 | By Dr Gareth Thompson MD MBA Chief Medical Officer at Our Mobile Health |
Doctors are a funny breed. We want the best for our patients, and access to the latest technologies to help achieve this. Then we grumble when the latest advance in healthcare technology arrives on our doorstep – because it disrupts our cosy tried and tested ways of working. Statements such as “I prefer writing my notes on paper” are not yet consigned to the dustbin of history where they belong.
There are always luddites who try and resist the disruptive onslaught of digital technologies, and doctors are no different. I sympathise- there is nothing worse than a new technology that doubles my workload instead of making it more efficient and there are countless examples of terrible hospital IT systems to make these complaints valid. However, they are missing a vital insight. Doctors who are tech-enthusiasts recognise the power and potential of digital & mobile technology to not only improve the delivery of healthcare, but to change the structure and function of healthcare systems as we know them. It has been said a million times before, but it is worth repeating. Digital technology will have such a profound impact that the nature of the delivery of healthcare itself is about to undergo a radical transformation.
“Ok so what on earth does this have to do with mobile health apps?” I hear you say. Everything. The humble medical dictionaries, diagnostic libraries and medical calculator apps are only a teaser of what is coming next. Health & medical apps are going to place unimaginable amounts of knowledge & capability in the hands of both patients and doctors. Knowledge is power, and so what we are really talking about is the empowerment of both patients and doctors to deliver high quality healthcare quickly & cheaply through entirely new processes to billions of people.
With that lofty ambition, if we come back down to earth, the focus right now should be on identifying problems and barriers that stand in the way of the advancement of mobile medical app use. Here we have a rundown of 10 issues that doctors who use mobile medical apps are currently facing in practice:
1. Sceptical senior colleagues
The use of point-of-care apps offers doctors rapid access to tools that can perform complex calculations or drug formularies with dosing schedules and other vital information that nobody can learn by heart. If senior colleagues are not using apps they might be uncomfortable with their use. There is also the issue of being seen from a distance tapping away on your phone – and bystanders assuming you are texting or checking facebook updates. I have actually been accused of this in practice. Cultural acceptability for the use of apps in the workplace is therefore important, and the designers of medical apps should always have speed of access as a priority if apps are primarily being accessed on personal phones to minimise screen-time. Another solution to the bunking off work to text/facebook/tweet conundrum might be hospital issued tablets and apps.
2. Medical authorities not approving apps
If senior colleagues are sceptical, it follows that professional governing bodies and hospital boards may be even more suspicious. Rumours that one of the royal colleges that govern British doctors in the UK were considering telling doctors that “only CE marked apps are recommended for use”, are one example. To date, only a handful of apps have CE accreditation so this is obviously going to act as a considerable barrier and slow adoption down to a crawl. Solutions to this problem include quality control services of which very few are currently available. Government accreditation bodies are currently under-resourced and poorly equipped to deal with apps.
3. Lack of integration with hospital systems
Significant discussion and efforts are currently being focused on solving the inter-operability of hospital and community healthcare IT systems for sharing medical records. The next level up is integration with personal and professional devices. Without this integration, the power of app functionality will be limited to those uses that are suitable for individual doctors and their personal use. Imagine the potential for apps that allow communication between networks of doctors inside the hospital and beyond, such as by the Mersey Burns App for example, which facilitates communication between emergency doctors and plastic surgeons treating burns victims.
Hospital IT administrators may need to work closely with app developers to make this a reality, or developers may prefer to use a secure 3rd party communication channel.
4. Having poor access to the internet
Many hospital environments are likened to concrete bunkers. Few NHS hospitals in the UK currently have wireless broadband that covers all areas. Network signals for mobile phones are often weak or absent. If online access is essential for an app, then that app is going to be useless in these environments and others where access is poor (for example in rural areas). App developers need to think about how to incorporate as much offline functionality as possible to get around this problem until hospital and GP surgery wireless networks are fully deployed.
5. Figuring out where to find the best apps
The first problem is in finding where the high quality apps are located. There are over 5,000 apps targeted at doctors. Looking at the top 10 in the app store is clearly going to be an inadequate filter. Then there is the issue of user reviews. They are very subjective and opinions can vary markedly from one user to another. Journalists and editorials have attempted to address this problem but reading an entire article and then comparing it to an article on another app is also a very cumbersome process. Accreditation bodies are lagging far behind the pace of app release. Our Mobile Health has created a library of health & medical apps focused on health professionals, and the first expert review process that is sufficiently objective & structured to allow users to make rapid comparisons between apps.
6. Poor quality of content or functionality in apps
The quality of the apps themselves is also an issue. Some apps offer very superficial content or few functions to be genuinely useful to doctors. Newcomers to mobile health apps may be put off by these poor apps and assume that medical apps are mere gimmicks or poor substitutes for other sources of information – the most obvious source being trusted websites. Again, robust review processes are needed to identify the best apps on the market and the new apps that show the most potential as rising stars.
