3/17/ Contact Information. + Objectives. + Some Key Terms. + Have you downloaded an app to fulfill a medical purpose?

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1 Contact Information Timothy Dy Aungst, PharmD Affiliations: Assistant Professor of Pharmacy Practice, MCPHS University Editor, imedicalapps LLC Phone: Website: www. TheDitgitalApothecary.com Smartphones, Tablet Computers and mhealth: How are apps and mobile devices impacting pharmacy? Timothy Dy Aungst, PharmD MSHP Annual Meeting 2014 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. Objectives Some Key Terms Feel free to keep this slide handy 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 Term mhealth Mobile Device Smartphone SMS Application (app) Web-based app Social Media Wearable Technology Definition Healthcare or related activities delivered via mobile devices and global infrastructure Handheld computer with display screen and touch input Mobile phone that integrates functions of a phone and computer Texting Software developed for use on a mobile device Software available only through internet connection but designed to display on a mobile device Webspaces designed for social networking Accessories designed to be worn or placed on person incorporating computer or advanced electronic technology Do you currently possess a smart phone or tablet computer ( Phablets count too)? Have you downloaded an app to fulfill a medical purpose? A Yes A Yes No No C What s a Smartphone??? 1

2 Have you ever consulted a medical related app for a clinical decision? Have you ever used an app with a patient? A Yes A Yes No No?? 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 A Mobile World in Healthcare Technology is Changing Goodbye Dumb Phone Hello Smartphone We are already doing it, even if we do not realize it. Ray SM, et al. Am J Health Syst Pharm Apr 1:70(7): Image courtesy of stockimages/ FreeDigitalPhotos.net Image courtesy of Naypong/ FreeDigitalPhotos.net s_large_verge_super_wide.jpg 2

3 iphones, ipads, and Androids, Oh MY! Lets face it, they re here to stay enefits of mobile medical apps Who is using them? Everyone Your Kid Your Parents You Not your Dog What are they used for? Social Media (Facebook!) usiness (Who Loves ?) Photography (Instagram) Games (Angry irds) Clinician Tools Helps increase access to clinical information for pointof-care Communication Sharing of data Workflow Increase productivity Integration into EHR Education Patient Engagement Education Data collection and feedback Students and Practitioners use apps differently Students use educational and clinical apps Docs use clinical calculators and drug information Payne K, et al. MC Med Inform Decis Mak. 2012;12:121 Goldbach H, et al. J Am Med Inform Assoc. 2013; In Press. App Overload Role of Mobile Medical Apps Mobile Medical App Growth is Substantial Point-of-Care Tool Clinical Reference Medical Education Patient Education Communication Telehealth EHR Integration Social Media/News Issue No organizations or societies have advised members on medical apps Ozdalga E, et al. J Med Internet Res. 2012;14(5):e128. Images courtesy of KROMKRATHOG / FreeDigitalPhotos.net Van velsen L, et al. MC Med Inform Decis Mak. 2013;13:23. Mobile Application Explosion Substantial growth of mobile applications Two largest platforms for medical apps are Google Android and Apple ios Pure Oxygen. How many apps are in each store? 148biz.com. App Store Metrics. Apprain.com Number of available Android Applications. Mobile Applications by OS 900, , , , , , , , ,000 0 Medical Applications itunes, Google Play, 7884 Apps for Pharmacists Please download after! 3

4 Please do not try to download the apps during the presentation May crash the WiFi. 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 Subscription 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 Drug Interaction Checker IV Compatibility Select medications to compare for possible drug interactions then Analyze Add IV medications to compare for possible compatibility issues then Analyze Analysis indicate possible drug interactions found Analysis indicates compatibility of IV Medications 4

5 Drug Identifier Micromedex Free/Subscription Input identifying markers into the app then search! Only this app is free All other features cost a yearly subscription $9.99/29.99 List of medications that could be a possible match are presented with image if listed Other apps include: IV Compatibility Drug Interactions NeoFax Pediatrics Medscape Free Multiple functions News CME Medical References 5

6 Epocrates Free/Subscription 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 App Name LexiComp Micromedex Medscape Epocrates Cost $ 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 Source: ipad/iphone Drug Interaction Checker Yes Yes ($9.99) Yes Yes Pill Yes No Yes Yes Identification Medical Yes No No Yes Calculator OTC Meds and Yes No Herbals No Herbals No Herbals Herbals Disease Info Yes No Yes Minor Omnio Free 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 6

7 Medical Calculators Rx Shortages Free MedPage Today Free 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 Medscape Free Pharmacist s Letter Subscription 7

8 APhA DrugInfoLine Free/Subscription News Updates & CE Credits App Name MedPage Today Medscape Pharmacist s Letter US Pharmacist Pharmacy Today Cost Free Free $ Free Free Device Support News Yes Yes Yes Yes Yes Specialty Yes Yes Yes Yes Yes News 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 own It s easier than you think! True or False: All Apps are appropriate to use and were evaluated for their medical content prior to inclusion on the app store. A True False Have you ever advised your personnel or students what apps are appropriate for use? A Yes No 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 8

9 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 reach of data Data will it be sold? Mosa A, et al. MC 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 Content Requirements 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? Misra S, et al. JAMA Dermatol Jun;149(6):661-2 Technical Requirements Support Is the app continually updated? Is there a way to communicate with the developer? Usability Does the app function correctly for intended purpose? App Checklist Ultimately a Medical Application should demonstrate several key features Apps for a specialized purpose may require further analysis Misra S, et al. JAMA Dermatol Jun;149(6):661-2 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 What s the uzz behind mhealth? Only have to look at the news mhealth Patient Centric Apps and Devices 9

10 Who cares about mhealth? You may be surprised Hospital Networks Reach and communicate with patients Integrate communication between providers Government Agencies Public Health Initiatives ig usiness 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 731_540x540.jpg Indirect Monitoring Monitoring lood Pressure Direct Monitoring Monitoring lood Pressure Direct Monitoring Monitoring lood Glucose 10

11 Direct Monitoring Monitoring Heart Rhythm Exercise Lets strap on some wearable technology! The Modern Tricorder Yes, that s what they are calling it. reathalyzer Yes, Someone made one Running Can e Fun! Gamification of Healthcare 11

12 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 oxes Even available on SkyMall Pharmacy Has Already Taken an Interest Many community pharmacies are making apps Creating mobile applications Used to refill medications Manage and remind about medication use Will be used to reward patients for filling medications And are Partnering with Organizations 12

13 Exercise and Fitness Future Regulations Rewarding Patients at the Pharmacy 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. Certification Independent organizations have created methods to ensure app quality Happtique, mhimms 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 True or False: The FDA will begin regulating apps that are dealing with self-reported levels (e.g. SMG, P, HR, Exercise). A True 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 Thank you Questions? 13