Text Messaging

Can Text Messaging Improve Patient Engagement Outcomes?

Text messagesMedication non adherence is a significant problem, it always has been and it will continue to be so with an estimated cost to the NHS of £600m* a year! So what can be done to improve patient outcomes? Changing patient behaviour is key to this and there have been a number of clinically led studies conducted that demonstrate that apps can help to improve compliance.  But, when looking at patient engagement, perhaps there is another solution where a person-centric approach is more likely to improve the odds of success. A successful engagement programme needs healthcare providers to be able to reach their patients in familiar and effective ways and by doing this, patients are encouraged to take an active role in their treatment which will in turn lead to better healthcare outcomes.

This is where I think text messaging could be the answer.

It’s a cost effective way of providing a more personalised experience with a greater reach than just smartphone users. Last year over 145 billion* text messages were sent and despite the rise of instant messaging platforms among younger users, text messages remain device agnostic and one of the easiest ways reach anyone with a mobile phone.

The Personal Touch

Your health is a private matter and the more personalised the experience, the more likely patients are to respond and take an active role in managing their own treatment. Medication reminders, exercise reminders, appointment booking, pre-op instructions, post op advise can all be communicated ‘one-on-one’ and doing this on a personal level, knowing that a real person is supporting them, can be a real motivator to empowering them to make the necessary changes.

A GSMA study in 2012 showed that 54% of consumers wanted to improve their healthcare using their mobiles in more personalised ways, taking more control in their treatment.

Patient Preferences

Reach

In order for any patient engagement programme to be successful the number of patients you are able to reach is very important. Patients comes from a variety of backgrounds and demographics with a range of communication preferences. Combined with the fact that it’s not always possible to be connected to the internet, text messaging offers the lowest common denominator and most reliable way of contacting patients. Text messaging also is the quickest way to reach the most people. The average text message is read within the first 90 seconds, whereas the average email is opened within the first 90 minutes*.

Security

Clearly security and compliance are also considerations for any healthcare system that communicates patient information. The text messages can be stored securely inline with HIPAA compliance but because security depends on the cooperation of all parties involved in the transmission process there are bound to be challenges. However if the tool is used correctly, with guidelines in place to support patients with their treatment plans and not for discussing medical issues, many of these security concerns are negated.

Conclusion

There is no doubt that apps and smartphones will make communication easier, reduce costs and improve efficiencies throughout the NHS. But let’s not just assume that apps are the answer before considering all the technologies available to us and the way in which patients use them. Familiarity, reach and simplicity can play a big role in the success of an initiative like this and, used in the correct way, could see tangible benefits in terms of outcomes and cost savings.

*http://europe.newsweek.com/health-apps-created-surgeons-put-patients-control-313531
*http://www.hsj.co.uk/resource-centre/best-practice/qipp-resources/how-improved-medication-adherence-can-prevent-costly-medicine-waste/5041067.article#.VVXLXJNVhBc
*http://www.theguardian.com/technology/2014/jan/13/number-text-messages-sent-britain-falls-first-time
*http://www.pewinternet.org/2012/11/30/the-best-and-worst-of-mobile-connectivity/
Image credit: Amancay Maahs (https://www.flickr.com/photos/amanky/3211478871/)
Sencha Touch

How to install, use and build Sencha Touch 2.1 apps on Windows

Sencha Touch is a Javascript Framework used for building high performance cross platform mobile apps. My experience with installing Sencha Touch was horrible. The docs are severely lacking with outdated and conflicting information. With much experimentation, web searching and thanks to some help on the Sencha forum I managed, finally to get it installed. This post deals with installing Sencha Touch, generating your first app and ‘building’ it so it’s ready for production web use. It doesn’t cover coding a Touch app or packaging your app for iOS and Android which I expect to cover in another post.

This was a piecemeal process and very much a learning experience. There may be errors in my recommendations or assumptions but the end result works for me. If I were to do it again I’d most likely choose a more ordered folder structure for the various installations just for the sake of good housekeeping.

