Medical Professionals and Medical Apps: Why Oversight Must Come from Within

BackgroundHospitals have been identified as very high-risk places for COVID-19 transmission between health care workers and patients who do not have COVID-19. Health care workers are the most at-risk population to contract and transmit the infection, especially to already vulnerable patients who do not have COVID-19. In low-income countries, routine testing is not feasible due to the high cost of testing; therefore, presenting the risk of uncontrolled transmission within non–COVID-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA–polymerase chain reaction testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also enable efficient use of the limited testing kits.ObjectiveThe aims of this study are to describe an early warning in-hospital mobile risk analysis app for screening COVID-19 and to determine the feasibility and user-friendliness of the app among health care workers.MethodsThe primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with over 69% of the health care workers having logged more than 67% of the required times. Over 93% of the participants reported that the tool was easy to use.ResultsThe primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with 69% of the health care workers (69/100) having logged more than 67% of the required times. Of the 100 participants, 93 reported that the tool was easy to use.ConclusionsThe EWAS mobile app is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of COVID-19. Although it was not designed to be a diagnostic tool but rather a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted COVID-19.

There are more than 318,000 mobile health apps available worldwide and more than 200 new apps become available each day. Although most are general wellness apps, the number of those related to patient care and management of health conditions continues to increase and has reached 40 percent of all health apps on the market. In fact, there is at least one high-quality app (i.e., apps with such attributes as good patient ratings, frequent updates, and promising clinical evidence) available to support patients’ needs at each stage of the care continuum, from prevention to treatment. More than 570 studies on mobile apps have been published, providing a robust amount of clinical evidence on their quality and effectiveness.1 One survey identified that 75 percent of U.S. health consumers believe technology, including apps, is important for managing their health. Mobile health apps are being embraced by patients for a multitude of uses, including virtual care and tracking, recording, and sharing health data, such as blood pressure and heart rate.2 Top uses for virtual care have included after-hours and follow-up appointments and concern-specific discussions. The use of virtual care continues to increase; 25 percent of surveyed consumers indicated they used these services in 2018, which is up from 21 percent in 2017. The majority of 2018 respondents who used these services (74 percent) said they were satisfied with the virtual care they received; in fact, approximately 50 percent of all respondents reported they would prefer a faster virtual care appointment than a delayed in-person visit.2 Moreover, 79 percent of U.S. consumers reported in another survey that they are more likely to choose a health care provider who has methods in place to connect virtually instead of one who does not.3 Ninety percent of patients surveyed indicated they are willing to share their health data obtained from mobile apps and wearable devices with their health care team.2 For health care professionals, mobile apps are beneficial for a range of uses, including to access medical references for point-of-care decisions; assist with hospital information systems, such as the electronic health record; communicate with other clinicians; perform training; and remotely monitor patients. In one survey, approximately 30 to 50 percent of U.S. clinicians reported using apps to actively engage in patient care, including to collect patient information at the bedside and monitor medical device information.3 Approximately 66 percent of the 100 biggest U.S. hospitals provide mobile apps for patients; 40 percent of these developed the apps in house.4 Health apps have been proven to reduce use of acute care services for diabetes, asthma, and cardiac and pulmonary rehabilitation; the use of apps in just these categories has the potential to save $7 billion in health care costs annually in the United States.1 Mobile apps can augment care for both patients and health care providers at all stages of care. Surveys of U.S. health care consumers and professionals point to an increasing adoption of this technology, highlighting the importance of identifying ways to incorporate these tools into patients’ health maintenance and care. This month’s lead feature discusses the use of mobile apps to aid patients in their postoperative recovery, including for medication compliance, pain management, and follow-up care.

Are Medical Apps the future of medicine?

Strategies for Partnering with Health Care Settings to Increase Physical Activity Promotion

BackgroundThe prevalence of long-term or chronic conditions that limit activity and reduce quality of life in young people aged 10-24 years is rising. This group has distinct health care needs and requires tailored support strategies to facilitate increasing personal responsibility for the management of their condition wherever possible, as they mature. Mobile phone and tablet mobile technologies featuring software program apps are already well used by young people for social networking or gaming. They have also been utilized in health care to support personal condition management, using condition-specific and patient-tailored software. Such apps have much potential, and there is an emerging body of literature on their use in a health context making this review timely.ObjectiveThe objective of this paper is to develop a systematic review protocol focused on identifying and assessing the effectiveness of mobile phone and tablet apps that support young people’s management of their chronic conditions.MethodsThe search strategy will include a combination of standardized indexed search terms and free-text terms related to the key concepts of young people; long-term conditions and mobile technology. Peer-reviewed journal articles published from 2003 that meet the inclusion and exclusion criteria will be identified through searching the generated hits from 5 bibliographical databases. Two independent reviewers will screen the titles and abstracts to determine which articles focus on testing interventions identified as a mobile phone or tablet apps, and that have been designed and delivered to support the management of long-term conditions in young people aged 10-24 years. Data extraction and quality assessment tools will be used to facilitate consistent analysis and synthesis. It is anticipated that several studies will meet the selection criteria but that these are likely to be heterogeneous in terms of study design, reported outcomes, follow-up times, participants’ age, and health condition. Sub-group analyses will be undertaken and where possible meta-analyses will take place.ResultsThis review will synthesize available knowledge surrounding tablet and mobile phone apps that support management of long term physical health conditions in young people. The findings will be synthesized to determine which elements of the technologies were most effective for this population.ConclusionsThis systematic review aims to synthesize existing literature in order to generate findings that will facilitate the development of an app intervention. The review will form the first phase of development and evaluation of a complex intervention as recommended by the United Kingdom Medical Research Council. The knowledge gained from the review will be verified in subsequent phases, which will include primary qualitative work with health professionals and young people with long term conditions as research participants. Young people living with long-term conditions will be involved as co-researchers and consumer advisors in all subsequent phases to develop and evaluate an app to support the management of long-term physical health conditions.Trial RegistrationPROSPERO International prospective register of systematic reviews: CRD42014015418; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014015418#.VRqCpTpnL8E (Archived by Webcite at http://www.webcitation.org/6XREcWqQY).

