One Health Tech caught up with CEO of Our Mobile Health, Julie Bretland for a conversation about how she came to set up the organisation, and it's vision and work to help verified and trustworthy digital health solutions make a practical impact on the way people manage their health.

Can you tell us about Our Mobile Health?
Our Mobile Health helps identify, assess, review, curate and distribute good high-quality health apps, so that health and care organisations can recommend, deploy and ultimately prescribe digital health services with confidence.  To that end we assess apps for the NHS apps library. We partner with EMIS to provide the EMIS app library powered by Our Mobile Health for GPs, we work with Parkinson's UK to identify and make available apps relevant to people with Parkinson's and we assess apps for London's Good Thinking Project.

How did the idea for Our Mobile Health App Library come about?
I was working in Africa on a project looking at how mobile electronic health records could help bridge the gap between the village health workers who saw patients in their homes, and the hospitals, often based four hours or more away in the cities.  When I came back to the UK, I realised that the UK, despite our fabulous global reputation for both health and technology, was actually behind in our adoption of digital health solutions.  Yet at the same time, we have all these changes we need to address in terms of greater life expectancy, poor lifestyles and budget constraints.

Apps and digital solutions were being developed, but we found either that the apps were being developed in isolation, either by or within the health service with little input from industry and the best practices. The user experience was often poor; data security standards were poor; and there were apps being promoted which stopped working when there was an update to the new operating system. Or apps were being developed by industry without the input of the health service, and thus there wasn’t the buy in from health professionals. As a result, health care professionals quite rightly didn’t have confidence in digital solutions and so the digital solutions weren’t adopted.

What we can bring to the party is good practice from the mobile industry, and an understanding of the regulations, standards and best practices that are already the norm. I ’ve been lucky enough to build a great team with years of experience in healthcare and a fabulous panel of clinicians, health professionals and academics who provide their independent expertise to help review products.

Our research showed that patients are quite happy to look at the app store for wellness apps but when they want to look for medical apps, they turn to their GP or healthcare professional; When it comes to apps, healthcare professionals don’t have anywhere to turn, as they would turn to a drug formulary for example for a medicine. So we fill that gap.

Who has access to the Our Mobile Health App Library? Is it available to the public?
We don’t have a single library that’s open to the public. Our aim isn’t to recreate the major apps stores but to provide a highly relevant portfolio of the best of the best apps. We do two things – we do a lot of work on identifying, assessing and reviewing apps according to an in-depth assessment process which we’ve co-developed over a number of years. Continued....

Read the full interview HERE

Follow Julie on Twitter: @JulieBretland

Winners of the 2018 FDM everywoman in Technology Awards were announced on 8th February.
 
The theme was “Inspiring Tomorrow’s World”, with this year’s programme focussing on the importance of nurturing an interest in science, technology, engineering and mathematics from a young age. Recent studies show the staggering shortage of female students choosing these subjects, including computer science (17.2% female) and engineering & technology (17% female).
 
This is one of the reasons why everywoman has created and showcased successful role models, women working in the technology industry who can inspire the younger generation to follow in their footsteps.
 
This year had a record-breaking number of entries, and further information and winners list can be found HERE
​

​Our Mobile Health and Parkinson’s UK are to create a curated library of health and care apps and devices for people with Parkinson’s. The app library is in response to an increasing demand for digital health solutions from people with the condition.
 
People with Parkinson’s can expect to find apps that track symptoms and help them to manage their condition within the library, which is expected to launch early next year, all of which have been rigorously assessed by independent experts and tested by users who also have Parkinson’s.
 
Our Mobile Health will source the apps from developers and review them against their rigorous quality assurance process. The reviews are conducted by a panel of independent experts and look at a range of areas like patient safety, data security and indicators of effectiveness.
 
