors that want to integrate. The minimal costs would be between $3,000 and $6,000. File sharing. This feature allows patients and doctors to exchange medical images, lab results, and other healthcare documents to facilitate the diagnosing procedure. This will add $4,000 on average to your medical app development costs. Virtual waiting room. This feature is very useful in medical applications that support telehealth. It allows patients to check in from their mobile devices and inform their doctor that they are ready for the appointment. Additionally, you can implement a simple text communication between the waiting patients and the medical staff, so that users can answer some basic questions to speed things up during the appointment. Implementing a virtual waiting room will cost you around $5,000–$10,000. Video calls. This feature allows users to consult healthcare experts in real time using video. Make sure that this communication is secure and encrypted. To streamline the consultation, you can grant doctors access to patients’ medical history. The expenses associated with this feature consist of implementation costs and the video streaming services’ subscription fees. The most stable and fast way to incorporate video calls in your health app is to use an external SDK. This will cost around $10,000 for the basic streaming functionality. And the price will increase with more live traffic and extra features, such as the possibility of saving video-on-demand (VOD) content. Medical records integration. This is useful for both patients and doctors. Patients maintain track of their health and doctors can refer to medical records during patient consultations. Research shows that the number of health apps integrating with EHR systems increased by 20% during 2020 alone. The most popular integration platform was Epic App Orchard, which saw a spike of 43%. Integrating medical records will cost you $10,000 per integration on average. AI and ML integration. There are many ways in which artificial intelligence can enhance your healthcare app and give it a competitive advantage. Check the next section below for more information. One example is incorporating ML-powered chatbot that can serve as patients’ first line of interaction when they want to research their symptoms. After viewing the symptoms, the chatbot can pose additional questions and come up with an initial diagnosis. This can cost $2,000–$5,000. Factor #4: Innovative technologies your mHealth app will rely on Incorporating cutting-edge technology will increase the total health app development costs, but it will enable you to offer more value for your customers. Let’s see what these technologies can do exactly. Artificial Intelligence AI has many benefits for the healthcare field in general and for mHealth apps in particular. Here are some examples of what the technology can accomplish. Managing mental health. AI-powered avatars can help mHealth app users cope with mental conditions by asking relevant questions. For example, Happify enables users to gain control over their moods by playing supervised games. Monitoring chronic conditions. AI-driven nursing assistants can support users with chronic conditions by measuring their health parameters, such as weight and blood pressure, and answer some of the questions these people may have. For instance, New York-based One Drop offers AI-powered support to patients while also connecting them to real-life professionals who can help in the case of escalation. Assisting in remote diagnosing. Software, such as WebMD, can detect common diseases from a user’s symptom list. Matching patients to doctors. Medical applications can connect users to the best-fitting physicians after they fill in an extensive survey. One example of such a health app is developed by the New York-based Spring Health. Supporting patients with health monitoring. For instance, Amsterdam-based SkinVision can evaluate suspicious spots on the skin through a smartphone camera and advise users on whether to see a doctor or not. The app can also help monitor skin lesions’ condition over a period of time and notify users if it worsens. Assisting doctors with diagnosis. AI-driven technology can help doctors detect and classify different diseases. For instance, it can help diagnose cancer. Massachusetts-based Iterative Health uses artificial intelligence to improve disease diagnosis in gastroenterology. The costs of incorporating AI models in your medical app will vary depending on whether you adopt a ready-made or a custom-developed algorithm, and on the efforts associated with the training data. If you can use AI models with additional minimal training, you can build each one of the AI solutions described above within the timeframe of two months, and it will cost you $10,000–$20.000 on average. But those estimates account for the AI solution alone, and there will be additional expenses depending on which features you want to include. If we look at the AI-powered avatar mentioned above, the total costs will depend on how realistic you want the avatar to look. Is it 2D or 3D? Will you use Unity or Unreal Engine? What is the size of your audience? Those and other factors can increase the costs of making a healthcare app significantly. For more information, check out our recent article on AI costs. Augmented reality (AR) Augmented reality has had a profound impact on the healthcare sector, especially since the beginning of the pandemic. Here are some ideas of how you can enhance your healthcare application by implementing AR. Assisting in medical manipulations. AccuVain offers an AR-powered solution that helps clinicians visualize patients’ veins to withdraw blood as quickly and painlessly as possible. Offering support during training and education. Augmented reality-driven healthcare applications, such as Microsoft’s HoloAnatomy, can help medical students learn more about the human body by projecting organs, skeleton, and muscle tissue. Other apps, such as Touch Surgery, allow doctors to practice surgical procedures to sharpen their skills. Guiding patients with memory deterioration conditions. For instance, Dorothy is an AR-powered assistant that helps patients navigate through their environment and accomplish daily tasks, like taking medication. Simulating the impact of different health conditions on people. For example, EyeDecide by Orca Health assesses how various eye conditions affect a person’s vision and creates simulations in augmented reality. Augmented reality is