All About Asthma: Top Resources for Children, Adolescents, and Their Families

Mobile health (m-health) smartphone interventions for adolescents and adults with overweight or obesity.

Mobile health applications for asthma

BackgroundThe terms health app and medical app are often used interchangeably but do not necessarily mean the same thing. To better understand these terms and better regulate such technologies, we need distinct definitions of health and medical apps.ObjectiveThis study aimed to provide an overview of the definitions of health and medical apps from an interdisciplinary perspective. We summarized the core elements of the identified definitions for their holistic understanding in the context of digital public health.MethodsThe legal frameworks for medical device regulation in the United States, the European Union, and Germany formed the basis of this study. We then searched 6 databases for articles defining health or medical apps from an interdisciplinary perspective. The narrative literature review was supported by a forward and backward snowball search for more original definitions of health and medical apps. A qualitative analysis was conducted on the identified relevant aspects and core elements of each definition. On the basis of these findings, we developed a holistic definition of health and medical apps and created a decision flowchart to highlight the differences between the 2 types.ResultsThe legal framework showed that medical apps could be regulated as mobile medical devices, whereas there is no legal term for health apps. Our narrative literature review identified 204 peer-reviewed publications that offered a definition of health and medical apps. After screening for original definitions and applying the snowball method, 11.8% (24/204) of the publications were included in the qualitative analysis. Of these 24 publications, 22 (88%) provided an original definition of health apps and 11 (44%) described medical apps. The literature suggests that medical apps are a part of health apps. To describe health or medical apps, most definitions used the user group, a description of health, the device, the legal regulation, collected data, or technological functions. However, the regulation should not be a distinction criterion as it requires legal knowledge, which is neither suitable nor practical. An app’s intended medical or health use enables a clear differentiation between health and medical apps. Ultimately, the health aim of an app and its main target group are the only distinction criteria.ConclusionsHealth apps are software programs on mobile devices that process health-related data on or for their users. They can be used by every health-conscious person to maintain, improve, or manage the health of an individual or the community. As an umbrella term, health apps include medical apps. Medical apps share the same technological functions and devices. Health professionals, patients, and family caregivers are the main user groups. Medical apps are intended for clinical and medical purposes and can be legally regulated as mobile medical devices.

The terms health app and medical app are often used interchangeably but do not necessarily mean the same. Medical apps can be regulated as mobile medical devices and therefore need to meet general safety and performance requirements. On the contrary, health apps are not part of this legal framework and do not need proof of their efficacy or guaranteeing data security. We need distinct definitions of health and medical apps to understand these terms better and regulate such technologies more effectively. We will provide an overview of health and medical apps definitions and a differentiation flowchart from public health and legal perspectives. A search in 6 databases identified 22 publications that defined health apps and 11 reports that described medical apps. The core elements of these definitions were identified through qualitative analysis. Health and medical apps share the same devices, technical functions and collect health data. While it can be highly challenging to decide which legal requirements have to be fulfilled by an app, we deem it unfit as a distinction criterion. It requires legal knowledge, which is neither suitable nor practical for users. However, medical device law is closely linked to the app’s intended medical or health purpose criteria, which allows a clear differentiation. Additionally, the difference in the user group can be used for separation. Our suggestion for the definition would be that health apps are software programs on mobile devices that process health-related data on/for their user. They can be used by every health-conscious person to maintain, improve or manage the health of an individual or the community. As an umbrella term, health apps include medical apps. They share the same technological functions and devices as health apps. Health professionals, patients, and family caregivers are the main user groups of medical apps. Due to the intended use for clinical purposes, medical apps can be regulated as mobile medical devices.Key messages• Separating apps based on legal regulation is impractical & can’t be expected from all stakeholders. Differencing between health and medical apps requires the user group and the health aim of the app.• Health apps include medical apps. Since 2019, medical apps in Germany contain digital health applications (DiGA). Since 2022, medical apps partly include digital care applications (DiPA).