Julie Bretland, Founder and CEO of Our Mobile Health, says, “It’s fantastic that Parkinson’s UK are responding to the changing needs of people with Parkinson’s and embracing digital health interventions as convenient and supportive tools for those people living with and managing lifelong conditions on a daily basis.”
 
Parkinson’s UK are setting up a user panel who will test and evaluate these new digital tools.
Julie Dodd, Director of Digital Transformation and Communication at Parkinson’s UK commented, “We believe that technology is a vital part of helping people with the condition live empowered lives. Over the last year we’ve seen enquiries about apps and devices increase significantly. People turn to us for guidance on the apps and devices that work best, but until now we’ve been unable to recommend specific interventions with complete confidence. Not only will all the apps and devices in our library have been rigorously quality checked by Our Mobile Health, but our user panel will provide real-life feedback and guidance for other users.”
 
Emma Lawton, Devices and Apps Strategist at Parkinson’s UK, witnessed for herself how powerful technology can be when last year she was featured in the BBC2 Documentary 'Big Life Fix' where an inventor from Microsoft created a bespoke wearable device, the 'Emma Watch', which helped her to write and draw clearly again. She adds, “With very little advancement in treatments for Parkinson’s over the last 50 years, those of us with the condition are increasingly looking to technology to step up and help us manage our symptoms.”
 
Our Mobile Health are actively looking for app or device developers to submit their products for assessment for this ground-breaking initiative. Organisations or developers who have an app or device that could help support people with Parkinson’s can find out more by contacting Our Mobile Health via julie.bretland@ourmobilehealth.co.uk.    
 
Anyone with Parkinson's of any age in any area of the UK can apply to be part of the user panel. People interested in joining should contact us or fill in the form at: http://surveys.parkinsons.org.uk/s/technologypanel/. 

Digital health solutions are high on the agenda for health systems and providers and that means there are lots of opportunities out there to secure funding for new digital health interventions. As long as you have a good idea, think it through, and answer each of the questions fully, getting funding isn’t the challenge you might think.

A good idea?
Assessors tend to be older experienced people who know the topic well, so any attempt to dig up an old idea – perhaps one that got short shrift in an earlier funding competition – is likely to be summarily rejected, so don’t bother unless you have a new spin on it. As an example, investment cases for smart homes are old hat, however introducing robotics creates a whole new opportunity.

Harder to deal with are the “cost of failure” proposals which involve automating a process that shouldn’t by rights exist. For example, we know that many hospital doctors refuse to code their own interventions, resulting in hospitals losing substantial NHS tariff income in the UK. Therefore introducing handwriting recognition could actually be a step forwards. However, do we want to take that step, essentially into a cul-de-sac, or encourage direct coding, or even perhaps introduce voice recognition so they could speak it directly and have the precise code agreed verbally? Recognising that such thoughts will swirl around the heads of assessors, perhaps explaining how what looks like a cost of failure may be a step in the right direction, could make all the difference to the attractiveness of the proposal.

Thinking it through
One feature that has become evident recently is that good ideas need to integrate into care pathways: a ‘point solution’ that requires manual input and manual output is alien to a care pathway where data should flow from start to finish, with the patient and clinician. Integrate-ability is therefore almost essential. At the same time, a good idea that transforms a care pathway has ramifications well beyond that part of the pathway covered by your proposal, so do be sure to recognise all the implications and risks of the proposed transformation in your response. A demonstration of this was the Whole System Demonstrator programme where the name rightly recognised the potential impact of adding telecare and telehealth interventions, although by insisting on minimal care pathway change to maintain purity of RCT, the academics ensured very little whole system benefit.

Regulation is becoming increasingly important in the medical technology world, both of data privacy and medical devices. The General Data Protection Regulation (GDPR) comes into force on 25 May 2018 and has wide implications on things like explicit consent and where & how data is stored. For new investment proposals, perhaps the most important, if personal data is being stored and especially if it is sensitive personal data[1], is to recognise the need to seek professional expertise and include a sum for so doing.

