Evaluating Mobile Medical Applications For Utilization By Pharmacy Students Timothy Dy Aungst, PharmD MCPHS University
Presenter Information • Email: Timothy.Aungst@MCPHS.edu • Twitter: @TDAungst • Affiliations: • Assistant Professor, MCPHS University • Editor, iMedicalApps LLC • Disclosure: • The presenter is an editor for iMedicalApps.com, a website that reviews mobile medical applications. The site and authors do not represent or consult for any app developers, do not receive funding or financial reimbursement for reviews, and do not advertise for any mobile apps.
Objectives • Discuss growing size of medical apps currently available on the market • Identify what medical apps may be of use to pharmacy students in the classroom and during clinical rotations for professional development • Identify qualities of an app that would be preferential to use in practice based upon key characteristics • Discuss changes that may occur in medical app development due to Federal oversight and outside organization intervention
Mobile Application Explosion Substantial growth of mobile applications Two largest platforms for medical apps are Google Android and Apple iOS Medical Applications Pure Oxygen. How many apps are in each store? 148biz.com. App Store Metrics. AppBrain.com Number of available Android Applications.
Role of Mobile Medical Apps Point-of-Care Tool Clinical Reference Medical Education Patient Education Communication Telehealth EHR Integration Social Media/News Ozdalga E, et al. J Med Internet Res. 2012;14(5):e128.
Benefits of mobile medical apps • Clinician Tools • Helps increase access to clinical information for point-of-care • Communication • Sharing of data • Workflow • Increase productivity • Integration into EHR • Education • Students and Practitioners use apps differently • Students use educational and clinical apps • Docs use clinical calculators and drug information • Patient Engagement • Education • Data collection and feedback Payne KB, et al. BMC Med Inform DecisMak. 2012;12:121 Goldbach H, et al. J Am Med Inform Assoc. 2013; In Press.
Drug Reference Many references provided by commonly used companies in pharmacy Not all information available via app is as complete as that provided through a browser based system
Clinical Reference Many references available via web-based browsers are available via mobile apps Information can be completely downloaded to device negating any online connection Many apps are created by renowned institutions for clinical purposes
News and Reading Medical news websites have apps available for recent news for pharmacists Integration of CE/CME Portals to institution libraries for medical journal access
Issues with current mobile app development – • Lack of evidence-based information • Reviews have demonstrated that apps identified often lack medical references • Lack of accuracy • Dermatological apps have range of specificity and sensitivity • Opioid conversion apps are not uniformly accurate • Lack of clinical input into design • Multiple apps have no input by medical professionals • Many Startups have no medical staff • Maintaining Privacy • Password Protection • Breach of data • Data – will it be sold? Mosa A, et al. BMC Med Inform DecisMak. 2012;12:67. Haffey F, et al. Drug Saf. 2013;36(2):111-7 Wolf JA, et al. JAMA Dermatol. 2013;1-4. Ferrero NA, et al. J Am AcadDermatol. 2013;68(3):515-6
Implication for Pharmacy Practice – • What applications should be taught or advised for students to use? • Is the information provided via an app sufficient for clinical reference? • Lack of standardized education for future pharmacists • No infrastructure in place by most colleges • No requirement to educate students on rising use of mobile technology • Development of best practice for education of students is required
Evaluating Medical Applications Content Requirements Technical Requirements • Information provided • Is it accurate or verifiable? • Developer background • Who made it? • Relevancy • Does the app do anything to benefit practice? • Efficacy • Does the app perform its intended goal? • Support • Is the app continually updated? • Is there a way to communicate with the developer? • Usability • Does the app function correctly for intended purpose?
App Checklist Ultimately a Medical Application should demonstrate several key features Apps for a specialized purpose may require further analysis Misra S, et al. JAMA Dermatol. 2013;In-Press.
Putting it into Practice • Classroom • Conducted an interactive lecture on med apps • Review what to look for in an app • Clinical Site Involvement • Identify what apps supported at a clinical site • Preceptor identifies what is appropriate utilization • Library Support • Create a dedicated website listing supported apps by the school • Infographic • Professionalism • Teach students when is an appropriate time to use a device for support
Future Regulations • Certification • Independent organizations have created methods to ensure app quality • Happtique, mHimms • Regulatory Oversight • FDA has a Draft Guidance • Has already made interventions on questionable apps • Areas currently covered: • “…are used as an accessory to a regulated device; or transform a mobile platform into a regulated medical device.” • Medical Society Involvement • Medical groups may stake a claim in certain areas and provide oversight Food and Drug Administration. Draft Guidance for Industry and Food and Drug Administration Staff - Mobile Medical Applications
Conclusion • Mobile medical applications will play a substantial role in pharmacy practice • Many apps are readily available across multiple OS • Not all apps are created equal • Pharmacists must be made aware of pros/cons of med apps • Apps need to be properly identified for use • Opportunity presents itself to educate students on app use • Classroom, clinical site, workshops • Future oversight may present itself to help regulate medical apps • FDA, FTC, App Certification Programs
References • 148biz.com. App Store Metrics. http://148apps.biz/app-store-metrics/ (accessed 10 June 2013). • AppBrain. Number of available Android applications. http://www.appbrain.com/stats/number-of-android-apps (accessed 10 June 2013). • Pure Oxygen. How many apps are in each app store? http://www.pureoxygenmobile.com/how-many-apps-in-each-app-store/ (accessed 10 June 2013). • Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res. 2012;14(5):e128. • Mosa AS, Yoo I, Sheets L. A systematic review of healthcare applications for smartphones. BMC Med Inform DecisMak. 2012;12:67. • Wolf JA, Moreau J, Akilov O, et al. Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection. JAMA Dermatol. 2013;:1-4. • Ferrero NA, Morrell DS, Burkhart CN. Skin scan: a demonstration of the need for FDA regulation of medical apps on iPhone. J Am AcadDermatol. 2013;68(3):515-6. • Haffey F, Brady RR, Maxwell S. A comparison of the reliability of smartphone apps for opioid conversion. Drug Saf. 2013;36(2):111-7. • Misra S, Lewis T, Aungst TD. Medical application use and the need for further research and assessment for clinical practice. JAMA Dermatol. 2013;In-Press. • Food and Drug Administration. Draft Guidance for Industry and Food and Drug Administration Staff - Mobile Medical Applications .http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf (accessed 31 May 2013).