cheaper on average than both AI and IoT because all AR solutions are built on top of existing frameworks. Coming back to the list above, the third option is the most challenging to execute and the most expensive. The system needs to be able to recognize the environment (a patient’s house with different rooms), determine the patient’s exact location, and decide how they can navigate to their medication without bumping into a chair or another piece of furniture. The time and costs needed to create such a healthcare mobile app increase with every additional task or flow. For more information on costs associated with creating an augmented reality app, refer to our blog. The Internet of Things (IoT) IoT has many use cases in the medical sector, from smart hospitals to the Internet of Bodies. IoT healthcare solutions rely on web apps, mobile apps, and voice assistants to display the processed sensor data and enable users to interact with IoT devices. Here are some examples of how IoT solutions could enhance your health app. Monitoring users’ movement and health parameters. IoT sensors can help patients measure their glucose levels, heart rate, and other vital signs from the comfort of their homes. Such an IoT system analyzes the data and some of these solutions can notify the responsible doctor if the readings are abnormal. Another application is when sensors track elderly patients’ movements and alert their caregivers if they fall. Ingestible sensors. Such sensors can collect information from inside the human body in a less invasive way than a traditional probe stick. Such mini devices can gather data on the stomach’s PH level or help detect internal bleeding. Ingestible sensors can also be used to monitor medication adherence. For example, the first FDA-approved ingestive e-pill, Abilify MyCite, aims to track medication intake in schizophrenia patients. Mood-aware IoT. These devices can collect data that is indicative of a person’s mental state. It can track parameters, such as eye movements, that can help catch any mood swings. For instance, Takeda tested Apple Watch app’s potential to track the mood of patients with major depressive disorder (MDВ) Drug storage monitoring. Hospitals can place wireless sensors in refrigerators to monitor the medication storage environment and alert the facility’s staff about any changes before the products are spoiled. Hearing aid. An IoT hearing aid sensor, such as the one built by Whisper AI, can give users control over the surrounding sounds. With the help of a mobile app, users can adjust the sounds to their comfort level. An IoT system for drug storage monitoring would be the cheapest and easiest option among the points presented above. It would take three to five months to build. Ingestible sensors are the most challenging on this list, as you will have to deal with FDA and similar approvals. When it comes to IoT-related costs, you need to factor in building/purchasing hardware, acquiring all the necessary certifications, and developing embedded software if needed. Additionally, there will be costs associated with data storage and analytics. For more information, check out our recent blog post on IoT costs. Factor #5: Compliance and certification requirements your product will have to meet Healthcare is a heavily-regulated sector, and any software developed for this field needs to comply with the corresponding country’s regulations that govern how you gather, store, and use personal medical data. For example, healthcare software that will be used in the US might need to comply with Health Insurance Portability and Accountability Act (HIPAA) regulations, Federal Food, Drug, and Cosmetic Act (FD&C Act), Federal Trade Commission Act (FTC Act), and FTC’s Health Breach Notification Rule. Every country has its own set of compliance rules that you and your development team need to be aware of from the very beginning of your project. Implementing extensive privacy and security can add at least $20,000 to the total cost of developing a health app, and will require complex and expensive infrastructure. If this seems like a large sum, remember that the US government imposes heavy penalties on those who fail to comply, including serving an actual prison sentence for gross violations. The total sum of fines depends on the violation’s severity and the size of the non-compliant business. For example, violating the Privacy Rule under HIPAA can cost up to $50,000 per violation, while selling identifiable health information for commercial gain can result in $250,000 in fines. If you incorporate compliance in your product’s architecture from the start, it will only take a few additional hours of an architect’s or a CTO’s time. You can also use CTO as a service approach if you don’t have a full-time employee or aren’t sure how to approach the issue. How much it costs to build a health app: summary You can find the summary of the factors and the corresponding added costs in the table below. Real-life medical app development cost estimates from ITRex portfolio Now that you know what factors might affect the cost of building a healthcare app, let’s take a look at real-life projects from our portfolio to better understand the pricing. Note that the estimated budget presented below focuses purely on development costs. Every project also has extra expenses that are not accounted for in this estimation. Additional costs can be monthly licensing fees, depending on the used tools, and maintenance costs, depending on the support plan selected by the client. Custom heart rate monitoring device with an iOS app A digital health startup collaborated with ITRex to produce a heart rate monitor device supplemented with an iOS healthcare application that will visualize the monitor’s data and alert doctors in the case of an emergency. To be able to aggregate sensor data in real-time, our team used the OpenGL API and shifted part of the workload to mobile GPU. Health app development costs: $30,000–$50,000 Duration: 3 months Technology: iOS SDK, C, OpenGL library, OpenGL ES A web app for converting files with health information into HL7 messages ITRex cooperated with a software company based in Chicago to develop a web app that helps standardize medical data in healthcare organizations. This software could convert CSV files — with comma-separated medical entries — to messages compliant with the HL7 healthcare data exchange standard. The solution consists of three main modules — CSV parser, HL7 converter, and FTP uploader