7/4/ Presenter Information. Evaluating Mobile Medical Applications For Utilization By Pharmacy Students. Timothy.Aungst@MCPHS.

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1 Evaluating Mobile Medical Applications For Utilization By Pharmacy Students Timothy Dy Aungst, PharmD MCPHS University Presenter Information Affiliations: Assistant Professor, MCPHS University Editor, imedicalapps LLC Disclosure: The presenter is an editor for imedicalapps.com, a website that reviews mobile medical applications. The site and authors do not represent or consult for any app developers, do not receive funding or financial reimbursement for reviews, and do not advertise for any mobile apps. 1

edu Twitter: @TDAungst Affiliations: Assistant Professor, MCPHS University Editor, imedicalapps LLC Disclosure: The presenter is an editor

2 Objectives Discuss growing size of medical apps currently available on the market Identify what medical apps may be of use to pharmacy students in the classroom and during clinical rotations for professional development Identify qualities of an app that would be preferential to use in practice based upon key characteristics Discuss changes that may occur in medical app development due to Federal oversight and outside organization intervention Mobile Application Explosion Substantial growth of mobile applications Two largest platforms for medical apps are Google Android and Apple ios Mobile Applications by OS 900, , , , , , , , ,000 0 itunes Google Play Windows Blackberry Medical Applications Google Play, 7884 itunes, Pure Oxygen. How many apps are in each store? 148biz.com. App Store Metrics. AppBrain.com Number of available Android Applications. Role of Mobile Medical Apps Point-of-Care Tool Clinical Reference Medical Education Patient Education Communication Telehealth EHR Integration Social Media/News Ozdalga E, et al. J Med Internet Res. 2012;14(5):e128. 2

Federal oversight and outside organization intervention Mobile Application Explosion Substantial growth of mobile applications Two largest platforms for medical apps are Google Android and Apple ios

3 Benefits of mobile medical apps Clinician Tools Helps increase access to clinical information for pointof-care Communication Sharing of data Workflow Increase productivity Integration into EHR Education Patient Engagement Education Data collection and feedback Students and Practitioners use apps differently Students use educational and clinical apps Docs use clinical calculators and drug information Payne KB, et al. BMC Med Inform Decis Mak. 2012;12:121 Goldbach H, et al. J Am Med Inform Assoc. 2013; In Press. Drug Reference Many references provided by commonly used companies in pharmacy Not all information available via app is as complete as that provided through a browser based system Clinical i l Reference Many references available via web-based browsers are available via mobile apps Information can be completely downloaded to device negating any online connection Many apps are created by renowned institutions for clinical purposes 3

information Payne KB, et al. BMC Med Inform Decis Mak. 2012;12:121 Goldbach H, et al. J Am Med Inform Assoc. 2013; In Press.

4 News and Reading Medical news websites have apps available for recent news for pharmacists Integration of CE/CME Portals to institution libraries for medical journal access Issues with current mobile app development Lack of evidence-based information Reviews have demonstrated that apps identified often lack medical references Lack of clinical input into design Multiple apps have no input by medical professionals Many Startups have no medical staff Lack of accuracy Dermatological apps have range of specificity and sensitivity Opioid conversion apps are not uniformly accurate Mosa A, et al. BMC Med Inform Decis Mak. 2012;12:67. Wolf JA, et al. JAMA Dermatol. 2013;1-4. Maintaining Privacy Password Protection Breach of data Data will it be sold? Haffey F, et al. Drug Saf. 2013;36(2):111-7 Ferrero NA, et al. J Am Acad Dermatol. 2013;68(3):515-6 Implication for Pharmacy Practice Lack of standardized education for future pharmacists No infrastructure in place by most colleges No requirement to educate students on rising use of mobile technology What applications should be taught or advised for students to use? Is the information provided via an app sufficient for clinical reference? Development of best practice for education of students is required 4

medical professionals Many Startups have no medical staff Lack of accuracy Dermatological apps have range of specificity and sensitivity Opioid conversion apps are not uniformly accurate Mosa A, et

5 Evaluating Medical Applications Content Requirements Information provided Is it accurate or verifiable? Developer background Who made it? Relevancy Does the app do anything to benefit practice? Efficacy Does the app perform its intended goal? Support Technical Requirements Is the app continually updated? Is there a way to communicate with the developer? Usability Does the app function correctly for intended purpose? App Checklist Ultimately a Medical Application should demonstrate several key features Apps for a specialized purpose may require further analysis Criteria Information is verifiable and of sound background and cited within application App is developed by refutable company or discloses authors of clinical expert background Information is time-stamped and updated on reasonable schedule App is has dedicated support, and there is a mechanism to report errors App meets regulatory compliance where applicable App discloses any conflicts of interest App has mechanism in place to secure privacy where relevant Y/N Misra S, et al. JAMA Dermatol. 2013;In-Press. App Review #1 5

Usability Does the app function correctly for intended purpose?

6 App Review #1 App Review #1 App Review #2 6

7 App Review #2 Putting it into Practice Classroom Conducted an interactive lecture on med apps Review what to look for in an app Library Support Create a dedicated website listing supported apps by the school Infographic Clinical Site Involvement Identify what apps supported at a clinical site Preceptor identifies what is appropriate utilization Professionalism Teach students when is an appropriate time to use a device for support Library Infographic 7

Clinical Site Involvement Identify what apps supported at a clinical site Preceptor identifies what is

8 Future Regulations Regulatory Oversight FDA has a Draft Guidance Has already made interventions on questionable apps Areas currently covered: are used as an accessory to a regulated device; or transform a mobile platform into a regulated medical device. Certification Independent organizations have created methods to ensure app quality Happtique, mhimms Medical Society Involvement Medical groups may stake a claim in certain areas and provide oversight Food and Drug Administration. Draft Guidance for Industry and Food and Drug Administration Staff - Mobile Medical Applications Conclusion Mobile medical applications will play a substantial role in pharmacy practice Many apps are readily available across multiple OS Opportunity presents itself to educate students on app use Classroom, clinical site, workshops Not all apps are created equal Pharmacists must be made aware of pros/cons of med apps Apps need to be properly identified for use Future oversight may present itself to help regulate medical apps FDA, FTC, App Certification Programs References 148biz.com. App Store Metrics. (accessed 10 June 2013). AppBrain. Number of available Android applications. (accessed 10 June 2013). Pure Oxygen. How many apps are in each app store? (accessed 10 June 2013). Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res. 2012;14(5):e128. Mosa AS, Yoo I, Sheets L. A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak. 2012;12:67. Wolf JA, Moreau J, Akilov O, et al. Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection. JAMA Dermatol. 2013;:1-4. Ferrero NA, Morrell DS, Burkhart CN. Skin scan: a demonstration of the need for FDA regulation of medical apps on iphone. J Am Acad Dermatol. 2013;68(3): Haffey F, Brady RR, Maxwell S. A comparison of the reliability of smartphone apps for opioid conversion. Drug Saf. 2013;36(2): Misra S, Lewis T, Aungst TD. Medical application use and the need for further research and assessment for clinical practice. JAMA Dermatol. 2013;In-Press. Food and Drug Administration. Draft Guidance for Industry and Food and Drug Administration Staff - Mobile Medical Applications. (accessed 31 May 2013). 8

Certification Independent organizations have created methods to ensure app quality Happtique, mhimms Medical Society Involvement Medical groups may stake a claim in certain areas and provide

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