7. Poor user interfaces
Another major quality issue with apps that can put users off is the interface- this determines if an app is user-friendly or not. A lot of early medical apps were simply digitized versions of textbooks or clinical guidelines. The original books and guidelines were the best available on the market, but when the content was transferred into app format the developers gave no consideration to the user interface. The result is an app that is full of very high quality content that is inaccessible and slow to use. The hallmark of these apps is a poor search function. For example, in one well-known British series of medical textbooks the phrase ‘CT scan’ produces no results in the search function! This is a critical design flaw.
8. An absence of peer-reviewed content or professional backing
Closely related to the quality control issue again is the credibility of the sources. Medical apps have a responsibility to reference the scientific studies that have been used to create their clinical content or algorithms. Failure to do so falls short of gold standard medical care. At the very least, where scientific evidence is lacking, then the backing of the relevant professional body or association would go a long way to building trust and confidence in professional users. Peer review processes are one potential solution to this problem.
9. Data security flaws
A problem for next-gen mobile medical apps is the critical need for data security when handling patient data. Data governance is becoming increasingly more regulated, especially when it comes to the handling of medical data because this data has additional legal protections over and above those that apply to personal data. Doctors will be very wary and reluctant to use apps that have not been approved to handle sensitive data. App developers need to consider carefully how to either design the app to avoid the use of patient identifiable data, or work very closely with the relevant authorities to ensure data governance standards are being followed to the highest available standard.
10. Lack of regulatory or legal approval
As well as the stringent regulation around data handling, the use of some medical apps is subject to additional regulatory oversight. Some apps are subject to the same laws that govern medical devices. As a very rough rule of thumb, apps of higher complexity that are directly used in medical decision making without the user viewing the underlying mechanics of a decision are likely to be considered a medical device. Doctors may not be aware of this requirement and find themselves in a position where they have used an app that does not have legal backing. If there was a clinical incident associated with the use of an app this could have repercussions for the doctor involved. This is currently an unlikely scenario, but as the complexity of apps increases and more powerful functions become commonplace then doctors must have confidence that the app has legal backing. App developers are strongly encouraged to seek legal advice at an early stage of development to ensure that all the legal requirements around medical devices are met.
If these issues are addressed, then we together we can work to improve mobile medical apps for doctors in order to remove the barriers to adoption. Ultimately, of course, the aim is to improve care for patients.
This article is intended as a stimulus to further conversation, and to contribute to the awareness of what is required to generate ideas and accelerate the development of next-gen mobile medical apps. This is an exciting time for healthcare innovators at the cutting edge.
Our Mobile Health is creating a library of high quality health & medical apps for professionals and health organisations to help them identify the best apps on the market. We also work closely with health & medical app developers and offer expert & technical review services that will enable them to ensure their apps meet quality standards and gain greater visibility in the market.
“Ok so what on earth does this have to do with mobile health apps?” I hear you say. Everything. The humble medical dictionaries, diagnostic libraries and medical calculator apps are only a teaser of what is coming next. Health & medical apps are going to place unimaginable amounts of knowledge & capability in the hands of both patients and doctors. Knowledge is power, and so what we are really talking about is the empowerment of both patients and doctors to deliver high quality healthcare quickly & cheaply through entirely new processes to billions of people.
With that lofty ambition, if we come back down to earth, the focus right now should be on identifying problems and barriers that stand in the way of the advancement of mobile medical app use. Here we have a rundown of 10 issues that doctors who use mobile medical apps are currently facing in practice:
1. Sceptical senior colleagues
The use of point-of-care apps offers doctors rapid access to tools that can perform complex calculations or drug formularies with dosing schedules and other vital information that nobody can learn by heart. If senior colleagues are not using apps they might be uncomfortable with their use. There is also the issue of being seen from a distance tapping away on your phone – and bystanders assuming you are texting or checking facebook updates. I have actually been accused of this in practice. Cultural acceptability for the use of apps in the workplace is therefore important, and the designers of medical apps should always have speed of access as a priority if apps are primarily being accessed on personal phones to minimise screen-time. Another solution to the bunking off work to text/facebook/tweet conundrum might be hospital issued tablets and apps.
2. Medical authorities not approving apps
If senior colleagues are sceptical, it follows that professional governing bodies and hospital boards may be even more suspicious. Rumours that one of the royal colleges that govern British doctors in the UK were considering telling doctors that “only CE marked apps are recommended for use”, are one example. To date, only a handful of apps have CE accreditation so this is obviously going to act as a considerable barrier and slow adoption down to a crawl. Solutions to this problem include quality control services of which very few are currently available. Government accreditation bodies are currently under-resourced and poorly equipped to deal with apps.
