Data Challenges in Evaluating the Patient Engagement, Quality and Safety of Mobile Health Applications

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1 Data Challenges in Evaluating the Patient Engagement, Quality and Safety of Mobile Health Applications David W. Bates, MD, MSc Chief, Division of General Internal Medicine, Brigham and Women s Hospital, Boston 1

2 Roadmap for adoption of health apps IMS Institute for Healthcare Informatics. Patient Apps for Improved Healthcare: From Novelty to Mainstream;

3 Characterizing the value of apps Role in High-Cost, High-Need Patients Does the app improve health? Do consumers find the app useful? Is the app safe? Does the app meet the needs of the patient? Would a doctor recommend this app? 3 3

4 Characterizing the value of apps Literature Review Interviews with Experts App Review Usability Study 4 4

5 Do apps improve health? 5 5

6 Do apps improve health? Systematic review of RCTs Evidence-based practice in nursing & healthcare: a guide to best practice Bernadette M. Melnyk and Ellen Fineout-Overholt, 2005 One RCT Well-designed controlled trials without randomization, quasi-experimental Well-designed case-control and cohort studies Systematic reviews of descriptive and qualitative studies Single descriptive or qualitative study Opinion of authorities or reports of expert committees 6 6

7 Do apps improve health? Randomized controlled trial Randomized trial with no control Non-randomized controlled trial Before-after study Interrupted time series Prospective cohort study Cross-sectional study Qualitative research Case report or case series Study design 0% 20% 40% 60% 80% 100% Median number of participants Median length of follow-up App as only intervention Registered on clinicaltrials.gov mo 12% 7% Included adults 65 years old Authors also developers Evaluated clinical outcome Positive clinical outcome 30% 61% 21% 72% 7 7

8 Do apps meet patient needs? Number of studies on apps 175 App found on app store 30% App name not stated in study 40% App not found on app store 30% 8 8

9 Do apps meet patient needs? 9 9

10 Do apps meet patient needs? In the scientific literature On the app store 21% Provides educational info 58% 26% Reminds or alerts 64% 75% Records info 88% 31% Summarizes info 85% 37% Provides guidance 45% 21% 9% Data sharing with caregiver Data sharing with clinician 59% 59% 8% Engages through social media [VALUE] 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% 10 10

11 Do apps meet patient needs? 11 11

12 App store rating vs. clinical utility vs. usability 12 12

13 Are apps safe? Apps without privacy policy 36% Data sharing via separate login 10% Data sharing using Data sharing using text Data sharing using HealthKit Data sharing using Google Fit 48% 12% 11% 3% 13 13

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15 Results Three groups 9 caregivers 10 patients with depression 10 with diabetes Given condition-specific tasks Enter your blood glucose Completion rate 43% without assistance Key themes Lack of confidence with technology Frustration with design features and navigation Interest in having technology to support their selfmanagement

16 Conclusions re Apps Apps have the potential to improve healthcare Yet also potential to cause harm as they become increasingly integrated with the healthcare system What if low blood glucose values not recorded? What if no one alerted about suicidal ideation? Not being directed at patients who can benefit the most from them Level of evidence to date re benefit limited Apps are hard to use for patients with chronic illnesses But patients do want them! Key frontiers Linking mobile apps with EHRs and PHRs Getting wearable data in and sifting through it

17 OECD Takeaways Quality Even more important and very big gaps Literature is lacking Safety Clearly problems and some standards or best practices are needed Privacy not yet adequately addressed Patient engagement Lots of room for improvement little gamification, use of social media approaches 17

18 Team University of Michigan Karandeep Singh, MD, MMSc Brigham and Women s Hospital David W. Bates, MD, MSc Adam Landman, MD, MS, MIS, MHS Kaitlin Drouin, MS, MA Erika Pabo, MD, MBA Ronen Rozenblum, PhD, MPH Arild Faxvaag, MD Elissa Klinger, MS Stanford University Donna M. Zulman, MD, MS UCSF Urmimala Sarkar, MD, MPH Gato Gourley, MSc Partners Healthcare System Lisa P. Newmark Malina Filkins Elizabeth Silvers Kevin Kron Asan Medical Center, Seoul, Korea JaeHo Lee, MD, PhD 18 18