In many
ways, the usage of mobile apps within healthcare is a natural progression of
both the technology and health sectors. Combining digital innovations like
smartphones, IoT networks, data analytics and cloud computing with healthcare
processes in dire need of streamlining has led to an abundance of convenience
for patients, medical professionals and health authorities; specialised apps
designed to fit seamlessly into the user’s daily digital experience have
started to gain prevalence, momentum and popularity as they solve the
logistical problems of their legacy-tech or manually-based forebears.
Healthcare
Global takes a closer look at mobile apps designed by Cerner, Medic Creations
(supported by BT), Navenio, and Doctorlink to find out how they’re laying the
foundations for truly digital healthcare.
Personal health monitor
Mobile
apps provide users with a direct and tangible link to their healthcare process;
instead of merely being a passive agent, patients can take a far more active
role and understand in greater detail why certain decisions or courses of
action are followed. Heather Owen, Manager and Senior Solution Leader for
Cerner, says, “Cerner’s Well-being app engages individuals to understand their
current health risks and opportunities while also connecting them to their care
team. Through this app, people can view health data, connect wellness trackers,
participate in health-related challenges, register for events, learn about
health topics, securely message health coaches and more.” All of this is built
on the idea that prevention is better than curing; if a user’s individual goals
can be guided and engaged with specific activities, Cerner hopes to create,
maintain and improve lifestyle behaviours.
Centred
on a Big Data platform capable of aggregating data from multitudinous sources,
including aspects such as clinical claims, payer data and social determinants
of health insights, Owen says that Cerner’s app creates a detailed longitudinal
record for each user. “Intelligence runs within the platform to provide
insights and suggest next steps to the individual, coach and the broader care
team via the longitudinal plan,” she continues. “Analytics dashboards within
our app also enable proactive management of wellness-related campaigns and
metrics within and across cohorts.” Essentially, Cerner’s app integrates an
extensive framework of functions and capabilities created in-house, as well as
third-party and partner developers, to provide a simple, unified experience for
the user.
Perhaps
the most significant aspect of Cerner’s app is its ability to both empower the
individual and incorporate the collective: rather than simply be a mobile app
which a patient uses alone, Cerner’s solution connects patients with their
carers in a direct manner. “Cerner’s Well-being offering breaks away from the
siloed approach of traditional standalone wellness apps and puts the person at
the centre, connecting them and their associate data with the broader
healthcare team,” states Owen. With modern wellbeing comprising health
coaching, care coordination, benefits administration, pharmacies and much more,
this app-based method for integrating a complex ecosystem for users is a strong
model of contemporary patient-centric care.
Enabling efficiency in patient assessment
Another
application for mobile healthcare apps can be to streamline the patient
assessment process and accelerate triaging. One such example is Doctorlink,
currently used by 12mn patients via the NHS in England. Its creator, Rupert
Spiegelberg, defines two principle advantages it provides: “Firstly, it enables
patients to get access to their local health service 24/7. The app can then
help them determine what’s wrong, how serious it is, where to go for treatment
and so on, in addition to offering users the ability to book appointments and
get sick notes,” he explains. “Secondly, Doctorlink can help to free up NHS
capacity by 30% through reducing the number of appointments GPs need to make:
sometimes 20mn fewer!”
What
differentiates Doctorlink from its contemporaries is its online triage
capability: a clinically-approved set of algorithms assess (based on questions)
what someone’s health situation or condition might be, determine the acuity of
the user’s problem and then recommend a course of action, whether it be a GP or
nurse appointment, pharmacy recommendation, or simply to rest. “This is one of
the best ways of generating capacity in a crisis situation, such as we’ve seen
with the COVID-19 pandemic,” Spiegelberg adds. “The advantage is that
algorithms can be updated very quickly to identify people with specific
symptoms, even if the disease is relatively new.”
Earning
a BA in French and Philosophy from the University of Bristol (1990-1994) and an
MBA from INSEAD (1999), Spiegelberg has enjoyed a varied career, including
roles at Bloomberg, Investis Inc and IDnow before joining Doctorlink in late 2019.