that will upload the resulting HL7 message to a file on a dedicated FTP server. Costs of developing the health app: $10,000 — $25,000 Duration: 3 months Technology: C#, HTML/CSS, .NET Core, ASP.NET Core, Entity Framework Core, xUnit.net, Bootstrap, SQL. An app to help users build and sustain healthy habits A digital health startup turned to ITRex to build a mobile app that clinics can use to help their clients adopt healthier habits and follow doctors’ recommendations. This solution keeps track of the user’s long- and short-term goals, comments from the user’s coach/physician, and selected meal and workout plans. Users can book doctor appointments through the app, get suggestions on how to improve their performance, and chat with their coach. The solution integrates with the clinic’s management system and allows users to view their lab results. Medical app development costs: $400,000 — $600,000 Duration: 8–10 months Technology: React, React Native, AWS, Node.js A mobile-first web application for heart failure support A multinational biotechnology company turned to ITRex to build a device-agnostic app that supports patients during their first 100 days after being discharged from a hospital. Patients can create a profile, link their caregiver account, and receive personalized content through a preferred channel, which can be an SMS, email, or WhatsApp message. Costs of developing the health app: $400,000 — $600,000 Duration: 9 months Technology: React, Java 11, Spring, Spring Security, Adobe Experience Manager, MySQL, Google Analytics, AWS, Twilio Web and mobile app for personalized health plans This HIPAA and GDPR-compliant solution allows patients to register, fill in an introductory survey, and receive a personalized health plan, and subsequent notifications and reminders. Users can also communicate with their doctors via chat and video calls. This medical application also gives patients the option to set up family accounts and share progress on social media. The solution also includes some advanced features, such as an AI-powered content recommendation engine and a DNA analysis tool based on BioJava. Healthcare app development costs: $600,000 — $800,000 Duration: 5–6.5 months Technology: React.js, Java, Amazon Web Services, Kotlin, Swift How to reduce healthcare app development costs: tips from ITRex Overall, you could pay $30,000–$70,000 for a simple custom healthcare application. This is a significant amount, and your expenses might not end here, as your medical solution will require maintenance and support. Also, you might want to implement additional features to keep up with the customers’ demands. To help you reduce health app development costs, you could: Minimize the number of integrated wearable devices. The medical app development costs will increase with every sensor you want to integrate into your application since it will require more development effort and you will pay higher licensing fees. It’s also worth mentioning that some hardware manufacturers have strict integration requirements that you need to follow if you want to use their devices. For example, Oura ring asks you to preorder 10,000 pieces before granting you access to their API specifications. Use a unified communication protocol for all your devices, if possible. If you build all the hardware that your app will connect to, make sure all your product line uses the same communication protocol. This will help you save on integration costs, as your team will write integration code only once and use it for all devices. When it comes to integrating with hospitals’ systems, like electronic health records, use ready-made, open-source solutions that rely on international standards, such as FHIR and HL7 Benefit from existing open-source tools. For example, OpenCDS is an open-source, standard-based clinical decision support tool that already does a lot of the integration-related work for you. It includes some of the protocols necessary to communicate with clinics. It has a business rules engine, which enables doctors to configure different rules without having to write code. For instance, a doctor can set up a rule on when a particular patient has to take their medication, and the health app will send reminders to that patient accordingly. In addition, OpenCDS already includes a reliable and verified drug database, so you won’t have to build it from scratch. Don’t rush to incorporate AI in the early stages of production. In the beginning, you can use heuristics — i.e., hard-coded algorithms — which are much cheaper to implement while they can still analyze data, derive conclusions, and deliver the results you need during the proof-of-concept phase. You can always implement AI during later phases to increase the accuracy of your predictions. Determine which compliance standards you need to follow and take steps towards that from the very beginning. Only comply with the regulations in your country(s) of operation. Trying to comply with as many global standards as possible will increase the costs of developing your health app without adding any value. Understand who is your audience and tailor your health app to them. If your solution targets senior or disabled citizens, you need to follow the corresponding guidelines and accessibility standards. And in contrast, if your software targets the younger population, there is no need to go the extra mile to make it senior-friendly. Carefully consider your platform choices. Choose cross-platform development over native, when possible. But if you plan close integration with hardware, then the cross-platform option will become more expensive. Also, when examining your hardware choices, consider the circumstances of usage. For example, if you want to build an app that connects to a smartwatch that tracks the location of people with dementia and notifies their caregivers, then it’s a priority that the hardware maximizes the battery’s lifetime and doesn’t need to be charged very often, as it will cause maintenance overhead. Focus on the core features to speed your time to market. For your MVP implement just enough features to satisfy the initial user demand. When the product gets traction, you can expand its functionality set. Do you have an idea of a healthcare app that you believe will impress customers? Get in touch! Our team will explain where the total costs come from and help you strike the balance between affordability and functionality. Originally published at https://itrexgroup.com on December 20, 2022.