SUPPORTING EVIDENCE FOR MEDICAL APPS
Although mobile health apps are not intended to replace patient-doctor interactions, it is now widely acknowledged that they have a significant role to play in helping address the multitude of challenges facing health and social care providers, in the UK and globally.
The potential of mHealth and medical apps
In health and social care, mobile health is driving change in many innovative ways. For example, apps can assist in shifting the focus from expensive, reactive and mainly hospital-based care to care that is less costly, more proactive, and delivered closer to the patient. They can help healthcare professionals work collaboratively with patients and providers for the more effective day-to-day management of chronic physical and mental illnesses.
Overall, mHealth apps have the potential to facilitate the delivery of high-quality care and services to an increased number of patients, within available staff and budget resources.
In a recent interview to the Financial Times, NHS Chief Clinical Information Officer, Keith McNeil, said: “In five years’ time, smartphones … will take the burden away from the limited number of human specialists we have. People will get … triage that’s personalized to them from their phones, or be empowered to look after their own chronic conditions, like diabetes, via home monitoring.”
Case studies of success stories
Collaboration between care providers and the mobile health industry has already started, and the benefits of app usage to healthcare professionals, patients and the public are becoming apparent. The following case studies.
CANTAB MOBILE memory impairment detection app. Developed by Cambridge Cognition Holdings, CANTAB Mobile is a simple, 10-minute, self-guided iPad test that can help identify the first signs of clinically-relevant memory impairment.
It is essentially the mobile version of a test that has been used for over 30 years in clinical trials of Alzheimer’s disease. The idea behind the app is that it can assist healthcare professionals in making more accurate diagnosis of dementia illnesses at a larger scale and at the point of care, so that more patients can receive timely treatment. Clinicians who used the app have seen their rates of diagnosis improve from 39 to 46%. Economic models have estimated that routinely using CANTAB Mobile in GP practices could cut diagnostic costs in dementia by 40% and save the NHS £33 million are just a few examples.
CORDIO voice monitoring app for heart failure. This smartphone app can accurately detect from the tone of the user’s voice whether their congestive heart failure (CHF) is deteriorating. The patient’s voice is captured by the app and sent for analysis to determine the presence of fluid in the lungs – a characteristic symptom of worsening CHF. If fluid build-up is detected, alerts are triggered, so that the patient can receive the necessary treatment, and avoid hospitalisation. For example, they may be recommended to take an additional dose of a heart medicine. In clinical trials, CORDIO has accurately predicted admission to hospital one week before patients’ CHF exacerbated. The voice-monitoring app is now being considered for use among NHS patients.
EPI flu outbreak tracking app. In 2015, England and Wales recorded the largest increase in number of deaths from seasonal flu since 1968. An extra 28,189 people died compared with the year before. Globally, flu outbreaks cause 250,000 to 500,000 deaths annually. A US team of researchers from Duke University and the University of North Carolina at Chapel Hill has developed a smartphone app that can predict how the disease will spread within a community. The app works by collecting real-time data – such as heart rate, blood pressure, social interactions, and physical activity levels – which allow to estimate a person’s risk of developing flu. The information can be used to implement preventive or other measures (e.g., vaccination, throat swabs, improved hand washing) to contain the outbreak and potentially reduce mortality. The team successfully tested the app within a study of university students, the results of which were presented at an International Conference on Knowledge Discovery and Data Mining, in Sydney, Australia.
MY MRI at KING’S
MY MRI at KING’S app. Physicists at King’s College Hospital, London, created a virtual reality (VR) app that helps reduce the anxiety children often experience before and during a magnetic resonance imaging (MRI) scan. The medical app uses 360 degree videos that can be viewed on a VR headset, smartphone or tablet. Incorporating sound effects and supported by the explanations of a radiographer, the videos allow children to experience an MRI scan before of the actual procedure, both at hospital and home. The app has been successfully trialled by a 10-year-old patient with brain tumour, who needs regular MRI scans. “Even though my dad explained I couldn’t imagine what it would be like … the app is really helpful as it shows you what to expect … it really feels like you are inside the machine,” he said.
OVUSENSE fertility sensor and app. For couples trying to conceive, the ability to accurately identify the time of ovulation increases significantly the probability of pregnancy. Fertility Focus developed OvuSense, a combined sensor and fertility app, which can predict the date of ovulation up to 24 hours in advance, with an accuracy of 99%. The device consists of a vaginal sensor that collects temperature readings during a woman’s cycle. Using the same technology of contactless payments, the readings are downloaded to an app and displayed on a smartphone or tablet. Unlike other fertility kits, OvuSense is a regulated, CE marked medical device, and is clinically proven. It has enabled couples to conceive, even when pregnancy was deemed unlikely due to the presence of medical conditions such as polycystic ovarian syndrome (PCOS).