Briefly, if like me you struggled to cut through the marketing hype, these are the core Sencha Products and what they do:

  • Ext JS – Javascript framework for developing desktop apps.
  • Touch – Javascript framework for developing mobile apps.
  • Architect – Standalone product for developing Ext JS or Touch apps using a GUI (as oppose to hand coding)

For the record, I am only concerned with Touch. I tried Architect but found the documentation so lacking that I gave up and decided to just use Touch instead. Unless you are an OEM, Touch is free to use. Architect is a paid product.

Installing and using Sencha Touch 2.1

What you need – I provide specific download links in the instructions below:

1. Apache

First up, if you don’t have a local webserver installed, do it now. Because I’ve used it before, I chose Uniform Server, a WAMP server (Windows Apache MySQL PHP). Uniform Server downloads as an exe (Coral_8_7_2.exe in my case). Run the exe and point it to the folder you want to work from. I chose:

C:\Users\Gareth\Documents\Sencha

So the path to my web root is:

C:\Users\Gareth\Documents\Sencha\UniServer\www

Next we need to allow other devices on your network to access the new Apache installation. This assumes the IP address used by your network is 192.168.1.X. If it’s different, you will need to change the input below accordingly. In the above folder there should be an .htaccess file. Open it in a text editor and change line 9 from:

Allow from 127.0.0.1

To

Allow from 127.0.0.1 192.168.1.0/24

192.168.1.0/24 allows any device using an IP in 192.168.1.X range to access your server.

Click Start_as_program.exe form C:\Users\Gareth\Documents\Sencha\UniServer folder. Don’t worry about passwords if prompted. From the interface click ‘Start Apache’ and it should open a browser window with the Uniform Server homepage.

To access your server from another device (i.e. your mobile or tablet) you need to enter the IP address of the machine you installed Uniform Server on in the web browser. To find your IP Address, open a command prompt (start > type ‘cmd’in the search box and press enter) and type ipconfig. In the first few entries you will see a line that says IPv4 address. Make a note and type this in your mobile browser address bar and you should see the Uniform Server homepage.

Note: Your IP Address could change every time you restart your machine so you will need to know it to be able to see it from your mobile or tablet.

2. JRE

Next install JRE – Java Runtime Environment. Download from:

http://www.oracle.com/technetwork/java/javase/downloads/jre7-downloads-1880261.html

I chose Windows x64 ( jre-7u10-windows-x64.exe at the time), you should choose the correct version for your system. I left the default install options which made the install path:

C:\Program Files\Java

3. Ant

Install Ant. Download from:

http://ant.apache.org/bindownload.cgi

Ant is a library used by other tools when building applications. Download, unzip and move the files to the folder of your choice. I chose c:\ant because that what’s mentioned in the install guide. Assuming you used c:\ant, you should have the folders C:\ant\bin, C:\ant\etc and so on.

Now, open a command prompt. At the prompt type:

set ANT_HOME=c:\ant
set PATH=%PATH%;%ANT_HOME%\bin

Close the command prompt window.

4. Ruby

Install Ruby. Download from:
http://rubyinstaller.org/downloads/

I used the defaults which installed to C:\Ruby193 and checked all 3 options:

Once Ruby is installed, open a command prompt. Type:

ruby -v

This should display a line which looks similar to:

Ruby 1.9.3p362 (2012-12-25) [i386-mingw32]

5. Compass and SASS

Assuming the above works, in the same command prompt or a new one, enter the following 4 commands, waiting for each to complete before typing the next. These commands install items, including Compass and SASS which Sencha relies on when building apps:

  1. gem install haml
  2. gem install haml-edge
  3. gem install compass
  4. gem install sass

6. Sencha Touch

Install Sencha Touch. Download from:

http://www.sencha.com/products/touch/download/

At certain points in their documentation, Sencha refer to this is the Sencha Touch SDK (not to be confused with the obsolete Sencha Touch SDK Tools). I downloaded the GPL version sencha-touch-2.1.0-gpl.zip and extracted the contents to:

