In recent years, the debate about what we should do with health apps has centred around accreditation, certification or assessment. At the same time, multiple lists of health apps recommended by a range of known and recognised initiatives have been drawn up.
In this context, and with the Mobile World Congress 2017 in Barcelona in full swing, we can ask ourselves what role a Health Technology Assessment (HTA) agency has when considering mHealth.
There is a reality which we cannot evade. Any health intervention needs to be based on evidence, on knowledge of the highest quality at hand, and must be evaluated.
This cannot be done by turning our backs on the real world or innovation. A health app is a tool to carry out a health intervention and so health apps need to be seen as just another intervention, but of course, with some characteristics of their own which will mean there is an extra demand placed on one and all.
Technologists, HTA experts, professionals and citizens have the opportunity to understand each other if we want to be facilitators of recommending safe apps in health. We are not talking about initiatives that can be developed from one sector only and it is not only about apps.
Now more than ever, we need to be flexible and work from a multidisciplinary position. We already talk about co-creation and co-design; quite simply, of co-produced mHealth initiatives based on the expertise of multiple agents including, obviously, citizens.
AQuAS is participating in the assessment of several mHealth projects financed by the European Commission. The PEGASO project stands out, centred on promoting healthy lifestyles among adolescents, and DECIPHER, as an integral solution to facilitate the geographical mobility of patients with chronic diseases such as diabetes type 2 and m-resist, centred on schizophrenia and patients resistant to treatment.
We are faced with the challenge of integrating totally different fields such as the language of technologists and developers; the speed of innovation and the culture of assessment. In addition, this needs to be done without losing sight of the key role of scientific societies and the different points of view of health professionals and end users.
We know there is a lot of work to be done. Technologists and experts in health technology assessment, respectively, have the opportunity to learn a lot from each other. It is about sharing knowledge and expertise to facilitate, ultimately, health tools for citizens and professionals, which have been assessed, are based on evidence, are safe and reliable and have a strong collaborative component.
Post written by Toni Dedéu (@Toni_Dedéu) and Elisa Puigdomènech.
The Economist recently published an article in which they reported that the number of mobile health applications, or apps, was in the region of 165.000, a very high figure that poses many questions.
A large part of these apps are related to well-being and promoting healthy lifestyles, but what makes us choose one over another?
The first thing that comes to mind is that mobile health apps, being a health technology, could and should be assessed based on their impact on health and this is where we are faced with our first problem.
While there is a gold standard when assessing this impact in the area of medication and static interventions in randomized clinical trials, how is this impact assessed in a highly dynamic world? In a world that can include a range of components that users can use depending on their needs? Where pressure is added due to the fact that advances in technology are being made in leaps and bounds and we cannot wait for years before getting results? It is not that simple.
If we venture into the area of mHealth, the first thing we find is great diversity. The design, requirements and assessment of an app developed to help manage diabetes in older people is very different to an app aimed at providing a dose for some medication where improving its adherence is sought, or an app to promote not drinking alcohol among young people before sitting in the driver’s seat, or an app to manage depression and anxiety.
What are we trying to say with all this? Easy and complex at the same time: the intervention that one wants to do via a health app and the target users will determine their use and their adherence.
And we are only just beginning. Apart from aspects related to health and the suitability of content or other more technological factors such as interoperability and security -by no means simple-, other factors come onto the scene such as acceptability, usability and satisfaction, factors related to User Experience (UX).
User Experience in mHealth is essential given that the main aim of it all is to make the tools which are being developed viable, accepted and used by the population who they are meant for, and also that the aim for which they were designed be respected.
After all, the end user who has the last word in deciding whether a health app is used or not, and this is why their participation in all phases of developing these mHealth tools is crucial.
Pursuing these aims of feasibility, acceptability and usability can make us reflect on, for example, the difficulty some old-age people may have when learning to use a smartphone for the first time. However, these obstacles related to the generational factor also exist among young people with new languages.
Wesuggest let yourself surprised by this video that shows how some adolescents react and interact when using Windows 95 for the first time.
The experience involved 92 speakers and over 23 hours, which was also possible to follow via streaming. All in all, a challenge which the organizers were successful in delivering. You can read or re-read the Twitter comments from here: #ICIC16.
The International Conference on Integrated Care (ICIC) has become a must for professionals who provide care for people and managers working in the fields of health and social services, among others.
Different languages to express the same message: integrated care represents the path we need to follow in order to meet the challenges of our aging populations.
How can we do it? Integrated care proposes the integration of services as a response to the fragmentation of care practice, especially in the biomedical system. The coordination of professionals and institutions aims to improve the experience of patients’ who receive care, as well as their families and to improve their quality of life related to health. This becomes especially key when identifying patients with complex needs.
The main topics covered during the ICIC conference referred to people-centred care within the perspective of those treated and in the coordination, integration and, collaboration of services, professionals and systems (health, social, education, justice, corporate, etc.). In this regard, there were a variety of experiences presented from around the world of collaborative approaches that promote a multidisciplinary and integrated style.
The conference speakers emphasized the value of primary care and community health as being core to providing care to the community as well as the leadership of professionals from the areas of nursing, social work, the field of mental health and other disciplines and profiles.
Following this main topic, several presentations focused on different organizational models of collaborative care which report findings that endorse the adoption of strategies from the bottom up, in other words, strategies that would enable the initiatives proposed by health professionals to reach planners and administrators who, in turn, can provide the support and recognition.
It is important to highlight that there is an ever-increasing recognition of the importance of social determinants of health and looking to the community for the role it might play in shaping these determinants.
Another iniciative in AQuAS is the SUSTAIN project -funded by Horizon2020, an opportunity for professionals to work jointly with their peers in other countries in an effort to define a roadmap and establish synergies in the field of Integrated care in Europe, a project of great interest for Catalonia.
Finally, it is vital not to lose sight of another key issue which is equality in the access to and outcomes from services, and this implies regular analysis of variations in care which have not been justified.
A further helpful instrument for incorporating the opinions of those who receive care and the professionals involved is that of shared decisions. This involves a line of work which incorporates available evidence in a specific area or department of care, the preferences of patients when faced with the different health intervention options, and the essential information for improving the knowledge of all those involved (professionals, patients and their families and environment).