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Shining a light between the rock and the hard place: The importance of information to empower health-app users



Shining a light between the rock and the hard place: The importance of information to empower health-app users
Liz Ashall Payne

Liz Ashall-Payne, CEO, ORCHA

Apps, and their use for the promotion of health and wellbeing, are the subject of increasing interest and enquiry; particularly in light of the NHS’ Long Term Plan, and ever-increasing pressures on scarce NHS resources. But finding and downloading effective, engaging, and most importantly, safe health-apps, is a significant challenge. While many have suggested that health-apps could be a ‘silver-bullet’, aimed at quashing the woes that stem from decreasing funding and increasing demand for incumbent NHS services, it is important to tread with caution.

Unlike pharmaceuticals, over the counter remedies, talking therapies, physiotherapy or surgery, health-apps can not only be sought, but readily obtained in absence of gatekeeping and safeguarding. The result is that you or I can download upwards of 200,000 health-apps today, with as little as a click of a button on the app-store. While this can be argued as the unique value-proposition of app-based health technologies, a lack of guarantees regarding the quality and content of such apps, means that this open-access feature of apps also represents the chief concern; and is likely limiting the enthusiasm with which healthcare professionals engage and promote their use.

The number of apps labelled as ‘pranks’ or for ‘illustration purposes only’ has been subject to year-on-year growth. But for those looking for convenient, easily accessible, and often cost-free support; or for those who are either vulnerable or impressionable; such technologies can pose significant health risks, beyond those that are apparent and conveyed (if at all) in the short description within the app store. An app that misleadingly claims to monitor blood pressure or blood sugar for example, may result in either (1) misleading information, (2) modifications to disease management not representative of true disease status (including the use of insulin or warfarin), or (3) serious adverse events including hypoglycaemia or stroke. One such app for monitoring blood pressure has been downloaded upwards of 1,000,000 times on the Android Google Play app store, while boasting a review rating of 4.3/5.

This raises questions regarding the utility of both the subjective user review score (which is inherently limited in only capturing both very positive or very negative views) and the number of prior downloads of an app, as potential surrogates for app quality. Recent research into apps targeted at chronic insomnia disorder conducted by the Organisation for the Review of Care and Health Applications (ORCHA) confirmed this. In this analysis, which is now available in the journal BMJ: Evidence-Based Mental Health, it was demonstrated that both user review scores, and the number of prior downloads of a health-app, were not only unreliable as proxies for quality, but in fact were inversely related; and as these metrics increased, the objectively measured quality of apps decreased (as assessed by presence of clinical evidence, data privacy policies etc.) This has left a considerable void regarding where reliable indicators of the safety and quality of app-based health technologies can be found, something which at least in part, has been tackled by the National Health Service (NHS).

Courtesy of the NHS’s digital assessment questionnaire (DAQ), and the NHS apps library (beta version), the number of ‘accredited’ and NHS-approved health-apps is increasing, albeit at a leisurely pace, with approximately 50 apps accredited so far. While a step in the right direction, the rigour with which such reviews are conducted comes at the expense of speed, and an estimated review time of 6-8 weeks, limits the possibility of such initiatives being conducted at scale. As such, the difference between the total number of health-apps available (~300,000), and those which have been quality-tested and approved by regulators or accreditation bodies (~50); is if anything, increasing; leaving little or no information regarding the validity, efficacy, and most importantly the safety, of 99.99% of health-apps available today; which to date have been downloaded by potential users upwards of 50million times.

This is where the Organisation for the Review of Care and Health Applications (ORCHA) aim to transform the process of health-app research and information provision. Positioned as an open-access, free of charge and publicly facing repository regarding the user experience, clinical efficacy, and data privacy of thousands of health-apps, ORCHA’s aim is simple; to empower and inform potential users of health-apps regarding potential risks and benefits, prior to committing to use. Through a structured, objective and peer-reviewed assessment, consisting of 160 question areas, answered on a ‘yes’ or ‘no’ basis, ORCHA provides information to the 99% of users of health-apps, which are yet to be formally assessed by health technology assessment bodies, and in doing so, ORCHA removes the information asymmetry that is currently clouding the health-app market in, distrust, disbelief, and uncertainty. Publishing a new review of a health-app every 30minutes on average, ORCHA pull in information for all 300,000+ apps available on both iOS and Android Google Play, organise these into medically approved sub-categories (including diabetes, mental health and diet and exercise), and then order these apps from the most to the least downloaded.