For the medical device regulation, the lowest bar is the safety standard SCCi0129, which the NHS insists all hardware and software used clinically should comply with. This has important requirements like the appointment of a safety officer, the keeping of a log and such like. Far more significant though is the Medical Devices Regulation (MDR) due to come into force in early 2020. This is already replacing the Medical Devices Directive (MDD) as there is no ‘grandfathering’[2] allowed.

The key thing about this is to recognise that unless you have used good quality management practice specific to the medical device industry from the start of the development and manufacture of your hardware or software, you cannot subsequently receive CE certification; you have to go back and do it all over. This equally applies if your app, say, starts off merely as wellbeing device and then subsequently acquires the characteristics of a medical device by, say, monitoring heartbeat and automatically notifying the user’s clinician of episodes.

A full discussion of what is and what isn’t a medical device – and indeed what will become a medical device under the MDR[3], which extends both the definition and raises the Class of many categories of device – is well beyond this blog, so thankfully the MHRA has produced an excellent short document summarising the position. They also offer a service to advise on close calls – if your proposal looks to be one such, you really should get it checked by the MHRA before submitting your proposal, and say you have in the proposal, and the result. The worst possible thing is to ignore it as, as a rule of thumb, a cost of about £50k and a delay of 6 months in implementation (though these are only indicative – figures vary widely depending on the device) will result if it subsequently emerges that it is. At the very least, recognise it as a risk.

Answer the question fully
If you have thought through your project proposal fully, you should have decided, for example, on the methodology to use in project management, broken out your work packages, and completed a risk matrix. If you have, then put all this in – skimping for example on the risk matrix, not estimating probability and severity, in order to calculate possible impact, immediately gives the impression of poor potential project management.

Another common practice is the organisation that is so full of its own idea that it wants to repeat it in answer to any question where it can be sort-of fitted. Marks are scored for the right information answering the right question; everything else is wasting an opportunity to put other right information there to score more.

Not using the space provided fully is a dangerous practice as it suggests again that the proposal has not been properly thought through. Likewise if the question asks for the benefits you will receive from the funding and the benefits the taxpayer will receive, don’t merely tell the assessors how wonderful the project will be for you; not detailing why the taxpayer might want to fund it is unforgivable!  

And finally
There is nothing that irritates an assessor more than a proposal that has obviously not been proofread properly. The immediate conclusion that is (often unconsciously, and perhaps unfairly) drawn is that the proposing organisation will struggle to deliver the project if they cannot even communicate its key features clearly.

There are many potential sources of funding  - start by checking out Innovate UK and SBRI to see if there is a relevant competition to enter. Go into every funding application with conviction, and do your utmost to sell your product or service in the most impactful way you can. Knowing and acknowledging the risks shows you understand the market and gives confidence in your commercial acumen. That’s essential to converting an idea into reality.


[1] This relates to information concerning a data subject's racial or ethnic origin, political opinions, religious beliefs, trade union activities, physical or mental health, sexual life, or details of criminal offences.

[2] Thus a device that currently meets the MDD requirements though not the MDR ones, would become illegal immediately the MDR comes fully into force.

[3] Note inclusion of the words “prediction” and “prognosis” in particular, that were not in the MDD definition.

We’re thrilled to announce that Our Mobile Health Founder and CEO, Julie Bretland, has been awarded Women in IT Excellence Innovator of the Year! We’re immensely proud of Julie who was recognised for her leadership in enabling access to high-quality mHealth apps that patients and health professionals can use with confidence, and her role in bringing us closer to making digital health a reality for everyone.
 
Speaking about her win Julie said, “It is fantastic for digital health to be recognised amongst all these other exciting areas of innovation. We’ve come a long way in a short time and it’s a privilege to be part of this incredible journey to bring digital health to patients and health professionals.”
 
