Is assessment still the pending issue of health apps?

22 Mar
Marta Millaret

An article in JAMA has recently been published presenting the first smart watch approved by the FDA to predict epileptic seizures. It is called Embrace, a connected device which detects seizures linked to movement and electric fluctuations in the skin of a person and sends an alert so they can receive medical attention.

Last February, the Mobile World Congress was held in Barcelona. Among the different activities to be highlighted which are organised around this congress there is one called 4 Years From Now (#4YFN18), the part of the Mobile which connects companies, investors and institutions with each other to encourage collaboration in developing different ideas, business models and technological solutions.

The Digital Health & Wellness Summit 2018, organised by 4YFN Connecting Startups, the Mobile World Capital Barcelona and the Mobile World Congress with the collaboration of ECHAlliance, the European Connected Health Alliance, is the meeting point of technological and health issues. This year, among others, Neil Gomes, Maria Salido and Elena Torrente participated.

Neil Gomes from the Thomas Jefferson University of the USA pointed out that one of the challenges in mHealth is facilitating feedback between patients and health professionals.

Maria Salido, co-founder and CEO of the health app, SocialDiabetes, raised key issues for success with health apps: regulation + industry + users. And in particular, she highlighted the importance of the final users. An article published in The Economist was much commented on here with a provocative title:

Elena Torrente, Digital Health Coordinator at DKV, commented on Digital Doctor, a health app that incorporates a detector of symptoms and a tool to request a doctor’s appointment. She pointed out that there were more women than men in the user profile of the app.

In general, there was consensus on the fact that prior to developing an app, an analysis to identify needs must be done. That is, the first step should be to detect the needs of a user and then, based on the mapping of these needs, the moment would come to develop technological solutions.

The content of all these presentations is available and you can also read a compilation of the main ideas that were highlighted here and here.

Despite it not being the main subject of their presentations, in the follow up debate the need and convenience of assessment was brought up. At present, there are already 320,000 health apps on the market. But,… How are they assessed? Who does this? With what criteria? Can we already talk about the safe prescription of health apps?

We close the circle once again with the conceptual framework of mHealth Assessment published in JMIR mHealth and uHealth with which the Agency for Health Quality and Assessment of Catalonia (AQuAS) provides the culture of assessment to the everyday reality in which we find ourselves (in 2016 it was published in the first quartile, in the categories “Health Care Sciences & Services” and “Medical Informatics”, respectively, in the Journal Citation Reports). There are an increasing number of health apps and the debate concerning their assessment remains open.

Post written by Marta Millaret (@MartaMillaret).

Towards research in nursing with a (greater) impact

15 Mar
Núria Radó

What is it that makes a particular research have an impact on society beyond the strictly academic and which is truly transformative? Can a whole series of actions be planned in the way that one follows a cooking recipe which leads directly to the desired social impact? Unfortunately, the answer is no. The impact is multifactorial and depends on so many different elements and actors that it is difficult to establish a formula to guarantee it.

However, having said that, the fact that there is research which has a particular social impact does not mean that it is a totally random phenomenon and that there is no way of predicting, facilitating or promoting it. Years ago, from the Research Assessment group at the Agency for Health Quality and Assessment of Catalonia (AQuAS), and with the help and complicity of the International School on Research Impact Assessment, ISRIA, we identified a series of facilitators with regards the impact of research.

A fundamental facilitator is people, and the values, culture and capacity of leadership they have. Two identical results of research can have different impacts if the capacity of leadership, drive and will to get beyond academic impact is different. But this is still not enough. The strategy, organisation, collaborations and openness that institutions have will be a great facilitator or barrier for the researchers that have carried out the research.

Finally, both people and institutions will need two indispensable elements in order to aspire to having an impact: on the one hand, a close and effective communication with the different social actors that can play a role in transferring the results of research, and on the other, an approach focused on the participation of all these key players.

To paraphrase Confucius when he said “explain it to me and I will forget, show me and maybe I will remember, involve me and I will understand”, it is all about involving all the necessary actors to bring about a real change and make research transformative.

