A guest post by a couple good friends and fellow EIMers, with a great vision of where technology is heading, and it’s intersection with healthcare!
Unless you have been hiding under a rock for the last few years, you are probably aware that the cellular phone has evolved from a device dedicated to voice communication to a powerful, ‘smart’ handheld computer that holds more computing power and memory than your average desktop computer did 5 years ago. Over 50% of Americans now own a smartphone and smartphone adoption among the healthcare sector is even higher (as high as 85% in some surveys). Of healthcare professionals that own a smartphone, as many as 50% utilize them in clinical practice. And while the split among the two mobile computing heavyweights (iOS and Android) is relatively even in the general public, Apple, so far, has dominated the health sector.
Perhaps you count yourself among those that have not adopted smartphone or tablet use in your clinical setting yet. In fact, many physical therapists have not. As a profession, PT’s utilization rates for mobile computing platforms ranks below that of many other healthcare disciplines. But have you truly considered the potential utility for this technology in clinical practice? You can put a majority of clinical references, once as heavy textbooks, on your mobile device, and probably find the content much quicker. How about interactive outcome measures, HIPAA-compliant text-messaging, 3D interactive patient education, and patient documentation via EMR? If that doesn’t impress you, consider that you can view patient imaging (x-rays, MRI, CT, etc), monitor patient vital signs (BP, HR, ECG), perform an eye exam, identify a cancerous skin lesion, attach a head to your phone to perform ultrasound imaging, take a goniometric joint ROM measurement, and perform a urinalysis (okay, that’s probably outside the scope of PT’s, but we thought it was cool), all with a smartphone or tablet. The exciting part is that this technology is still very much in its infancy.
Along these lines, the medical research community has begun to show interest in medical apps. Just go to PUBMed and type in “smartphone” to see how popular this technology is becoming (424 results on the day that I searched)!
However, although mobile computing has presented a host of new possibilities for medicine, it’s not without unique problems and challenges. For example, one of the main issues currently in the spotlight is how to regulate these apps. The FDA has the challenge of ensuring public safety when it comes to the use of medications and medical devices. When an app is installed on a smartphone that allows the phone to perform a function that can result in a medical diagnosis, does that device now become a “regulated device”? The FDA has not published final guidance on this yet. They are actively seeking to determine how best to ensure that apps used in healthcare do not cause harm to the public, while at the same time not over-regulating so as to stifle innovation. Several apps have already been removed from app stores under direction of the FDA.
One of the other challenges facing this industry is app discoverability. How exactly do you find an app to fit your specific needs when you’re choosing from an app store that has close to 1 million apps! And if you in fact find an app that you think might meet your needs, how do you assess it’s quality? How does one determine a medical app’s validity, value and trustworthiness when there may be 10 or 15 similar competitors? Essentially anyone can submit an app to an app store, and there is no medical peer review system in place that determines whether the app (and it’s information or services) is safe or accurate for the public to use. The reviews in the app stores provide little value, as anyone can write them and they speak little to the safety and validity of the content. As mobile computing platforms become increasingly ubiquitous in healthcare, the need to evaluate these tools becomes paramount.
In response to these issues, several groups have come forward with potential solutions. Among the new players is iMedicalApps, which is a popular blog, run by physicians, that provides select reviews of medical apps as well as posts and commentary on mobile health related news and events. Another is Happtique, which is actively working with hospital networks to create an enterprise healthcare app store for medical professionals, and also provide a “certification” for apps. This will allow hospitals to offer apps to their clinicians that have been curated and vetted to some degree. A third is a website we started, Medical App Journal. The site curates and categorizes medical apps from a several platforms (iOS, Android, Windows) and provides news and commentary on medical app related content. However, our primary mission is to provide peer review of medical apps. The issue of peer review for medical apps has been brought up multiple times in the peer reviewed literature (Connor, 2013; Lewis, 2013; Wolf, 2013; Buijink, 2013) and we feel this issue is one of the biggest problems facing this industry going forward.
Establishing a sustainable peer-review system for medical apps poses a lot of challenges. How do you select the app reviewers? What qualifications do you look for in a reviewer? Which apps should be reviewed? How do you keep pace with app stores that add hundreds of new titles per month? For the past two years, we at Medical App Journal have been working hard to address these and other related questions. And while we still have a lot of work to do before we arrive at a perfect solution, we feel we have the makings of a sustainable platform for peer-review of medical apps going forward.
Where it’s feasible, we have attempted to replicate the peer review process utilized by medical journals as a model for our format and structure. Each app reviewer is carefully selected to review only apps that are within their particular field of practice (for example, an orthopaedic surgery app would be reviewed by an orthopaedic surgeon, a dermatology app by a dermatologist, a physical therapy app by a physical therapist, etc…). These app reviews then receive editorial review by both an associate and senior editor to ensure the app has been accurately and fairly represented prior to publication to the site. A link to the reviewers LinkedIn public profile is provided so readers can verify their credentials and experience.
Although this project is still in it’s infancy, we have been pleasantly surprised by the feedback and participation of healthcare professionals from around the world. In fact, some of our most enthusiastic collaborators to date have been physical therapists from the U.S. and abroad. We have had several apps receive peer review that are specifically designed for use by PT’s, such as DrGoniometer (and actually an entire systematic review of goniometer apps), Physiotherapy Exercises, Rehabilitation for Lower Limbs, and even an app for PT students (NPTE Exam Review). We’ve also had PT’s provide reviews for several apps that could theoretically be used by any discipline that manages patients with musculoskeletal complaints (i.e. family practice physicians, orthopedists, etc.), such as the STarT Back Tool, Clinical Prediction Rules, and Ortho App.
At the same time, we want to invite as much input as possible. We envision a community where all interested parties (i.e. app developers, reviewers, clinicians) can discuss and exchange thoughts and ideas. To this end, we’ve left a comment section at the bottom of each review for discussion. Users can also vote and rate apps based on their discipline, profession, and type of device used.
The medical community has truly stepped up to make this vision a reality (over 80% of our reviewers are physicians). It would be incredible to see a similar level of engagement and input from the physical therapy community. Along those line, if you already have an interest in medical apps and are using them in clinical practice, we encourage you to consider being a reviewer. We will provide a free copy of the app for you to review. Contact us at: firstname.lastname@example.org
So while navigating the world of medical apps can be a daunting and often frustrating endeavor, we hope this will become a tool which can help you make informed assessments on which medical apps may or may not offer value for your particular clinical setting. If you have been hesitant to dip your toes in the proverbial medical app waters because you have had trouble making sense of this market, we encourage you to try the Medical App Journal or some of the other resources listed above. With the addition of categorization and, more importantly peer review by subject matter experts, we believe the picture of medical apps becomes much more clear and the landscape much easier to navigate.
(Disclaimer – we are both on the editorial board of the Medical App Journal)