BackgroundThe COVID-19 pandemic has highlighted the importance of health care workers’ mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers.ObjectiveRMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app.MethodsThe impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days.ResultsThe anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021.ConclusionsThe impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely.International Registered Report Identifier (IRRID)DERR1-10.2196/26168

Can the use of mobile applications (apps) improve quality of life and disease management in adult patients with urologic disease? Technology has created new opportunities to promote behavioural change in the daily lives of patients. One third of adults in the United States who own smartphones or tablets use health apps to improve their health. The aim of this review was to analyse whether use of mobile apps improves the quality of life and symptom management of urological patients. Databases: PubMed, CINAHL, Scopus. Search terms (free terms, MeSH): mobile apps, urologic diseases. Papers searched included all randomized controlled trials, quasi‐experimental studies, analytical cross‐sectional studies, cohort studies, and case–control studies. Nine articles were analysed. The review showed that mobile apps purpose‐built for urological patients can improve quality of life, signs and symptoms. It is necessary that nurses and physicians be familiar with these apps in order to identify and benefit those patients who deal with disabling diseases that prevent them performing their daily activities to the desired degree. Mhealth makes inroads into the medical profession, both doctors and nurses should maintain awareness not only of drug and other therapies but also of the efficacy of the mobile health apps available. Digital health treatment has arrived and can no longer be considered merely peripheral.

Objective: All Nurses experience work stress that can take their focus away from patient care. Healthcare organizations strive to identify successful, cost-effective stress reduction programs. Mindfulness Based Stress Reduction (MBSR) training is a validated approach to stress reduction, usually in a class format. However, financial and time constraints make it inaccessible to most practicing nurses. Alternatively, mobile mindfulness apps offer an approach to mindfulness that can reach large populations, are available 24/7, anonymous, and cost effective.Methods: This prospective, study evaluated the efficacy of a mindfulness mobile app for stress reduction in nurses utilizing Whil, a Mobile App that offers mindfulness training specifically geared towards health professionals. Eight hundred and fifty-two nurses were recruited from twelve sites (71 per site) within a large Health Care System in the Northeast United States.Results: Two scales were used to test results. Nurses Stress Scale (NSS) results indicated that nurses experienced a reduction in stress level with use and time spent in the app. Nurses in the 31-40 age range and nurses on 12-hour shifts experienced greater stress levels.Conclusions: Significant differences were seen in the Subscales Conflict with Physicians, Conflict with other Nurses, and Lack of Support. There was no change in the Mindfulness Attention Awareness Scale (MAAS) over time. Spearman’s correlation showed a significant and negative correlation between NSS and MAAS scores. The Whil Mobile App is effective for stress reduction in practicing nurses on all shifts and is cost effective.

Hundreds of smartphone applications are available to support people with Alzheimer’s disease or dementia (AD/dementia) and their caregivers. Smartphone applications may provide a unique and effective means of administering interventions. The purpose of this study was to systematically search and describe the literature on mobile apps used in interventions on AD/dementia and to evaluate the potential of apps to be implemented in AD/dementia interventions. A systematic review was conducted in April 2016 using a set of predetermined search terms in several scientific journal databases. Only English articles pertaining to interventions using smartphone apps were included in the final sample. App functions, target user groups, country, app platform and study design were coded for each study in the final sample. A final sample of 11 studies identified for this review were primarily feasibility and pilot studies with small sample sizes. Studies were mostly conducted in Europe, with Android being the preferred platform. Functions of the mobile apps mainly focused on occupational therapy to support people with AD/dementia, and cognitive assessment to allow early screening of cognitive impairment. Findings of the review provide support for the use of app-based interventions on AD/dementia. The lack of large sample studies with rigorous research design using mobile phone apps may signal a need for additional studies on the potential use of mobile apps to assist individuals with mild or moderate AD/dementia, their family caregivers and health professionals. Additional concerns include the reliability and validity of cognitive assessment tool administered by mobile apps.

There is an increasing presence of patient-led social media, mobile apps and patient support technology, but little is known about the role of these in the support of bariatric surgery patients in the UK. This study aimed to seek the views of allied health professionals (AHPs) working in bariatric surgical teams to understand their current perceptions of the role of social media, mobile apps and patient-support technology within bariatric surgery in the UK. A confidential, printed survey was distributed to the AHPs at the British Obesity and Metabolic Surgery Society (BOMSS) 7th Annual Scientific Conference in January 2016. An email to AHPs who did not attend the conference was sent requesting voluntary participation in the same survey online through Survey Monkey® within 2weeks of the conference. A total of 95 responses were received, which was a 71% response rate (n=134). Responses were from nurses (34%, n=46), dietitians (32%, n=32), psychologists (16%, n=12) and 1 nutritionist, 1 physiotherapist, 1 patient advocate, 1 surgeon and 9 respondents did not fill in their title. The use of social media and mobile apps by patients is increasing, with AHPs concerned about misinformation; advice may differ from what is given in clinic. Technologies, e.g. telehealth and videoconferencing are not widely used in bariatric surgery in the UK. AHPs are unclear about the role of technologies for bariatric surgical patient support. Further discussions are needed to understand the potential of technology with AHPs supporting/facilitating patients as this becomes more commonplace.