Health Record Maintenance and Access
Apps
are also available that aid in data collection and retrieval, such as entering
information into a patient’s EHR or EMR.Hospital information systems often
include features that allow HCP management of EHRs and PACSs, permitting secure
access to patient information (medical history, vitals, prescriptions, lab
results, x-rays, scans, consultations, and discharge notes) either on site or
remotely.
One
health care software company, Epic Systems, has partnered with Apple and
released versions of the Epic scheduling, billing, and clinical support app for
the iPhone and iPad. PatientKeeper Mobile Clinical Results provides physicians
with access to patient clinical data via either Apple or Android mobile devices.
Teamviewer is a general-purpose record maintenance and access app that can be
installed on mobile devices, allowing remote access to desktop PCs. In the
absence of such apps, a virtual private network (VPN) log-in can often be
obtained from the hospital to allow remote secure access into the in-house
network through the Internet to view records for emergency consultations.
Specialized
apps are also available for remote viewing of medical imaging scans.10Mobile
MIM is a free app for the iPad and iPhone, approved by the Food and Drug
Administration, that allows remote viewing of x-rays and imaging scans when
users cannot access imaging workstations. This software works with a paid
subscription or pay-per-use plan using MIMCloud, a HIPAA-compliant server that
allows users to store and share medical images.6 Images can be downloaded from
the cloud and viewed with the MIMViewer paid app in any setting, whether during
discussions with team members or patients.
In some
instances remote evaluation of image scans via a medical device has been proven
to be just as effective as viewing them at a standard workstation. In fact, one
group demonstrated that its members could use their iPhones to diagnose acute
stroke on CT brain scans just as accurately as when a workstation was used.
Mobile devices’ cameras are also useful for documenting images to aid in
diagnoses, such as taking pictures of gross or microscopic pathology specimens
to get a colleague’s opinion or for personal reference.
Improving medical staff’s communications
Despite
their crucial importance to a hospital’s operations, research by British
Telecom (BT) indicates that the communications networks used by doctors and
nurses have room for greater efficiency. To address this, BT supported software
company Medic Creations in the development of Medic Bleep, which it likens to a
“dedicated WhatsApp for doctors”. Citing a peer-reviewed study in which the app
was found to save nurses 21 minutes per shift and doctors 48 minutes, Medic
Creations believes that this kind of efficiency could save the NHS £1.35bn per
annum. “Frontline staff currently waste much of their time standing by the
phone thanks to antiquated pager and switchboard systems,” says Dr Sandeep
Bansal, Founder and CEO. “The NHS has been using pagers since it was founded 70
years ago. I'm passionate about our healthcare system and want to make sure it
sustains itself for the next 70 years. Technology is going to be a key part of
that; healthcare must evolve and embrace this digital age to ensure medical
professionals can continue to give the best possible care."
The
utility of this optimisation would be important at any time, but it is
especially important now when COVID-19 restrictions and strains continue to
pressure hospital capacity. Unlike WhatsApp or other common, non-specialised
communication-based apps which doctors and nurses might use to alleviate the
problem, Medic Bleep is a self-contained app which doesn’t include any
distracting or unnecessary features. Describing its innovation and potential,
Robert Jones, Head of Messaging at BT, commented, “Medic Bleep [...] can be
scaled at pace across the NHS to help nurses and doctors to work more
efficiently and securely. “We are excited to be partnering with Medic Creations
to offer Medic Bleep as a messaging solution to our customers, complementing
the existing portfolio of BT solutions on offer to our NHS customers.”
Hospital mapping
Following
on from the pursuit of greater efficiency in hospitals, other mobile apps seek
to make use of automation to reimagine infrastructure altogether. Navenio
provides indoor location solutions - the equivalent to GPS - which can power a
range of apps and platforms in the healthcare sector. Niki Trigoni, Chief
Technology Officer, states that Navieno is an “AI-led ‘Intelligent Workforce
Solution’ which assigns tasks to hospital teams based on their location. This
helps prioritise workloads in real-time on the basis of ‘right person, right
time, right place’.” Critically, the app’s secure system uses smartphones and
doesn’t require investment in new infrastructure, something Trigoni highlights
as a significant benefit. “One of the most common alternatives is installing
beacons which trigger when someone passes them. Unfortunately, when installing
beacons around a large building (such as a hospital), you’ll need hundreds, if
not thousands, to create an accurate map.” Navenio circumnavigates this issue.