In doing so, ORCHA believe that focusing attention on providing information about the risks and benefits of apps currently used the most, and those which others are most likely to download, is likely to have the largest overall impact on the safety and effectiveness with which such apps are used. By providing a short, sharp summary of each app, prior to download, highlighting concerns including the lack of a data privacy policy, a lack of evidence to support claims of effectiveness, or a lack of accessibility options for those who are hard of sight or hearing for example; ORCHA is providing information regarding the ‘many’ health apps currently in use, and eliminating the information uncertainty that not only limits the allure of health-apps, but also puts users at risk when unknowingly using health-apps which do not look after your data, and may cause physical harm if used in the belief that they are approved medical technologies.


Improving Healthcare with Technology Depends on Faster Adoption of Innovation





Lucienne M. Ide, MD, PhD, Founder of Rimidi

When Electronic Medical Records (EMRs) were introduced in the early 1970s the vision was clear: digitizing patient records would make healthcare more efficient, and better for the patient and provider. Fast forward to today—we’ve come a long way towards the goal of a better system, but we aren’t quite there. We’ve identified the industry’s pain points, and laid the groundwork for solutions. Widespread adoption of the three healthcare tech ideas below will be crucial to building a healthcare system that is better for patients and the clinicians alike.

Interoperability and SMART on FHIR

In 2018, the Centers for Medicare and Medicaid (CMS) renamed “Meaningful Use” to “Promoting Interoperability”, which is a good indicator that we are inching closer to greater efficiency in healthcare. Essentially, interoperability means the ability for health information systems and software apps to communicate, exchange data and use the data they’ve shared. “Digitizing healthcare” was initially driven by revenue optimization and then care standardization. Clinical efficiency seems to be the forgotten promise but will ultimately be one of the most meaningful outcomes. While EMRs have made huge strides in digitizing healthcare and allowing for data to lead the way, they haven’t always communicated well with each other or other technology. Enter Fast Healthcare Interoperability Resources, or ‘FHIR.’

FHIR is a standardized API that enables better discreet data exchange between different EHRs and health IT apps. FHIR created a shared language for health IT systems that all health IT players could use to exchange, interpret and process health data.

Substitutable Medical Applications and Reusable Technologies (SMART) added an additional layer of consideration to FHIR, addressing how users would engage with third-party applications inside of the Electronic Health Record (EHR), or other health IT platform workflow. The standard supports both single sign-on to third party applications as well as an integrated user experience. While it’s certainly still in its early days, SMART on FHIR is catching on across the industry.

Clinical Decision Support – CDS Hooks

The primary care physician checklist is ever-growing. Does the patient use tobacco? Do they wear a seatbelt? Do they floss? Do they eat enough kale? Instead of leveraging technology to empower the physician to know what is best for their patients, we’re adding more mandatory boxes to check that may not even pertain to that patient’s problem that they are presenting with. On top of that, physicians are tasked with keeping up with rapidly changing clinical guidelines and new therapeutics. Arming clinicians with the information they need to make the best decisions for their patients—while working within their workflow–is essential.

What if the software systems that clinicians use could be more dynamic? What if technology could prompt the clinician with the information they need when they need it in order to make a more personalized clinical decision? The CDS Hooks specification was created to support this idea. The vision for CDS Hooks is this: A ‘hook’ is programmed within the clinician’s workflow in the EHR, and can share information with third party applications, like the SMART on FHIR apps mentioned above. The app can then trigger a CDS, or Clinical Decision Support, notification and prompt the clinician with relevant information. For example, a new lab result may be available in the EHR indicating worsening kidney function. When the clinician opens that patient record, the EHR silently communicates with the third-party SMART on FHIR app, or launches the app automatically, to show guideline-based medication dosing recommendations for patients with compromised kidney function. Put simply, embedded clinical decision support tools will make it easy for physicians to do the right thing for their patient, and hard to do the wrong thing.

Remote Patient Monitoring and Personalized Medicine

The vison of ‘personalized medicine’ is entirely dependent on bringing in patient-generated health data from connected devices (think step counters with apps but measuring more clinical information, like blood pressure or blood-glucose levels). Clinicians need a way to know what’s going on with patients the 8,516 hours per year that they aren’t engaging with the healthcare system, versus the four hours they may be with their doctor. This data set has been largely ignored but as price points come down on cellular and Bluetooth-enabled devices, data transmission, and cloud storage, connected devices are finally be available to the masses. Interoperability allows us to pull this data into analytics platforms and connect it with patient record data from the EHR, giving clinicians a more complete view of their patients’ health—whether at the point-of-care or virtually.

Not only can technology like this arm clinicians with a better view of each patient’s unique needs, but it can enable remote monitoring to detect costly complications before they happen, and prompt clinicians to intervene with appropriate guideline-based management.

Make no mistake: The convergence of these three emerging healthcare technology trends can change healthcare—but providers must be ready to adopt them.

