A report from the Royal Society of Medicine (RSM) Meeting, 18th April 2013
The RSMs latest telemedicine and ehealth event was aimed at promoting the use of apps in supporting improved healthcare delivery and patient self-care. Presentations from a wide range of healthcare sectors demonstrated that this aim is well advanced.
In identifying the apps that deliver improved patient outcomes, the first speaker, Professor Sir Michael Rawlins, President of the RSM, advanced NICEs work in transforming established paper and web based tools into convenient and easy to use mobile apps. In particular he considered having the BNF, BNFC and the NICE Guidance on his smartphone as transformational. Whilst strictly speaking these are electronic documents rather than apps Sir Michael did identify on-going app work that would, later in 2013, deliver the NICE Pathways to clinicians in a handy app.
Dr Neil Paul has been involved in developing apps since the launch of the iPhone back in 2007 and he shared some of his vast experience of developing apps whilst running a busy GP practice with the audience. To date Neil has managed to develop a range of apps for both medical students and clinicians including the very popular Prep4Finals and A2Z of Dermatology.
Many of us will have noticed over the last two years the proliferation of medical apps onto the market and concerns have been expressed in the literature about the validity of some of these. In particular articles have identified medical apps that have been developed with little or no testing or clinical input and this has raised safety concerns. It was therefore reassuring to hear Dr Sebastian Alexander and Inderjit Singh talk of the rigorous clinical safety assurance apps require before getting in to the NHS app library and Dr Neil Ebenezer summarise the European Medical Device Directives and the UK regulations relating to software in medical devices.
On a slightly lighter theme, expensive clinical machinery such as MRI scanners are now operational for much of the day and as a consequence the time available for hands on training is considerably reduced. Shawn Larson’s presentation entitled Augmenting reality, showed how mobile devices could address this problem. Shawn demonstrated that the iPhone and iPad can render clinical scenarios and medical equipment in realistic 3D offering opportunities for anatomical viewing, product demonstration and simulation training. Shawn’s fluoroscope simulator was very realistic.
Trainee surgeons face a similar problem according to Dr Andre Chow. Because of the European Working Time Directive, junior surgeons now find themselves with fewer hours in their working day to learn at the shoulders of their senior colleagues. To get around this problem Dr Chow, a trainee surgeon, along with three colleagues developed touch surgery, a very realistic app simulating many common surgical procedures.
After lunch three case studies were presented of apps that had been developed for real hospital situations. In the first Sarah Amani introduced us to the “My Journey” mobile app that had been developed to enable young people to access the appropriate mental health service, identify early warning signs of relapse and take effective action. Early results suggested that the “My Journey” app, developed with input from young people, had significant potential to improve mental health awareness and reduce relapse rates.
The second report was from Mr Aman Coonar who, like many, had become frustrated with the complexity and difficulties associated with using health IT. In his attempt to overcome this problem he founded a lean healthcare IT project which led to the release of the Consent app in January 2013. This app, Aman claimed, enhanced communication with patients, reduced errors and litigation and helped move towards a paper free environment and clearly many agreed with Aman as the app has already had several hundred downloads.
The final report was from Professor Lionel Tarassenko of the Institute of Biomedical Engineering in Oxford who summarised 10 years research investigating the use of apps for chronic disease management. Lionel is the author of 150 journal articles, 160 conference papers, 3 books and the holder of 24 patents and the evidence from this output showed that targeted interventions using mobile health apps for limited periods of time (up to six months) can deliver improved patient outcomes. Results were particularly impressive for the case study of improved control of gestational diabetes.
One of the major problems faced by app developers is how to ensure their product gets into the hands of their target audience particularly with Google and Apple libraries containing many tens or even hundreds of apps doing the same thing. An alternative approach, presented by Matt Jameson Evans, demonstrated the benefit of promoting your app through an already well-established website used by your constituency e.g. the ovarian cancer symptom checker app promoted through the ovarian cancer national alliance website (www.ovariancancer.org/app/). According to Matt this approach has been used successfully by a large number of app developers allowing patients to get access to well-developed mobile tools.
Despite this enthusiasm for apps we all know what big IT is like, inflexible, opposed to change and reluctant to share data, all prerequisites for the uptake of apps. Although this is a sweeping generalisation this is exactly how Rob Dyke summed up mainstream NHS IT. So will the good ideas presented at this meeting stall as they get bogged down in the NHS IT system? Hopefully not according to Rob who through HANDIHealth and Tactix4, promotes open data, open standards and open source within the NHS and other healthcare organisations – good luck with that one Rob.
This was a full on day with some fabulous examples of the creativity that exists in the NHS. It provided a blend of real life case studies, projects still on the drawing board and a timely reminder that apps used by patients and HCPs need to be regulated but not stifled.