Describing
the tech which drives the app, Trigoni states that a complex network of IoT,
cloud and artificial intelligence (AI) algorithms generates positioning
infrastructure. “Our indoor positioning system comprises a plethora of
smartphone and cloud-based algorithms that enable location-based services in a
scalable and infrastructure-free manner. At the core, we have developed robust
signal processing and deep learning algorithms for human and asset motion
tracking using inexpensive inertial sensors on smartphones and IoT devices.”
What is perhaps more impressive is that when floorplans are unavailable,
Navenio’s smart algorithms can collect anonymised smartphone data to gain
insights into building architecture in order to function. It’s a powerful tool
and one which emphasises how mobile apps can solve problems which would have
been impractical with previous technology.
“Although
it is intended to be a personal award, what I see under the hood is a
reflection of the unbelievably talented technical team that I have had the luck
to work with at Navenio. They are the true culprits for the technical
innovation, research and product development underpinning this award."
“This award
also bears a strong symbolic meaning; it is a constant reminder for me to
encourage women and other underrepresented groups into lead technical roles,
and support their initiatives for transformational change in the workplace.”
How will mobile apps help shape healthcare?
As we
have seen, mobile apps for digital healthcare can have myriad uses and it’s
conceivable that they have an even larger part to play in the health services
of tomorrow. “Mobile apps put information and engagement at your fingertips –
having your health goals and progress right on your phone will keep it
accessible and top of mind,” Owen says. “Engagement of the individual is
critical to the progress of healthy behaviors impacting goals; clinical
condition and holistic well-being goals alike.” More than simply bringing
further convenience for patients, mobile apps have the potential to streamline
entire hospitals and allow doctors and nurses to provide a consistently better
service. Following on from the COVID-19 crisis, which forced the issue of
finding tech-based solutions to logistical challenges, the health sector is now
primed to explore what else can be done. “Now the ice has been broken, more
patients will likely be introduced to such systems and the benefits they
bring,” states Spiegelberg. Trigoni agrees with this assessment of mobile apps’
potential: they can empower doctors and nurses to work to their full potential.
However, she also adds a caveat: “Covid-19 has shown health teams across the
world that their processes need to be watertight and also that the accuracy of
data on patients, staff and visitors is paramount,” she concludes. “Mobile apps
can remove many of the burdens which currently slow medical teams down, but
they won’t (and shouldn’t) replace medical professionals.”
Need for Mobile Devices at the Point of Care
One
major motivation driving the widespread adoption of mobile devices by HCPs has
been the need for better communication and information resources at the point
of care.7,14 Ideally, HCPs require access to many types of resources in a
clinical setting, including:
·
Communication
capabilities—voice calling, video conferencing, text, and e-mail
·
Hospital information
systems (HISs)—electronic health records (EHRs), electronic medical records
(EMRs), clinical decision support systems (CDSSs), picture archiving and
communication systems (PACSs), and laboratory information systems (LISs)
·
Informational
resources—textbooks, guidelines, medical literature, drug references
·
Clinical software
applications—disease diagnosis aids, medical calculators.
Medical devices and apps are already invaluable tools for HCPs,
and as their features and uses expand, they are expected to become even more
widely incorporated into nearly every aspect of clinical practice. However,
some HCPs remain reluctant to adopt their use in clinical practice.Although
medical devices and apps inarguably provide the HCP with many advantages, they
are currently being used without a thorough understanding of their associated
risks and benefits.Rigorous evaluation, validation, and the development of
best-practice standards for medical apps are greatly needed to ensure a
fundamental level of quality and safety when these tools are used. With the
implementation of such measures, the main determinant of an app’s value may
ultimately be its ability to provide meaningful, accurate, and timely
information and guidance to the end user in order to serve the vital purpose of
improving patient outcomes.