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Evaluating Mobile Medical Applications For Utilization By Pharmacy StudentsTimothy Dy Aungst, PharmDMCPHS University

+Presenter Information

Email: Timothy.Aungst@MCPHS.edu

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).