Proposal’s context, positioning and objective(s)
Mobile Health (mHealth) has the potential to play a positive role in various domains affecting the individual's health condition (well-being, prevention, management, monitoring or follow-up of known or suspected pathologies) while being economically beneficial to the healthcare system. The use of mHealth (apps or devices) can reduce the number of medical visits, maximizing convenience for the patient while minimizing the cost 1 to the healthcare system. However, several factors hinder this potential: diversity and plethora of often confusing products; Variability of reliability and/or relevance of a solution depending on the context of its use; Difficulties in assessing its qualities and added value; Multitude of areas covered (health and / or wellbeing); Diversity of users/patients characteristics (clinical and paraclinic data, lifestyle, individual preferences). In addition, there is a lack of knowledge of the psycho-social aspects/effects related to the arrival of this new technological third-party in the patient-doctor relationship. ApiAppS project will contribute to remove the bottlenecks that constrain rational use of mHealth.
Like medical prescriptions, physicians have a crucial role to play in ensuring that the use of mHealth can really be at the service of the patient and be properly integrated into his/her follow-up and health management. The assumption we make in the ApiAppS project, is that physicians can play a central role in guiding the choice processes when mHealth use is a possibility/option for better patient health. We believe that it is necessary to move towards a mechanism of technical integration (in practice and patient management softwares) and human integration (in the physician-patient relationship) of mHealth comparable to the mechanism of a usual medical prescription. In order to achieve this, as it is done with drugs prescription tools, physicians must have tools to appreciate (as best as possible): the quality, the indications and contraindications, the possible effects of mHealth apps/devices and their evolution/revision (new market entrant, removal, modification of features…). In addition, physicians need to know the possibilities for integrating and analysing the data produced by these mHealth apps/devices and how they can best be used to enrich the relationship with the patient.
To do this, the first step in cataloguing mHealth apps and devices is already underway. There are indeed specialized health platforms, which offer such catalogues (for examples: myhealthapps.net, appscript.net, mhealth-quality.eu, medappcare.com). Some technical or conceptual problems still have to be resolved: advanced categorization of mHealth apps/devices, indexing with rich and standardised medical terms, labelling of apps and devices, follow-up of uses, indications concerning tools complementarity....
Beyond the intrinsic improvements that can be made to these platforms, the key step to guide the choice of an mHealth app/device that meets the patient's needs, will be coupling these platforms with one or more information sources which can give a detailed level of the medical context. For this reason, the electronic medical record (EMR) is a valuable source because it contains information rigorously collected, numerous, diversified, semantically rich and medically validated with an individual detail level (concerning the patient). Medical knowledge repositories/databases (clinical practice guidelines, medical drugs characteristics…) are other sources to consider for at least two reasons. First, consulting such repositories reflects the user’s particular concern (a medical context) for the information accessed (for example: consulting web pages about asthma or a beta2-mimetic drug signs a very specific concern). Second, these repositories contain validated knowledge (evidence-based practice recommendations, drugs indications or effects to monitor,…) that must be taken into account when suggestion of a mHealth app/device consistent with this knowledge is desired (for example: suggest an app for the daily steps tracking is consistent with guidelines indicating that regular physical activity is recommended for diabetic persons).
To this date, EMR, medical knowledge databases and platforms cataloguing mHealth apps/devices (mHealth app web store), evolve in silos without interoperating. mHealth app web stores operate as standalone applications and are based on rudimentary data to guide the choice of an mHealth app/device, limited to what a user can (and agrees to) fill through a search form. Using EMR software and / or medical knowledge databases, the users (physicians) do not have access to mHealth apps/devices selected for their relevance in the management of a given patient. Consequently they cannot recommend/prescribe in an informed and relevant manner mHealth apps.
Impact and benefits of the project
The ApiAppS project will help support and optimize change in practice which is now beginning but still unbridled, haphazard and more business oriented rather than based on medical strategies and on validated scientific knowledge. At the end of the project, we will provide the community with specifications 4, which allow interoperability with the decision support module and the integration of the results in other medical software (shareability). Thus, project findings will be reusable in various mHealth environment and tools developed will be adaptable to other architectures (example: French DMP, Hospital Information System...).
The consortium agreement will be drafted with the objective of facilitating re-use, adaptations or specializations of the decision support module and the search engine. ApiAppS will allow significant progress in rationalizing the use of mHealth technologies and will provide an operational framework and demonstrator in which technical and psychosocial aspects as well as interests and limits of prescribing or recommending mHealth in clinical practice, will be studied and disseminated (through scientific publications and communications). This will give a clearer overview of what GPs groups, agencies or national institutions can plan in order to foster mHealth.
The ApiAppS project will move forward reflection of the proper use of mHealth in the patient-physician relationship. Moreover, since some mHealth apps will be prescribed/recommended rather than others depending on quality criteria, ApiAppS will promote regulation of mHealth apps and quality criteria understanding by GPs and patients. Quality criteria have recently been published in “Good practice guidelines on health apps and smart devices” by the HAS. They have already been taken into account within our project and are being implemented by DMD.