C:\Users\Gareth\Documents\Sencha\UniServer\www\sencha-touch-2.1.0-gpl

So I have the following example folders:

C:\Users\Gareth\Documents\Sencha\UniServer\www\sencha-touch-2.1.0-gpl\builds

C:\Users\Gareth\Documents\Sencha\UniServer\www\sencha-touch-2.1.0-gpl\cmd

C:\Users\Gareth\Documents\Sencha\UniServer\www\sencha-touch-2.1.0-gpl\docs

Etc

7. Sencha Command

Install Sencha Command. Download from:

http://www.sencha.com/products/sencha-cmd/download

(SenchaCmd-3.0.0.250-windows.exe.zip for me). I used the default install directory which was C:\Users\Gareth\bin so ended up with the following example directories:

C:\Users\Gareth\bin\Sencha\Cmd\3.0.0.250\ant

C:\Users\Gareth\bin\Sencha\Cmd\3.0.0.250\lib

C:\Users\Gareth\bin\Sencha\Cmd\3.0.0.250\phantomjs

Etc

That should be it. Close all command prompts and then open a new one and type the following. You will need to change the paths to the correct ones. The first path is the path to where you installed Sencha Touch, the second is where you want your app folder:

sencha –skd C:\Users\Gareth\Documents\Sencha\UniServer\www\sencha-touch-2.1.0-gpl generate app FirstTest C:\Users\Gareth\Documents\Sencha\UniServer\www\FirstTest

This will create a folder in the www directory called FirstTest which contains all the files for a basic Sencha Touch app. If you visit http://localhost/FirstTest (using Chrome) you should see the app:

My local IP Address is 192.168.1.96 so if I visit http://192.168.1.96/FirstTest on my iPhone I see:

Finally, to ‘build’ your app, that is, to export it in a format optimised for a particular environment, open a command prompt, change directory to the one we created for your FirstTest, and type:

sencha app build production

Your output should look like the screen shot below and your FirstTest folder should contain a new folder tree of ‘build/FirstTest/production’. Now, if you navigate to the address below you will be viewing the optimised, production ready version of your app:

http://192.168.1.96/FirstTest/build/FirstTes/production

That’s it. You should be up and running. The following resources where used by me and might help you if you get stuck:

http://www.ladysign-apps.com/developer/sass/installing-sass-compass-for-windows-os-x/ installing compass and sass on windows.

http://ant.apache.org/manual/install.html#windows – installing ant on windows

http://www.sencha.com/forum/showthread.php?252680-Docs-appalling-how-to-actually-get-started – my forum thread where Brice Mason provided a concise list of requirements.

 

Clinical Business Excellence

Mobile Medical Apps: A Great Way of Reaching HCPs?

Damon Lightley featued in Clinical Business ExcellenceDamon Lightley, Marketing Director at Genetic Digital was approached by one of the editors from Clinical Business Excellence to write an article about medical apps.

The article has now been published and appears on page 8 of the August 2012 issue of Clinical Business Excellence. It is titled: “Mobile Medical Applications: A Great Way of Reaching HCPs?” A PDF version is also available.

Mobile Medical Apps: A Great Way of Reaching HCPs?

Mobile technology to foil counterfeit drugs

An American technology company is utilising mobile phone technology in an attempt to combat the $75 billion-a-year counterfeit drugs market. Copies of proprietary brand drugs not only eat into the margins of pharmaceutical companies, who invest hundreds of millions of dollars in developing medicines every year, but also threaten the health and safety of those that take medicines not subject to stringent industry testing.

Drug counterfeiting is a global problem and is endemic in certain parts of the developing world where up to 30% of all medicines are counterfeit. To combat the increasing availability of fake drugs, PharmaSecure has developed a system that creates a direct link between manufacturers and the end user. This provides consumers with a guarantee that the medicines they are taking were produced by the licensed and regulated company.