Charles Lowe, Our Mobile Health Associate and Managing Director of Digital Health And Care Alliance (DHACA) added, “Julie is a most impressive innovator and visionary. She spotted the opportunity before others to establish an mHealth assessment organisation, set it up and secured her first customers extremely rapidly. From this position of strength she has maintained her influence on the assessment process, collaborating with, and influencing, the NHS team established to decide which apps they will support as well as playing an important role influencing EU mHealth app assessment guidelines. Her work has been well rewarded of late with a string of contract wins, including one that will put excellent Our Mobile Health-assessed mHealth apps on GPs’ desktops at more than 4000 practices in England. Congratulations to her for a richly-deserved success.”
 
The awards were created to inspire the new generation of women working in IT by highlighting female entrepreneurs, innovators, leaders and pioneers who are building the infrastructure of the future.
 
http://events.computing.co.uk/womeninitawards

Read Our Mobile Health founder Julie Bretland’s perspective on what needs to be done to make digital health a part of our health ecosystem in the current issue of New Statesman’s Spotlight on Health. 

Our Mobile Health is thrilled to be partnering with AXA on their new ‘Women in Health Tech Entrepreneurs’ category of the 2018 AXA Health Tech & You Awards. The award, which opened for nominations on this week, has been created to support women who are developing innovative ways to change the way people think about their health. 
 
We are working with Collider Health to coordinate and promote the awards, with support from other partners including One HealthTech and Women of Wearables. We’re excited about working together to uncover new and innovative health technology that has been designed and pioneered by women.
 
Half the world’s population is female, and most health decisions are carried out by women, but only 9% of health tech businesses are founded by women, just 9% of investment into UK start-ups goes to female founders, and a mere 17% of the UK technology sector is female.
 
Our Mobile Health Founder and CEO Julie Bretland says, “Recognising the achievements of women in technology is crucial in encouraging women to build a career in this area. As a female tech entrepreneur, I am passionate about supporting other women to succeed. That’s why this new award category is so important to me.”
 
If you’d like to register your interest, or nominate a female tech entrepreneur who has inspired you please complete the form here. 

​Israel is leading the way in digital health integration. 100% of the Israeli population has access to their full personal health records online via their smartphone; they can schedule appointments, renew prescriptions, and even have an online visit to their physician.
 
Yossi talks of his unique window on this changing landscape: “I continue to practice medicine, not just because people and the art of diagnosing and healing are my personal and moral passion, but also because it presents me with the opportunity to experience, in first-hand, the needs and gaps for patients, clinicians, and organisations. That gives me a unique perspective when it comes to translating those needs into solutions which aim to combine technologies and human experiences.”
 
Through his experience leading the digital transformation of Israel’s largest health organisation, Yossi learned that digital health can’t be deployed as if it was a standalone technology solution. For it to be adopted it must be warmly embraced by the different stakeholders and interact with the existing healthcare infrastructure and solutions. Yossi explains his experience with mHealth apps:
 
“Healthcare is a challenging environment – very traditional, virtually immune to change, and overwhelmed by regulatory, legal and ethical complexities. Medical teams are an essential component in the adoption of mHealth solutions. If your physician sees the mHealth solution as one that enables him to provide better, more personalised and more efficient care, you will also look at it as a medical device rather than as a nice-to-have app. The internalisation of the value of mHealth solutions by the medical team personnel and their will to convey this value to their patients is crucial.”
 
That insight was what led Yossi and his team to the concept of prescribed apps.
 
