Guidelines required on use of medical apps and mobile devices

Monash University researchers have called for the development of guidelines on the use of mobile devices and medical apps in clinical practice to ensure safety and quality.

While there are many obvious benefits to mHealth applications, including access to information at the point of care and better communication between healthcare providers and patients, there are also some risks that need to be confronted, Monash University researchers Jennifer Lindley and Juanita Fernando argue.

In a paper published in the European Journal of ePractice, Ms Lindley and Dr Fernando write that with WHO figures showing more than a third of doctors and almost three-quarters of nurses using medical apps on smartphones daily for work purposes, “it is imperative to scrutinise the use of mobile devices and medical apps in healthcare and develop a more considered and comprehensive approach.”

Benefits such as easy access patients records, decision support tools and treatment information systems at the point of care, along with the information sharing and consultation capability of telemedicine and telehealth, are frequently cited, as is the ability to use SMS for appointment reminders and treatment compliance promotion.

“Potential benefits of mobile devices and medical apps are certainly alluring, since their technology is not restricted by time or location and has the capacity to provide easy access to current data and evidence,” they write.

“It also has the potential to provide support for distributed health care, which is particularly valuable when spread across a wide geographical area. In addition, improved quality of interaction during consultations can be facilitated by the use of digital resources.”

Mobile devices are also very attractive to healthcare practitioners as they are often easy and pleasurable to use, and voice-activated applications and services, convenience and reduced computer start-up time are also cited as attractive to clinical end-users.

However, there are also disadvantages and significant risks, including their potential to distract clinicians through email sign-ups, pop-ups, advertising banners, notifications and alerts, along with the well-documented privacy and security concerns over the loss or theft of devices, the potential for voice and video calls to be intercepted, and social media conversations being permanently stored on devices.

Another potential drawback is the lack of knowledge on the part of some app developers about the particular standards used in healthcare, and the potential to embed data mining capabilities within apps.

“Although there is a significant trend towards use of mobile devices in health care environments, this is not universal,” they write. “Clinical practitioners may be reluctant to move away from familiar desktop environments to the use of mobile devices and apps, or they may lack expertise in the selection and use of apps.”

They cite research showing that clinicians may also be concerned that using a mobile device during medical consultations can be mistaken by patients as a lack of attention to them or may create a negative impression with colleagues.

“Mobile device governance and control shortcomings can erode clinician confidence in the use of the technology.

“Many governments have begun to act on this challenge: therefore, the formal guidelines being developed for quality control or the vetting of apps may in the future have significant impact on patient care and safety.”

The US Food and Drug Administration released draft guidelines on some of medical apps in 2011, and the organisation also regulates apps claiming therapeutic benefit.

“In Australia, legislative frameworks are generally limited to intended purpose, labelling and advertising claims of medical software,” they write.

“Guidelines providing certainty around the use of mobile devices and medical apps in clinical practice are necessary to inform best practices and ensure safety and quality in technology-linked patient care.”

They also recommend looking at the importance of education on the use of digital technologies in healthcare, despite many healthcare professionals and students being 'digital natives'.

While there are guidelines available, the researchers argue that these fail to “systematically address mobile digital technologies in health care, and do not focus on the critical evaluation of apps and their use.

“Students need to realise that the apps used do not ‘do the thinking for you’,” they write.

“There is a mismatch between real-life health care practice and education. In the case of an adverse event, who precisely is responsible: the app developer, the individual clinician user, the health care provider organisation or the government regulators?”

They conclude that best practice use of the technology needs to be incorporated into the education of healthcare professionals, and that new approaches to education for the use of mHealth are required for healthcare practitioners.

“However, this requires certainty around the use of mobile devices and apps in clinical practice, including the clarification of responsibility for technology-linked patient care.

“There is a need for regulatory guidelines for use in clinical care, particularly beyond the concept of mobile devices used to mediate a ‘face-to-face’ consultation or even a clinical ‘toolkit’ managed by an enthusiastic end-user.

“This raises significant issues for professionalism in patient care, making imperative a more considered and comprehensive approach to the use of mobile devices and medical apps in health care.”

Posted in Australian eHealth

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