PharmaSecure’s track and trace authentication system provides a unique ID code on product packaging, which can be used to track every stage of the drug’s journey through the supply chain right into the hands of the end customer. The customer can then use a simple SMS messaging system to verify authenticity. The system ensures the customer is protected from the dangers of counterfeit medicine and the company protects its trademark as well as maintaining the integrity of its products and brand identity.

Due to the simplicity of the system and the relatively low cost of implementation, PharmaSecure track and trace programme has the ability to be scaled on a global level and deal a severe blow to the counterfeiters.

Mobile health apps need new regulatory framework

Last month, a mobile phone app became the first of its kind to be registered by the Medicines and Healthcare products Regulatory Agency (MHRA) as a medical device.

The app was developed by the team at the Mersey Regional Burns and Plastic Surgery Unit and is designed to help medical staff assess burn damages. This neat bit of kit is listed by the MHRA as a class 1 medical device and is available for free in the Apple app store.

According to research, 81% of healthcare professionals own a smartphone and as a result the Mersey Burns app will no doubt be useful by sharing the specialist knowledge from the burns unit with their medical colleagues. However, the licensing of the app has raised all kinds of questions on the future registration of mobile phone apps for use in the healthcare professions.

On the face of it, registration is eminently desirable; in healthcare accuracy is everything, so it is important that diagnostic, treatment and monitoring apps are rigorously tested to ensure their suitability for public release. Unregulated mobile health apps have the potential to put the public at risk.

However there is concern, particularly in the US, that excessive regulation of mobile apps will vastly increase the costs of app development and slow market availability down to such an extent that the technology could be out of date by the time it hits the market.

As a result, on both sides of the Atlantic, web and app developers and healthcare and pharmaceutical companies are calling for a new regulatory framework which will allow the testing and processing of relevant mobile apps at speeds equal to the pace of rapid technological change.

Mobile apps on the rise in pharma

Pharmaceutical and other life science companies are becoming increasingly aware of mobile applications’ potential to boost the effectiveness of their communication.

According to Cutting Edge Information, a US company that provides management analysis reports, support services and consulting to pharmaceutical biotechnology companies globally, apps also hold the key to pharma digital marketing in the future.

Casey Ferrell, research analyst at Cutting Edge, said: “Apps for physicians hold the potential to revolutionise the way in which healthcare is administered.

“There are digital imaging apps for ECGs and radiological procedures; there are apps that improve emergency room efficiency; and there are apps designed to improve patient-physician interaction, including some that facilitate remote consultations.”

Other research from Cutting Edge Information study shows many early implementers of apps and mobile technology are now finding that the pre-launch commercialisation period presents the best phase for successfully utilising mobile pharma technology.

Ferrell said: “”I would argue there is an opportunity for the industry to shift its focus and look for innovative ways to use mobile technology to improve clinical development.

“From streamlining trial data collection and analysis, to connecting potential trial patients to investigators, the clinical development space is an opportunity for pharma companies to differentiate themselves from the pack.”

Internet and smartphone-based nursing can help diabetic patients

Nursing via the internet and smartphones can be an effective way to help patients with uncontrolled diabetes to manage their care.

According to a new study conducted by McGill University, Canada for the Public Health Agency of Canada, tele-monitoring is also increasingly seen as a workable way of delivering care to patients with chronic conditions who live in remote places, or who require monitoring on a long-term basis.

During the pilot project, diabetic patients in four regions of Quebec submitted their blood sugar readings to a nurse every day using a secure website.

Patients also answered a series of questions online about their exercise, diet and food care.

Their nurses then monitored their responses, providing appropriate advice as and when required. If a patient’s readings were a cause for concern, then they appeared in red text and triggered an alarm.

Nurses also emailed their patients educational material to help them manage their conditions.

Antonia Arnaert, professor of nursing at McGill University, said: “Patients with chronic diseases like diabetes, or who have gone through surgery, often have lots of questions and the doctors and nurses don’t always have the time to answer them.