Apps as prescribed clinical interventions
 
Today, physicians in Israel routinely prescribe apps for a range of purposes, including for chronic disease management such as diabetes prevention and Inflammatory Bowel Disease, ADHD, and medication adherence. Research has shown that using apps as health interventions does deliver measurable improved clinical outcomes. Yossi refers to prescribed apps as “pills composed of digital molecules”. That integration of health apps into practice didn’t happen overnight. Yossi talks about some of the barriers they had to overcome:
 
“Physicians are used to practicing medicine in a certain way, so in-order for app prescription to become part of their routine practice, they need to be educated on the value, the supporting evidence, the way to convey it to their patients, and the right way of using these “digital pills” so to maximise their potential benefits. In our organisation, we built a dedicated team which was responsible for managing the change associated with the adoption of mHealth solutions by the medical teams. We developed methodologies and processes aimed at engaging physicians, nurses and other medical team members, explaining to them the vision and making them curious and excited about how significantly these solutions can contribute to the quality of medicine they provide. Our approach appealed to their logical heads but also their hearts. That was key to drive a change in their beliefs about health apps as clinical interventions.”
 
“Alongside practical challenges like reimbursement; fear, suspicion, reluctance to change are all barriers. These physicians are not used to thinking about apps as medical interventions and the path to changing this is a journey rather than a one-off seminar. Even for the ones who are more inclined to change and who are more tech-savvy, app prescription requires a change in state-of-mind, training and practicing. It’s like learning and adopting a totally new treatment protocol after being used to a certain way of doing things for years. For change to happen you need to embed these new interventions into the existing workflow. You need to reduce the logistical hurdles while also addressing the emotional ones.”
 
There are also hurdles to be overcome on the patients’ side. Most patients are still not used to interventions that aren’t drugs. Yossi’s experience was the more the physician was engaged, the better they would emphasise the app as a bespoke clinical intervention to the patient. The doctor-patient relationship is the key to patients adopting mHealth solutions. 

​Evidence base for health apps
 
There is a growing body of literature about the clinical efficacy and health economic returns of digital health interventions. Individual studies support specific interventions but also hint towards a "class effect" that suggests when health apps are designed and deployed in the right way they can be very effective in improving outcomes, empowering the patient-physician relationship and reducing costs. Still, methods for assessing and evaluating mHealth solutions are in their early days, and advancements are required on all fronts –  including clinical outcomes, user experience, privacy, security, economic models.  
 
“Differentiating the truly digital therapeutic apps from ones that are not properly evaluated is crucial,” says Yossi. 

​The future of healthcare
 
We asked Yossi to share his perspective on how healthcare is changing: “We are about to experience one of the most remarkable changes in the history of modern healthcare. New mobile technologies, consumer trends, reimbursement models are converging to fundamentally change the industry, and address the challenge of delivering improved outcomes in a cost-effective way. The reimagining of healthcare is already underway and it will continue to accelerate. People will get more involved in their health, more engaged, healthcare will become more participatory and more personalised. The pace of change will increase as more millennials start to become “consumers” of healthcare. This is already happening, and this wave of change will grow whether we lead it or whether we physicians and the other healthcare stakeholders will be forced into it. I believe it is always better to lead because it allows you to influence the change and navigate the journey versus being carried away by hyped trends.”
 
“Digital health and the promise it brings to patient centricity and healthcare personalisation is just beginning. What we are seeing now is the tip of the iceberg. I feel really privileged to be part of this evolution of healthcare. My driving force and life mission is to expand this promise on a global scale, making my humble contribution to a healthier humanity. In order for this evolution to succeed, this requires a collaborative effort – with governments, health professionals, regulatory systems, tech innovators and consumers joining hands.”

The Women in IT Excellence awards were created to inspire the new generation of women working in IT by highlighting female entrepreneurs, innovators, leaders and pioneers who are building the infrastructure of the future.
 
Julie has been short-listed in recognition of her development of new processes and platforms that enable access to high-quality mHealth apps that patients and health professionals can use with confidence, and that bring us closer to making digital health a reality for everyone.
 
Speaking about the award, Julie said, ”I am honoured to be recognised alongside other inspirational women who are pioneering in their fields. Awards like these are so important in encouraging women to build a career in IT and technology. I am delighted to be able to play a role in that.”
 
Shortlisted entrants will now go through to a second panel of judges who will decide the winners before the awards ceremony in London on the 1st November. Read more about the awards here.