MSHP Slides Timothy Aungst

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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?

+

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.

+

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 +


+ Drug Interaction Checker

Select medications to compare for possible drug interactions then Analyze

Analysis indicate possible drug

interactions found


+ IV Compatibility

Analysis indicates

compatibility of IV Medications

Add IV medications to compare for possible compatibility issues

then Analyze


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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


+


+


+Medscape

Multiple functionsNews

CME

Medical References


Free +


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+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



+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


+Rx Shortages


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


Free

+Medscape


Free +Pharmacist’s Letter


Subscription

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+APhA DrugInfoLine

Free/Subscription


+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?

Documents

MSHP Slides Timothy Aungst