“With tele-nursing, whether using video-conferencing or text-messaging, patients say they feel they get lots of attention from their nurses, because they know that they have their full attention for an hour.”

“They said that tele-monitoring provided them with a sense of confidence in their ability to manage their diabetic condition themselves.”

Ad-funded drug apps on the rise

The popularity of smartphone technology within the pharmaceutical industry is growing, and while some prefer to pay to receive services ad-free, an increasing number of US medical professionals are opting for a different business model.

Epocrates, the app that provides information on drug dosage, side effects and interactions, has seen a rise in the uptake of its free ad-funded version.

According to reports, plans for its development include a virtual sales rep for pharmaceutical companies to showcase their new products.

Pharmaceutical giants such as Pfizer have already recognised the importance of putting their products literally ‘in the hand’ of the medical professionals within smart devices. Not only is this a more direct and measurable form of sales, but it can also create a better return on investment long term.

While the marketing messages offered in the free version of Epocrates will need to be refined to become more relevant to the user (as they currently have to be filtered  to get to the information requested), the launch of this type of app  introduces a new business model into the increasing mix of medical apps available.

Medical portal InPharm recently counted a total of 39 apps produced by the 11 largest pharmaceutical companies, across various markets and target groups.

Like Epocrates, the key to the success of smartphone apps will be the extent to which developers meet the needs of the specific medical groups by providing relevant content and timely propositions, so that an ad-funded business model doesn’t hinder their ability to access information they need to help their patients.

FDA to create new guidelines for mobile medical apps

The US Food and Drug Administration (FDA) is set to propose new regulations for smartphone apps.

The regulations affect a small number of medical apps in the States and provide a clue as to how regulation might develop in the UK.

Around 150 medical apps have been produced to date. These include patient diary apps and calculators for those working in the health sector.

The FDA has now launched a three month consultation in order to devise how it will oversee what it calls “mobile medical apps”. It is focusing on the apps that could present a risk to patients if they fail to work as planned.

These types of apps include those which enable doctors to see medical images on an iPad with a view to making a diagnosis from them.

Other apps that could come under the regulations include those which allow doctors to use their smartphone as an electrocardiography (ECG) machine, apps that calculate the maximum dosage of local anaesthesia based on a patient’s weight and age and apps that collect blood glucose readings to help manage diabetes.

The FDA has already approved a small number of apps for use. These include a smartphone-based ultrasound device and a medical iPhone/iPad app that lets doctors view medical images and X-rays.

Bakul Patel, FDA policy advisor, said: “There are advantages to using medical apps, but consumers and health care professionals should have a balanced awareness of the benefits and risks.”

Drug companies increase spend on mobile and online media by nearly 80%

Pharmaceutical companies across the world increased their investments in mobile phone apps and educational websites by nearly 80% last year.

According to a study by Ernst & Young, drug companies including Merck & Co and Novartis AG are leading the way in what seems to be a new wave of enthusiasm towards social media and the online landscape on the part of drug companies.

In total, global pharmaceutical companies started 97 new projects aimed at using IT to improve the quality of patient health. By comparison, 124 project had been started in the four previous years altogether, representing a massive leap forwards for development this year.

Just over 41% of this year’s projects were apps for smartphones – an increase from 11% since 2006.

Experts say that the move is partially due to the increased pressure that pharmaceutical companies are under from governments to prove that their products are worth their prices. Plans exist in the UK to match the prices of products to their benefits starting in 2014. This therefore calls for more involvement from patients throughout the lifecycle of a drug, from initial testing to post market surveillance – all of which can be easily and effectively facilitated via the use of social media.

Carolyn Buck Luce, global pharmaceutical leader at Ernst & Young, told one US website: “Pharma can’t exist the way they have existed; what is surprising is the pace of change.”

“The next big change in health outcomes is behavioural change, where medicines play an important part but not the only part.”