MSHP Slides Timothy Aungst
Transcript of MSHP Slides Timothy Aungst
3/17/2014
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Smartphones, Tablet Computers and mHealth: How are apps and mobile devices impacting pharmacy?Timothy Dy Aungst, PharmDMSHP Annual Meeting 2014
+Contact Information
Affiliations: Assistant Professor of Pharmacy Practice, MCPHS University Editor, iMedicalApps LLC
Phone: 508.373.5747
Email: [email protected]
Website: www. TheDitgitalApothecary.com
Twitter: @TDAungst
Disclosure: Editor for iMedicalApps LLC., an online news site that reviews mobile
technology and mobile apps. Does not consult or receive financial reimbursements from mobile application developers.
Timothy Dy Aungst, PharmD
+Objectives
Explain the growing role of mobile devices and mHealth in pharmacy practice
List medical applications that are beneficial for pharmacists on mobile devices
Describe features that demonstrate a reliable application for medical use
Identify mHealth devices and apps that are being developed for patient care
+Some Key Terms
Term Definition
mHealth Healthcare or related activities delivered via mobile devices and global infrastructure
Mobile Device Handheld computer with display screen and touch input
Smartphone Mobile phone that integrates functions of a phone and computer
SMS Texting
Application (app) Software developed for use on a mobile device
Web-based app Software available only through internet connection but designed to display on a mobile device
Social Media Webspaces designed for social networking
Wearable Technology Accessories designed to be worn or placed on person incorporating computer or advanced electronic technology
Feel free to keep this slide handy
+Do you currently possess a smart
phone or tablet computer (“Phablets” count too)?
Yes
No
What’s a Smartphone?
A
B
C ?
+Have you downloaded an app to
fulfill a medical purpose?
Yes
No
A
B
?
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+Have you ever consulted a
medical related app for a clinical decision?
Yes
No
A
B
?
+Have you ever used an app with a
patient?
Yes
No
A
B
?
+So what is an ‘App’ and why should I care?
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Never before has man had the sum knowledge of his work in the palm of his hand.
Image courtesy of KROMKRATHOG / FreeDigitalPhotos.net
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Image courtesy of stockimages/ FreeDigitalPhotos.netImage courtesy of Naypong/ FreeDigitalPhotos.net
A Mobile World in Healthcare
Ray SM, et al. Am J Health Syst Pharm. 2013 Apr 1:70(7):633-6.
We are already doing it, even if we do not realize it.
+Technology is ChangingGoodbye “Dumb” Phone – Hello Smartphone
http://cdn1.sbnation.com/entry_photo_images/7279947/cellphonebuyers_large_verge_super_wide.jpg
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+ iPhones, iPads, and Androids, Oh MY!
Who is using them?
‘Everyone’
Your Kid
Your Parents
You
Not your Dog
What are they used for?
Social Media (Facebook!)
Business (Who Loves Email?)
‘Photography’ (Instagram)
Games (Angry Birds)
Lets face it, they’re here to stay
+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
Payne KB, et al. BMC Med Inform Decis Mak. 2012;12:121
Patient Engagement
Education
Data collection and feedback
Goldbach H, et al. J Am Med Inform Assoc. 2013; In Press.
+ 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.
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Mobile Medical App Growth is Substantial
Issue – No organizations or societies have advised members on medical apps
“App Overload”
Van velsen L, et al. BMC Med Inform Decis Mak. 2013;13:23.Images courtesy of KROMKRATHOG / FreeDigitalPhotos.net
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Mobile Application Explosion
• Substantial growth of mobile applications
• Two largest platforms for medical apps are Google Android and Apple iOS
0100,000200,000300,000400,000500,000600,000700,000800,000900,000
Mobile Applications by OS
Google Play, 7884
iTunes, 19366
Medical Applications
Pure Oxygen. How many apps are in each store? 148biz.com. App Store Metrics. AppBrain.com Number of available Android Applications.
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Please download after!
Apps for Pharmacists
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Please do not try to download the apps during the presentation…
… May crash the WiFi.
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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
+LexiComp
Multiple packages exist
$75 – Lexi-Drugs
$115 – Drugs & Interactions
$175 – Clinical Suite (Calculator and Harrisons)
$215 – Lexi-SELECT
$285 – Lexi-COMPLETE
Can get institutional packages
Source: iPad/iPhoneScreenshot
Subscription +
Source: iPad/iPhoneScreenshot
+ Drug Interaction Checker
Select medications to compare for possible drug interactions then Analyze
Analysis indicate possible drug
interactions found
Source: iPad/iPhoneScreenshot
+ IV Compatibility
Analysis indicates
compatibility of IV Medications
Add IV medications to compare for possible compatibility issues
then Analyze
Source: iPad/iPhoneScreenshot
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+Drug Identifier
Input identifying markers into the app
then search!
