Ronak Brahmbhatt, Shadi Niakan, Nishita Saha, Anukriti Tewari, AshfiyaPirani, Natasha Keshavjee , Dora Mugambi, Nasrin Alavi , Karim Keshavjee

ITCH 2017, Victoria, BCFeb 17, 2017

LINK TO OPEN-ACCESS PAPER:

The Problem What’s preventing us from solving it? What we discovered about mhealth apps What we did to overcome the deficiency in mhealth apps What we learned when we applied that to diabetes apps Discussion Limitations Recommendations

Diabetes

Chronic disease with increasing prevalence worldwide

Cost 12.5 billion dollars annually to Canadians

Most important step in DM treatment is self-management involving lifestyle changes and long term adherence to meds

Technology involving mhealth apps is a novel approach to life style management and medication adherence

http://blog.mobiversal.com/how-many-people-use-mobile-health-apps.html

Conflicting Information: App provides information that conflicts with that received from health care providers (Bierbrier, Lo & Wu, 2014); Health Literacy: Language and terminology of the app may not be compatible with the patient’s health literacy (Caburnay, 2015); Data Entry: Patient has to enter the data themselves (Gruman, 2013); Meaningful Use: Patient cannot use information in a meaningful way;

e.g., he or she cannot order diagnostic testing or prescribe medications to himself or herself;

Lack of incentives like cost saving or social approval;

Not Habit Forming: Daily use of the app is not required and therefore the patient does not get into the habit of using it;Unknown Provenance: Providers don’t value data collected by patients in apps downloaded from an app store whose provenance and pedigree is not known or established (Terry, 2015); Lack of Tools: There is no way for providers to consume the large amounts of data that are collected in apps (Terry, 2015)

i. i.e., visualize, analyze, derive meaning from;Lack of Interoperability: Providers unable to integrate app data into their own (EMR) for analysis or follow-up or share the data in their EMR with their patient’s apps (Abebe,

2013).

Based on our screening criteria for optimal diabetes apps, how well functioning are currently available diabetes apps in the app stores?

We developed screening criteria using our reference architecture for design and development of mhealth apps,

Apple iTunes and Google Play app stores were searched for diabetes apps –found 201

Following a calibration exercise, two individuals independently reviewed and evaluated each app against the screening criteria

Data was collated and analyzed

201 total apps were reviewed No app met all the criteria outlined Most apps were replacement of paper journals or diaries Many apps were recipe apps Majority of the apps provided education/recommendations Most of the apps failed at integrations with devices

(glucometer, BP machine) and patients medical records (EMR, primary care provider)

Many apps were conference apps or guideline apps for professionals

Of the highest scoring apps, major reasons for not getting a higher score

Lack of integrations with devices–relatively easy these days (but requires FDA approval)

Lack of integration with EMRs –many features are dependent on this

There is great need for high quality apps which can be prescribed by a physician and whose use can be monitored by the health care team

Apps need to focus on managing the whole patient along with their disease and not a small part of a patient’s care such as self management

Better embedding physician patient relationship into patient app interactions for provider guided management

Due to budgetary constraints, we did not download apps from the stores

Some vendors had poorer descriptions of their product than others

A very small number of apps were in languages that are not understood by the people conducting the review

We were not able to quantitate which apps are used and which ones are not

We did not include any patients in defining the criteria nor in reviewing the apps.

Apps should be prescribed and monitored by health care providers Requires participation of EMR vendors in developing APIs for apps

mhealth app certification by a standards organization would go a long way to ensuring higher quality apps and increasing the level of trust for apps by health providers

An Interoperability Kit for EMRs and Apps would help make it easier to deploy an app

Standard interoperability for apps with medical devices would lower the investments required to create good apps