3. Lack of integration with hospital systems
Significant discussion and efforts are currently being focused on solving the inter-operability of hospital and community healthcare IT systems for sharing medical records. The next level up is integration with personal and professional devices. Without this integration, the power of app functionality will be limited to those uses that are suitable for individual doctors and their personal use. Imagine the potential for apps that allow communication between networks of doctors inside the hospital and beyond, such as by the Mersey Burns App for example, which facilitates communication between emergency doctors and plastic surgeons treating burns victims.
Hospital IT administrators may need to work closely with app developers to make this a reality, or developers may prefer to use a secure 3rd party communication channel.
4. Having poor access to the internet
Many hospital environments are likened to concrete bunkers. Few NHS hospitals in the UK currently have wireless broadband that covers all areas. Network signals for mobile phones are often weak or absent. If online access is essential for an app, then that app is going to be useless in these environments and others where access is poor (for example in rural areas). App developers need to think about how to incorporate as much offline functionality as possible to get around this problem until hospital and GP surgery wireless networks are fully deployed.
5. Figuring out where to find the best apps
The first problem is in finding where the high quality apps are located. There are over 5,000 apps targeted at doctors. Looking at the top 10 in the app store is clearly going to be an inadequate filter. Then there is the issue of user reviews. They are very subjective and opinions can vary markedly from one user to another. Journalists and editorials have attempted to address this problem but reading an entire article and then comparing it to an article on another app is also a very cumbersome process. Accreditation bodies are lagging far behind the pace of app release. Our Mobile Health has created a library of health & medical apps focused on health professionals, and the first expert review process that is sufficiently objective & structured to allow users to make rapid comparisons between apps.
6. Poor quality of content or functionality in apps
The quality of the apps themselves is also an issue. Some apps offer very superficial content or few functions to be genuinely useful to doctors. Newcomers to mobile health apps may be put off by these poor apps and assume that medical apps are mere gimmicks or poor substitutes for other sources of information – the most obvious source being trusted websites. Again, robust review processes are needed to identify the best apps on the market and the new apps that show the most potential as rising stars.
7. Poor user interfaces
Another major quality issue with apps that can put users off is the interface- this determines if an app is user-friendly or not. A lot of early medical apps were simply digitized versions of textbooks or clinical guidelines. The original books and guidelines were the best available on the market, but when the content was transferred into app format the developers gave no consideration to the user interface. The result is an app that is full of very high quality content that is inaccessible and slow to use. The hallmark of these apps is a poor search function. For example, in one well-known British series of medical textbooks the phrase ‘CT scan’ produces no results in the search function! This is a critical design flaw.
8. An absence of peer-reviewed content or professional backing
Closely related to the quality control issue again is the credibility of the sources. Medical apps have a responsibility to reference the scientific studies that have been used to create their clinical content or algorithms. Failure to do so falls short of gold standard medical care. At the very least, where scientific evidence is lacking, then the backing of the relevant professional body or association would go a long way to building trust and confidence in professional users. Peer review processes are one potential solution to this problem.
9. Data security flaws
A problem for next-gen mobile medical apps is the critical need for data security when handling patient data. Data governance is becoming increasingly more regulated, especially when it comes to the handling of medical data because this data has additional legal protections over and above those that apply to personal data. Doctors will be very wary and reluctant to use apps that have not been approved to handle sensitive data. App developers need to consider carefully how to either design the app to avoid the use of patient identifiable data, or work very closely with the relevant authorities to ensure data governance standards are being followed to the highest available standard.
10. Lack of regulatory or legal approval
As well as the stringent regulation around data handling, the use of some medical apps is subject to additional regulatory oversight. Some apps are subject to the same laws that govern medical devices. As a very rough rule of thumb, apps of higher complexity that are directly used in medical decision making without the user viewing the underlying mechanics of a decision are likely to be considered a medical device. Doctors may not be aware of this requirement and find themselves in a position where they have used an app that does not have legal backing. If there was a clinical incident associated with the use of an app this could have repercussions for the doctor involved. This is currently an unlikely scenario, but as the complexity of apps increases and more powerful functions become commonplace then doctors must have confidence that the app has legal backing. App developers are strongly encouraged to seek legal advice at an early stage of development to ensure that all the legal requirements around medical devices are met.
If these issues are addressed, then we together we can work to improve mobile medical apps for doctors in order to remove the barriers to adoption. Ultimately, of course, the aim is to improve care for patients.
This article is intended as a stimulus to further conversation, and to contribute to the awareness of what is required to generate ideas and accelerate the development of next-gen mobile medical apps. This is an exciting time for healthcare innovators at the cutting edge.
Our Mobile Health is creating a library of high quality health & medical apps for professionals and health organisations to help them identify the best apps on the market. We also work closely with health & medical app developers and offer expert & technical review services that will enable them to ensure their apps meet quality standards and gain greater visibility in the market.
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