After working as a physicist, a venture capitalist, an academic clinician and scientist, Lucienne Ide, MD, PhD, decided to start Rimidi to drive innovations in the healthcare industry.

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AI to help kids struggling with ADHD, Autism, Asperger Syndrome (ASD), PDD-NOS and other ASD’s (autism spectrum disorders)




Stephane Bourles, CIO at Brain Balance

Left Brain or Right Brain?

In a properly functioning brain, both hemispheres communicate equally and at lightning speed, millions of times per minute. In a poorly functioning brain, the left and right sides of the brain only impart partial information, causing frequent miscommunication. This is called Functional Disconnection and is the root of many types of learning, behavioral and social problems found in children. The Brain Balance program puts the left and right brains back in sync using sensory motor exercises, academic skill building, and nutrition guidelines.

How does the Assessment Work?

The assessment consists of sensory, motor, and academic testing of more than 900 functions. The outcome of this assessment is a highly customized report providing parents with a complete understanding of their child’s behavioral, social, and academic skill levels.

We use AI to determine which brain hemisphere we believe to be stronger or weaker. The Machine Learning algorithm used for the assessment is not always accurate, which we know based on the feedback from our staff—yes we let them disagree with the system, which is intended as a tool to help them support their own assessment, but not to necessarily force them into a decision they don’t agree with.
But as valuable as an individual observation based on years of experience is, it still remains just the view of one individual. That is why we look at Artificial Intelligence as a new solution combining neural network architectures with massive computing power to enable our solution to learn a pattern from large datasets and make statistical predictions based on test results and feedback we already have for tens of thousands of students.

What is next?

Thanks to many product releases with different Machine Learning models we tested, we were able to improve our assessment accuracy and achieve precision, recall and F1 scores over 0.95. The limitation of this AI model is it is not 100% accurate and you don’t know for sure the source of truth. Since AI is a “black box” which can’t explain its prediction for most models, you have to trust your staff first.

Similar to clinical decision support systems helping healthcare practitioners, we believe this fast growing dataset about children, combined with new Artificial Intelligence models such as Explainable AI, will help our staff improve a child’s initial assessment, which will then improve our overall program’s results.

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All About Breast Tightening and Liposuction



Women with overly large breasts can face a number of difficulties on a physiological and psychological level, such as being unable to find clothes that fit properly, permanent indentations left behind by their bras from carrying the immense weight of their bosoms, or suffering from chronic pain in regions like their back, neck, and shoulders that can affect their day-to-day living.

In these cases, breast tightening and liposuction procedures like Breast-Tite—a form of radiofrequency-assisted (RFA) liposuction designed to perform what is known as a scar-less breast lift—can improve your daily life. If you haven’t heard of this innovative procedure before, you may want to take notes, as it provides a fantastic alternative to traditional breast lift and breast reduction surgeries! Learn more about breast tightening and liposuction down below!

How Does Breast-Tite Work?

Breast-Tite uses a form of liposuction that relies on a small cannula and a set of probes that emit radiowave energy in a fashion similar to the opposite poles on a battery. A local anesthetic is applied to the area to be treated, and then the radiowave energy (or radiofrequency) melts away unwanted deposits of breast fat in the subcutaneous layer while tightening the skin above the fat at the same time.

The temperature and flow of the radiowave energy are controlled by the surgeon as they expertly sculpt a patient’s breast to a desirable and realistic size and shape, resulting in a subtle yet remarkable breast lift with no signs of the procedure other than a single small puncture wound that heals with minimal scarring.

Achieve a Natural-Looking Breast Lift with Breast-Tite

One of the best things about undergoing a Breast-Tite procedure is that no one will be able to tell you’ve had a breast lift done. Your breasts just end up looking naturally perkier as a byproduct of your breasts being freed of extraneous fat and extra weight, resulting in a moderate lift of one to two inches in height on average for a more natural aesthetic than you’d experience with traditional breast lifts and breast reductions.

Additionally, patients who opt for a Breast-Tite procedure won’t experience the same troublesome problems that afflict those who undergo traditional breast liposuction—namely, severely loosened skin and noticeable scarring that often require additional lifts and tucks in order to hide. Instead, with Breast-Tite, patients will notice that their skin feels firmer and tighter, molding perfectly to their newly lightened breasts.

However, breast tightening and liposuction procedures like Breast-Tite may not work out for every patient. A good way to tell if you’ll be a proper candidate for Breast-Tite is to examine your breasts for extreme drooping or sagging. If your breasts fall below your rib cage or inframammary line, traditional breast lift and breast reduction procedures may produce better results for your body.

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