Many thanks to independent consultant Charles Lowe, President-elect of the Royal Society of Medicine’s (RSM) Telemedicine & eHealth Section for the following report on the one-day conference Using apps to transform healthcare delivery at the RSM, London, 18 April 2013.
Reflecting the importance of the topic, this one-day RSM conference sold out weeks in advance. The audience confirmed the growing trend for RSM Telemedicine Section-organised events to be attended principally by clinicians, in this case mainly hospital-based.
The general themes that emerged from the event included:
The need for greater connectedness among app overseers – the different players in the UK, notably NICE, MHRA, NHS Apps Library and NIHR each have different, often overlapping, concerns about apps before they are able to recommend or approve them for use. There emerged during the day a case to be made for tighter coordination among these bodies and, doubtless, others not represented at the meeting.
Big data doesn’t respond to professional users’ or patients’ needs well – apps are a great way to make big data acceptable to users. The Consent app (ascendinnovations.co.uk) demonstrated was quoted as an excellent example.
Not everyone has to produce apps – by opening up, publishing the APIs to your data, others with the appropriate skill might be able to do the job better than the data owner.
The day began with a presentation by our President Sir Michael Rawlins, until recently chair of NICE who described the role of NICE and the apps currently produced by them that cover NICE guidance and the BNF. After his talk Sir Michael encouraged a lively debate on NICE’s future role in the apps world during which Prof Jonathan Kay, Clinical Informatics Director on the NHS Commissioning Board, commented that apps can only be evaluated in the context of the care pathway for which they were intended.
Dr Neil Paull, a GP in Sandbach, Cheshire and regular eHI contributor, followed this with a very practical session describing his experiences as an app writer. One piece of advice he offered was to produce one single app with multiple features, rather than many separate smaller apps (such as his itenniselbow), as the former resulted in a much higher position in the app sales league, in turn promoting greater sales. He discussed the different ways to build an app and, for the future, on balance concluded that HTML5 was best, even though many present said that some NHS browsers would be unable to interpret this. The universal apps builder was just too slow, and revealed itself when running apps.
Shawn Larson, from NHS CfH, was next with an excellent presentation on the serious challenges of migrating a 3D VR system to an app. He emphasised the value of CPD accreditation of apps by the relevant Royal College.
Inderjit Singh and Dr Sebastian Alexander followed this with two presentations describing the NHS apps library and the process for ascertaining the safety of apps submitted. A short paragraph cannot convey the wealth of important detail given: as this presentation was one of those videoed, readers interested are encouraged to watch this on the RSM website when available.
Ruth Chambers described how effective Simple Telehealth (aka Florence) is, and hinted that developments, particularly regarding automatic downloading of data to a patient’s smartphone, are planned. She mentioned a conversation with her medical insurer about the acceptability of telehealth, who suggested the test is “are you doing anything different than if the patient was in front of you?”
Andre Chow gave a hugely impressive demonstration of the TOUCHsurgery app explaining its use to help surgeons practice operations. He compared the practice a violinist does, including just before a concert, with the lack of practice that surgeons typically have if their only experience is when working on human patients: though not perfect, TOUCHsurgery is aimed at helping fill that gap. A depressing feature of his talk was how much more the app was being welcomed in the US than in the UK.
Proceedings after lunch began with Neil Ebenezer who gave an extremely helpful presentation on the regulation of apps in the UK, explaining what the key issues were that required an app provider to seek CE certification for a medical device. The picture is becoming much clearer but as it does it becomes apparent that a successful app developer needs to satisfy the requirements of a range of organisations that do not currently give the impression of being joined up. Again, there is not the space to cover the detail here so readers interested are encouraged to watch this on the RSM website when available.
Dr Olubukola Adeyemo from North Staffordshire Combined Healthcare Trust, presented an app that enabled early identification of dementia: she made a very strong case as to how this improved the lives of dementia sufferers and of their carers. An interesting observation is that many frequent attenders at A&E have at root a cognitive problem that if addressed would reduce attendance. As she was presenting, the Secretary of State for Health tweeted that he had just been making the case for early diagnosis of dementia in the House of Commons.
Sarah Amani, from Surrey & Borders Partnership Trust, then gave a powerful presentation of a mental health app, making a strong case of the use of apps to help people manage mental health conditions.
Professor Lionel Tarassenko, from Oxford University, focused primarily on the value of apps to help manage diabetes. As introduction he explained that the need to reduce clinical load is pushing increased sophistication of medical apps to promote appropriate self-care. The main example he gave was a recent reduction in the blood glucose level above which pregnant women were classified as having gestational diabetes that had increased fourfold the number of such people that needed monitoring in Oxfordshire; the app his team developed helped the health authority to cope with this. An interesting observation he made was that app usage over the period of a pregnancy was excellent; however for Type II diabetics where life-long adherence was typically required, usage was not as good. He also commented that in his experience adherence was improved with the use of patients’ own tablets and smartphones vs dedicated equipment.
Matt Jameson-Evans (www.healthunlocked.com) kindly stepped in at the last minute to present on how apps are likely to help the NHS to improve patient outcomes. Statistics he quoted demonstrated a huge change in the way people were using NHS Choices over the last two years with a big rise in app interest.
Rob Dyke, a co-founder of HANDI told the meeting about what his organisation can offer and espoused the benefits of a ‘good hack’. His enthusiasm for using apps to connect patients and professionals to ‘big data’ was palpable. Comparisons he made, e.g. of DrDoctor vs Choose & Book, HowAreYou vs GPSoc2 made the point well. Handi is a brilliant resource for helping people get medical apps up and running, and lobbying for good infrastructure.
Aman Coonar, a cardio-thoracic surgeon at Papworth Hospital, completed the event with a joint presentation on the Consent app, referred to earlier, with Dr Saif Abed. They admirably demonstrated practically how apps do add value to ‘big data’ in a hospital setting.
Copies of the presentations should be available to attendees soon. In addition, four of the presentations were videoed and should be available on the RSM website to RSM members soon (there is unfortunately a charge for access by non-RSM members).
The next event in this series will take place on 6th June at the RSM and is entitled Worlds in collision: Is mobile technology challenging conventional telemonitoring? This will explore how mHealth is disrupting conventional telemonitoring and delivering far greater benefit in the process. As there is the same limit on spaces as there was for this last meeting, and bookings are already high, anyone wanting to attend is advised to book soon. Details and booking at http://www.rsm.ac.uk/academ/ted04.php.
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