It is in this context that SARIS (Catalan acronym) came into being, the Assessment System of Research and Innovation in Health. It is a strategic tool which emerged from the PERIS (Strategic Plan for Research and Innovation in Health 2016-2020) with the aim of assessing the research carried out in health in Catalonia from the perspective of always wanting to facilitate and influence so that it has an impact beyond academia. To do this, the motivation and involvement of actors has been defined as a key factor for its development.

Last November, we started a series of participative sessions with nurses who were selected from the PERIS 2017 call in which a line of intensification of nursing professionals was financed.

It is important to emphasise that launching this line with nursing research makes full sense for three reasons: on the one hand, one of the thematic priorities of the PERIS is clearly that of “the development of clinical and translational research which facilitates the growth of scientific and technological knowledge, putting special emphasis on primary care agents and research in nursing”. In addition, the PERIS 2017 nursing fund has been the first to come to an end and it was appropriate to address ourselves to them first and foremost.

Last but not least, the conditions in which nursing research is carried out, with patients and their recovery as its central goal, makes it especially appropriate to ensure that this research has a direct impact on health. Hence, it is important that the research done in nursing be capable of demonstrating the impact that this group of professionals has because it can give it a comparative advantage with regards other biomedical disciplines. Indeed, nursing research is intrinsically translational.

Therefore, the first session centred on identifying the influential actors and in empowering the nurse to carry out an effective communication which amplifies the productive interactions needed to transform the results obtained into benefits for a better and improved health for patients.

We would like to express our deepest gratitude to the nurses for their participation (readiness and motivation) who attended of their own free will and in their time off work ensuring thus that the session was a success. This demonstrates that from the AQuAS we have leverage to give support to those researchers who are motivated to driving the impact of their research.

At present, we are preparing other sessions that will enable mutual learning between researchers and the assessment agents at the AQuAS.

Post written by Núria Radó Trilla (@nuriarado).

Jornada SARIS: Participación en recerca Barcelona, April 4th 2018.

Building gender equality

8 Mar
Iria Caamiña

The media systematically show us examples of the persistence of discriminatory situations for women such as the gender wage gap, the lack of women in managerial positions and the violence towards women, among other things.

These situations are a result of our social construct which is still based on an androcentric model where man is placed at the centre, as a reference of values and of the view of the world while at the same time subordinating women and rendering them  invisible.

Taking advantage of the fact that today is March 8, International Women’s Day, we would like to review and reflect on how we are tackling this reality with the Government of Catalonia’s public policies.

The history of gender policies of the Catalan Government Administration goes back a long way. The Catalan Women’s Institute was created almost 30 years ago and it was this institution which began to formulate programmes for equality with the aim of guaranteeing real equality between men and women. In this context, the concept of equality has been reinterpreted and broadened and is now multidimensional:

  • Formal equality: the affirmation of the equality of rights in legislation
  • Equality of treatment: the absence of direct or indirect discrimination for reasons of sex
  • Equal opportunity: the compensation of existing inequalities in the conditions and positions of women and men
  • Gender equality: the assessment and consideration of the diversity and differences between women and men

The evolution of the concept of equality has run parallel to the evolution of strategies for intervention by public administrations. The first programmes of policies for women were centred on guaranteeing equal rights and on the absence of discrimination between men and women. Later, once the shortcomings of this concept had been verified, new measures for positive action were introduced to guarantee equal opportunities. More recently, gender mainstreaming has been introduced and prioritised.

Gender mainstreaming is a concept that arose in Sweden in the early nineties of last century to promote policies for women and was incorporated in the international agenda within the framework of the 1995 Fourth World Conference on Women held in Beijing. The inclusion of this strategy to develop policies for women was a turning point.

Gender mainstreaming in the area of the Catalan Government requires the incorporation of the gender perspective in all policies and the promotion of specific actions in favour of women from the different areas of Government Administration. This is the framework within which work is being done at present by the Government of Catalonia. The Department of Health has taken part in the six programmes led by the Catalan Women’s Institute and also in elaborating the four reports on gender mainstreaming.

On the other hand, the drive and implementation of measures and actions linked to gender policies in the Department of Health takes place within the framework of the Work Group for gender mainstreaming. This group is made up of people of reference from all the units and entities of the department, including the Agency for Health Quality and Assessment of Catalonia (AQuAS), and it is coordinated by the Technical Cabinet of the General Secretary.