ROSEMONT pocket reference guide dosage calculator. Rosemont Pharmaceuticals Limited have created the first pharmaceutical app to carry the CE Mark and be certified by the Medicines and Healthcare Products Regulatory Agency (MHRA). The app allows healthcare professionals to access information on all Rosemont liquid medicines and easily calculate the accurate dose titration for any adult or paediatric patient. Downloadable on both tablets and smartphones, the app is playing an important role in helping Rosemont Pharmaceuticals successfully engage with customers and, at the same time, contribute to the health and wellbeing of patients by enabling healthcare professionals to prescribe more suitable forms of medication to patients with swallowing difficulties.
Mental health apps
The Five Year Forward Review, published in 2016 by the Mental Health Task Force, predicts that mobile health solutions will play a pivotal role in driving positive changes in mental health services. Such transformation is already under way, and clearly encouraged. The NHS offered £400,000 for digital innovations that can help better manage mental disorders and improve access to relevant care and services
Mobile apps have significant potential in this regard. Those that enable the self-management of mental health issues such as anxiety, depression and stress are especially sought-after, given that the majority of affected people avoid seeking face-to-face professional help, largely due to the stigma associated with mental disorders.
Mental health apps can help providers increase access to recognised psychological therapies, so that patients don’t miss out on the benefits. For example, certain smartphone apps offer self-guided versions of cognitive behavioural therapy (CBT) – one of the most effective treatments for a wide range of disorders, including depression, post-traumatic stress disorder and phobias. The effectiveness of these tools is increased if supported by email or SMS reminders, to ensure engagement with therapies. Not surprisingly, patient demand for mental health apps that facilitate self-management is strong. A survey appeared in the Journal of Medical Internet Research found, for example, that over three-quarters of respondents would use mobile apps for managing mental problems, if the tools were available for free.
For mental disorders such as dementia, there are opportunities for mHealth apps to assist care providers in optimising interventions that support independent living and wellbeing. Among various examples is a smartwatch developed by researchers from Gjøvik University College, Norway. The device collects biometrical data such as blood flow and body acceleration and temperature, from which healthcare professionals can extract useful information about the person’s daily activities (e.g., walking, sleeping) and health status. According to data from the Use of Smartwatches for Health Monitoring in Home-Based Dementia Care report, it may be possible to recognise an increase in the number of visits to the bathroom, which may indicate the presence of a urinary infection.
A potential downside of self-management is that patients may lose the motivation to engage with their apps. Gamification provides a means to overcome this potential problem. It involves the use of elements typical of game playing, such as setting goals and scoring points, to enhance the user’s motivation. For example, Public Health England’s Active 10 tallies minutes spent walking and awards badges for reaching daily walking goals established by the user.
In Canada, Vancouver-based Aygo has developed a gamified health app, called Empower, for chronic conditions such as diabetes. Through a game-based approach, patients can set goals for desired changes in behaviour, track medication use and receive reminders for activities. In addition, they are awarded points and badges for any completed task.
The research on the effectiveness of gamified health apps is still limited but promising. For example, a review of 10 clinical trials concluded that game-based app for depression can have a moderate positive effect on symptoms.
Wearables are considered major drivers of mHealth penetration. Although the majority are designed for the wrists, chest and arms, they also include devices that can be embedded in clothing and shoes.
An emerging new trend is wearables for the ear. Like most smart technology devices, they can monitor heart rate and steps taken. In addition, they can provide information about respiratory rate, oxygen saturation and blood pressure in a completely non-invasive way. Some can also calculate caloric intake and provide dietary suggestions. Since wearables like these collect data in a passive manner, they can be particularly useful for older adults, who may not be technology savvy.
More generally, for people with chronic conditions, wearables can monitor symptoms and other parameters in the background, and alert them if changes occur that require medical intervention. An example is the Health and Environmental Tracker (HET) system, developed by researchers of North Carolina State University for people with asthma. It consists of a wristband and a chest patch, which monitor environmental factors such as pollutants and humidity as well as physiological parameters. Complementing the system is a smart spirometer that measures lung function. The gathered data are transmitted wirelessly to a computer, and allow to predict the occurrence of asthma attacks.
Connectivity & medical device integration
Importantly, connectivity among mHealth devices has improved significantly in recent years. For example, wearables can now communicate with health apps on smartphones or tablets. In addition to increasing accuracy and convenience, this opens up a wealth of new opportunities, including the ability to forward health data from wearables to hospital and doctor office systems, so they can be accessed in real-time by healthcare teams for the benefit of their patients.