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Digital Footprint: A Step in Which Direction?

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Presentation from Dermot Ryan on the nature of the digital footprint created by remote assessment and monitoring technology for respiratory health.

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Digital Footprint: A Step in Which Direction?

  1. 1. “The bad”:Digital Footprints A step in which direction? Dr Dermot Ryan Honorary Clinical Research Fellow, University of Edinburgh Director of Clinical Strategy, OPC
  2. 2. Some Facts
  3. 3. • An App is an intervention • It provides information • Is Information a therapy? • Is an App a therapy? • Should Apps be subject to the same rigour as new medications?
  4. 4. Electronic reminders?
  5. 5. Compliance 9 This course is supported by an unrestricted educational grant from U-BIOPRED Any opinions expressed are those of the http://www.plosone.org/article/info:doi/10.1371/journal.pone.0098701 Acoustic readings
  6. 6. Compliance 10 This course is supported by an unrestricted educational grant from U-BIOPRED Any opinions expressed are those of the http://www.plosone.org/article/info:doi/10.1371/journal.pone.0098701 Acoustic readings
  7. 7. DIGITAL DOMAINS
  8. 8. DIGITAL DOMAINS
  9. 9. Educating Monitoring Knowledge Coaching Medication Data Cloud Skills Health system Research Clinician EHR Digital Health and wellbeing
  10. 10. Dosage Educating Monitoring Knowledge Technique Coaching Medication Reminders Data Cloud Prescription Billing Skills Health system Research Clinician EHR Reminders Alerting Follow up Stratifying Side effects Digital Health and wellbeing
  11. 11. • Provider notes • Clinical Notes • Guidelines • CDSS • Patient ID • Health Industry • Health Insurance • Consent Forms • Medication Alerts • Non Shared Personal info • Self Care trackers • Audit logs • Personal library• De identified info • Mandatory reporting • Community Profile • Public Health services • Survey data • Inspection Reports • Public Education Materials • Locality Alerts • Statistics • Population Health Risks • Communicable Diseases • Socioeconomic profile • Registries • Infrastucture data • Planning/polocy docs • Surveillance systems • Health disparities data Personal Health Dimension Healthcare Provider Dimension Population Health Dimension
  12. 12. Alerting Searching trends for allergic rhinitis and related queries such as pollen count and antihistamines such as loratadine and cetirizine USA 01/08-12/13 Allergy 2015
  13. 13. How online searching leads to targeted web advertising . Timothy Libert et al. BMJ 2015;351:bmj.h5974 In the United Kingdom, the NHS homepage generates third party requests to seven domains owned by American companies, including NetIQ, Amazon, and Google.
  14. 14. Data security
  15. 15. Closed Loop Patient Clinician Benefits • personal • private • shareable Risks • limited functionality • limited benefit/feedback • ( hidden transmittability)
  16. 16. Benefits • Records compliance • GPS location • Circumstances • Identify triggers • Opt out • Public Health: asthma clusters Harms • Tracking • Third party sharing • Privacy/hacking • Health system oversight • Penalties Open Systems
  17. 17. van Boven JF, Towards tailored and targeted adherence assessment to optimise asthma management. NPJ primary care respiratory medicine. 2015;25:15046. A different model?
  18. 18. Putting the Patient at the Centre Continuity of Care
  19. 19. • Incorporating patient centred perspective • Understanding what matters to patients • A voice for patients in guidelines • Engaging patients in clinical research Ann Am Thorac Soc Vol 11, Supplement 2, pp S112–S117, Feb 2014 Regulatory Agencies Industry Research Successful Patient Engagement = Successful research /trial process Patient Advocacy Groups
  20. 20. • Incorporating patient centred perspective • Understanding what matters to patients • A voice for patients in guidelines • Engaging patients in clinical research Ann Am Thorac Soc Vol 11, Supplement 2, pp S112–S117, Feb 2014 Regulatory Agencies Industry Research Successful Patient Engagement = Successful research /trial process Patient Advocacy Groups But: Including integration and interoperability
  21. 21. The Past • Extracting productivity improvements • Focused on improving transactions, • Removing duplication, • Increasing back-office efficiency • Streamlining certain processes Imison C, Castle-Clarke S, Watson R and Edwards N (2016) Delivering the benefits of digital health care. Research summary. Nuffield Trust
  22. 22. Patient Passive The past
  23. 23. The Future Triple aim: improving • Quality • Efficiency • Population Health Not about replacing analogue or paper or clinician processes with digital ones Rethinking what work is done, re-engineering how it is done and capitalising on opportunities afforded by data to learn and adapt
  24. 24. The Future Designed around the patient
  25. 25. The Future Designed with the patient
  26. 26. The Future Adapted around the patient
  27. 27. The right information, to the right person(s), in the right format via the right channel, at the right time
  28. 28. Risk Assessment Functionality Medical App/Risk assessment model A Low risk: little potential harm BMI, Activity monitors, calory counters, education, formulary Clinician self assessment B May cause harm without training or used innappropriately. Should be risk assessed prior to use Inter professional consultation or referral; drug conversion apps self certification peer review C Significant risk due to inherent complexity or potential for harm if misused Diagnostic support, patient decision support, medical calculators Best Practice guidelines. Assessed by local health organisation D Significant risk to patients due to combi of inherent complexity, functionality> Potential for medical harm: Any app that turns the platform into a regulated medical deice CDSS tools, control devices formal assessment and regulation Lewis TL, Wyatt JC. mHealth and mobile medical apps: a framework to assess risk and promote safer use. Journal of medical Internet research. 2014;16(9):e210.
  29. 29. Lewis TL, Wyatt JC. mHealth and mobile medical apps: a framework to assess risk and promote safer use. Journal of medical Internet research. 2014;16(9):e210.
  30. 30. mERA checklist domains Infrastructure Cost assessment Technology platform Adoption input: awareness, training Interoperability Scalability Intervention delivery Contextual adaptability Intervention content Replicability Usability/content testing Data security User feedback Regulatory Compliance Participant access Fidelity of intervention Agarwal, Smisha, et al. "Guidelines for reporting of health interventions using mobile phones: mobile health (mHealth) evidence reporting and assessment (mERA) checklist." bmj 352 (2016): i1174.
  31. 31. Key messages • Digital footprints from activities like internet browsing inadvertently reveal a great deal about our health • Despite strict regulation of clinical information, health information obtained through digital activities is now widely available to marketers with little protection • Such information also has potential to advance individual and population health • We need to tighten access to information used for marketing while discussing with patients how these methods could be borrowed by healthcare and public health organisations Timothy Libert et al. BMJ 2015;351:bmj.h5974
  32. 32. eHealth: The icing on the cake of healthcare

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