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Evaluating Mobile Medical Applications For Utilization By Pharmacy StudentsTimothy Dy Aungst, PharmDMCPHS University
+Presenter Information
Email: [email protected]
Twitter: @TDAungst
Affiliations: Assistant Professor, MCPHS University Editor, iMedicalApps LLC
Disclosure: The presenter is an editor for iMedicalApps.com, a website that
reviews mobile medical applications. The site and authors do not represent or consult for any app developers, do not receive funding or financial reimbursement for reviews, and do not advertise for any mobile apps.
+Objectives
Discuss growing size of medical apps currently available on the market
Identify what medical apps may be of use to pharmacy students in the classroom and during clinical rotations for professional development
Identify qualities of an app that would be preferential to use in practice based upon key characteristics
Discuss changes that may occur in medical app development due to Federal oversight and outside organization intervention
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Mobile Application Explosion• Substantial growth of mobile
applications
• Two largest platforms for medical apps are Google Android and Apple iOS
iTunes Google Play Windows Blackberry0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
Mobile Applications by OS
Google Play; 7884
iTunes; 19366
Medical Applicatio
ns
Pure Oxygen. How many apps are in each store? 148biz.com. App Store Metrics. AppBrain.com Number of available Android Applications.
+ 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.
+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.
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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
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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
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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
+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
+Implication for Pharmacy Practice –
What applications should be taught or advised for students to use?
Is the information provided via an app sufficient for clinical reference?
Lack of standardized education for future pharmacists No infrastructure in place
by most colleges No requirement to
educate students on rising use of mobile technology
Development of best practice for education of students is required
+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
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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 is 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;In-Press.
+App Review #1
+App Review #1
+App Review #1
+App Review #2
+App Review #2
+Putting it into Practice
Classroom Conducted an interactive
lecture on med apps Review what to look for in
an app
Clinical Site Involvement Identify what apps
supported at a clinical site
Preceptor identifies what is appropriate utilization
Library Support Create a dedicated
website listing supported apps by the school
Infographic
Professionalism Teach students when is
an appropriate time to use a device for support
+Libra
ry In
fogra
phic
+Future Regulations
Certification Independent
organizations have created methods to ensure app quality Happtique, mHimms
Regulatory Oversight FDA has a Draft 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
+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
+References 148biz.com. App Store Metrics. http://148apps.biz/app-store-metrics/ (accessed 10 June 2013).
AppBrain. Number of available Android applications. http://www.appbrain.com/stats/number-of-android-apps (accessed 10 June 2013).
Pure Oxygen. How many apps are in each app store? http://www.pureoxygenmobile.com/how-many-apps-in-each-app-store/ (accessed 10 June 2013).
Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res. 2012;14(5):e128.
Mosa AS, Yoo I, Sheets L. A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak. 2012;12:67.
Wolf JA, Moreau J, Akilov O, et al. Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection. JAMA Dermatol. 2013;:1-4.
Ferrero NA, Morrell DS, Burkhart CN. Skin scan: a demonstration of the need for FDA regulation of medical apps on iPhone. J Am Acad Dermatol. 2013;68(3):515-6.
Haffey F, Brady RR, Maxwell S. A comparison of the reliability of smartphone apps for opioid conversion. Drug Saf. 2013;36(2):111-7.
Misra S, Lewis T, Aungst TD. Medical application use and the need for further research and assessment for clinical practice. JAMA Dermatol. 2013;In-Press.
Food and Drug Administration. Draft Guidance for Industry and Food and Drug Administration Staff - Mobile Medical Applications .http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf (accessed 31 May 2013).
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