List of medications that could be a
possible match are presented with image
if listed
+Micromedex
Only this app is free
All other features cost a yearly subscription
• $9.99/29.99
Other apps include:
• IV Compatibility
• Drug Interactions
• NeoFax
• Pediatrics
Free/Subscription
Source: iPad/iPhoneScreenshot
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Source: iPad/iPhoneScreenshot
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Source: iPad/iPhoneScreenshot
+Medscape
Multiple functionsNews
CME
Medical References
Source: iPad/iPhoneScreenshot
Free +
Source: iPad/iPhoneScreenshot
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Source: iPad/iPhoneScreenshot
+Epocrates
•Two packages exist:•Free – drug reference, drug interaction check, and pill ID•$159 – Essentials drug & disease monographs and diagnostic tools, treatment guidelines, lab tests panels, ICD-9
•No IV compatibility
Free/Subscription
Source: iPad/iPhoneScreenshot
Source: iPad/iPhoneScreenshot
+App Name LexiComp Micromedex Medscape Epocrates
Cost $75-285 Free/Add-On($)
Free Free-$199
Device Support
Drug Info Yes Yes Yes Yes
Pediatric Info Yes Soon ($9.99) Yes Yes
IV Compatibility Yes Yes ($9.99) No No
Drug Interaction Checker
Yes Yes ($9.99) Yes Yes
Pill Identification
Yes No Yes Yes
Medical Calculator
Yes No No Yes
OTC Meds and Herbals
Yes No Herbals No Herbals No Herbals
Disease Info Yes No Yes Minor
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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
+Omnio
Free
Source: iPad/iPhone Screenshot
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+Medical Calculators
Source: iPad/iPhone Screenshot
+Rx Shortages
Source: iPad/iPhone Screenshot
Free
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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
+ MedPage Today
Source: iPad/iPhone Screenshot
Free
+Medscape
Source: iPad/iPhone Screenshot
Free +Pharmacist’s Letter
Source: iPad/iPhone Screenshot
Subscription
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+APhA DrugInfoLine
Free/Subscription
Source: iPad/iPhone Screenshot
+News Updates & CE Credits
App Name MedPageToday
Medscape Pharmacist’s Letter
US Pharmacist
Pharmacy Today
Cost Free Free $115.00 Free Free
DeviceSupport
News Yes Yes Yes Yes Yes
Specialty News
Yes Yes Yes Yes Yes
CE Credits Yes Yes Yes Yes Yes
Facebook Yes No No No No
Twitter Yes No No No No
+ How to find Apps on your ownIt’s easier than you think!
+All Apps are appropriate to use and
were evaluated for their medical content prior to inclusion on the app
store.True
False
A
B
True or False:
+Have you ever advised your
personnel or students what apps are appropriate for use?
Yes
No
A
B
+Items to consider before evaluating Apps
Consider what purpose you wish to fulfill
Technology should make work easier and not create another step in the workflow
What is the risk of using an app?
Is the app a product already commercially available that the institution utilizes?
Image courtesy of Praisaeng/ FreeDigitalPhotos.net
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+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 Decis Mak. 2012;12:67.
Wolf JA, et al. JAMA Dermatol. 2013;1-4.
Haffey F, et al. Drug Saf. 2013;36(2):111-7
Ferrero NA, et al. J Am Acad Dermatol. 2013;68(3):515-6
+Evaluating Medical Applications
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?
Content Requirements Technical Requirements
Misra S, et al. JAMA Dermatol. 2013 Jun;149(6):661-2
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App Checklist
Criteria Y/N
Information is verifiable and of sound background and cited within application
App is developed by refutable company or discloses authors of clinical expert background
Information is time-stamped and updated on reasonable schedule
App has dedicated support, and there is a mechanism to report errors
App meets regulatory compliance where applicable
App discloses any conflicts of interest
App has mechanism in place to secure privacy where relevant
• 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 Jun;149(6):661-2
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Patient Centric Apps and Devices
mHealth
+What’s the Buzz behind mHealth?Only have to look at the news…
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http://media.indiatimes.in/media/content/2013/Sep/smartphone_and_eye_main_article_2_1380181731_540x540.jpg
+Who cares about mHealth?
Hospital Networks Reach and communicate with patients
Integrate communication between providers
Government Agencies Public Health Initiatives
Big Business Estimated multi-billion dollar area
Will grow for next 5-10+ years
Start-Ups Healthcare products are a quick avenue to $$ if you do it right
You may be surprised…
+Indirect MonitoringMonitoring Blood Pressure
+Direct MonitoringMonitoring Blood Pressure
+Direct MonitoringMonitoring Blood Glucose
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+Direct MonitoringMonitoring Heart Rhythm
+ExerciseLets strap on some wearable technology!
+The Modern TricorderYes, that’s what they are calling ‘it’.
+BreathalyzerYes, Someone made one…
+Running Can Be Fun!Gamification of Healthcare
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+Have a Medical Question?There’s an App for That!
+Want to See your Medical Records?There’s also an App for that too!
+Smart Pill BoxesEven available on SkyMall
+ Pharmacy Has Already Taken an Interest
Creating mobile applications
Used to refill medications
Manage and remind about medication use
Will be used to reward patients for filling medications
Many community pharmacies are making apps…
…And are Partnering with Organizations
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+Exercise and FitnessRewarding Patients at the Pharmacy
+Future Regulations
Certification
Independent organizations have created methods to ensure app quality
Happtique, mHimms
Regulatory Oversight
FDA has a Standard Published 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
+The FDA will begin regulating apps that are dealing with self-reported
levels (e.g. SMBG, BP, HR, Exercise).
True
False
A
B
True or False: +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
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Thank you – Questions?