Aside from the achievements made based on measures taken and actions carried out, some of the most significant advances have been those made via regulation. Particularly noteworthy are:

Among the most noteworthy aspects of the Law of Equality (2015) is the regulation of interdepartmental bodies for coordination, in charge of applying gender mainstreaming both consultative and advisory in nature, and also of implementing mechanisms of collaboration, cooperation, control and sanction. Via this Law, the creation of the Observatory for Gender Equality was foreseen, a body which began functioning last June and of which the AQuAS forms a part of.

Despite the progress made, a lot of work remains to be done which we need to do together, not only as a legal obligation but also as a commitment to building a fairer society. No policy is neutral, and it affects men and women in different ways and this is why it is essential for us to put on our “gender glasses” during our daily tasks to identify possible differences so as to deal with them.

As you all know, dealing with gender is one of the editorial lines of the blog AQuAS (with posts written by Mercè Piqueras, Esther Vizcaino and Dolores Ruiz Muñoz) and we will be delving deeper into this subject shortly within the framework of the activity done at the AQuAS.

Post written by Iria Caamiña.

The experience of assessing innovation

1 Mar
Clàudia Pardo

Clàudia Pardo, a consultant of open innovation at Induct accompanies and helps entities in the health sector to adapt to the new needs of the future. Clàudia Pardo, together with Dolors Benítez, led the first edition of Innovate and Assess (see the previous post), a training programme of the Observatory of Innovation in Healthcare Management in Catalonia (OIGS).

This is why today we offer you an interview in which Clàudia Pardo of Induct talks to Francesca Moya, a specialist doctor in rheumatology, at present the Director of Processes and Quality in the Area of Healthcare in Mútua de Terrassa. We would like to share her experience at the OIGS in the context of the Innovate and Assess workshop because we feel that it could be of use to many other professionals.

Francesca Moya

What would you highlight about the OIGS in terms of assessing innovation?

The observatory has been an important lever in introducing the concept of innovation in micromanagement and healthcare practices among professionals and management teams. Personally, the OIGS has given me the necessary methodology and support to identify potential innovative practices and to introduce assessment in the project development process of projects that professionals themselves propose. It has also allowed me to get to know the experiences of other centres, to learn from this and to encourage relationships between other professionals.

In your opinion, why is assessing innovation in healthcare practices important?

The only way to quantify a clinical or organisational improvement that has been put into practice is to assess it. We learnt this during this OIGS course. The scientific interest that professionals have in innovation, with the aim of including new practices or technologies to bring us closer to an improved healthcare, can sometimes mean that certain resources are assigned to practices which do not provide any value and this can have a high cost, not only economic but also of opportunity and lead to inequality in the system.

How did the need arise to start assessing good practices in healthcare in your centre?

Innovation in healthcare practices is necessary if they are to be improved, and assessing it is essential to quantify improvements. I would say that the need to assess arose out of the curiosity and need to know whether what we are doing, including the novelties that we implement and the resources of all types that we assign, are in any way relevant to our clients and to the organisation. But there is another important aspect which encouraged and motivated us, by no means a minor one; giving visibility to everything we do and sharing it all as well as acknowledging the efforts and contributions of the professionals who make it possible to improve the health system. The OIGS is a tool aimed at facilitating the entire process.

What advice would you give when incorporating assessment in innovation?

In my experience, I think the first thing to consider when wanting to assess what is being done is to think about this from the start of any project that is to be implemented. Let me explain myself: one of the greatest problems that I have had personally when wanting to assess a practice, experience or project has been the lack of necessary data, problems of design and the lack of knowledge regarding the adequate methodology needed to do it. Therefore, my advice would be to start any new project by planning what you want to achieve and what you need to measure in order to know whether you have been successful or not. Methodology is basic in the field of assessment and that is the expertise of the AQuAS.

What reasons would you give the centre to take on this approach?  

I consider that knowing the results of what we do is basic for our organisations so that we are aware of the value it has, what it offers us, whether we should continue doing it, whether we can apply it to other areas of care, whether we should forget about it and change it for other practices or whether we can improve it.

Interview by Clàudia Pardo (@Claudiia_Pardo), Induct (@InductES).