The explosion in the number of applications (apps) designed for the medical and wellness sectors has been noted by many. Recently we have seen increased presence of truly medical apps, in addition to consumer health and wellbeing apps, designed for clinical professionals and patients with medical conditions. Consumer based mHealth apps typically allow people to do old things in new ways, such as recording health measures digitally rather than on paper. We see this also with medical apps, where increases in the quality and efficiency of existing health care models provide clinical staff with digital tools that replace paper based documentation. In rare and exciting cases we are also seeing mHealth applications that are doing things in entirely new ways to drive real innovation in health care delivery through mobile devices. The aim of the tutorial is to highlight real world, high impact mobile research that is relevant to the key discipline of Mobile HCI. Thus, the tutorial will be application rather than academically focused. The tutorial will highlight the wide range of mHealth applications available that go far beyond trackers and behavior change tools and encourage researchers to look beyond consumer applications in their research. Four key areas of mHealth applications will be covered including Apps for the HealthyWell, mHealth in Hospitals, Practice and Clinical Apps and Patient Apps and will cover applications for health assessment, treatment and triage, behavior change, chronic illness, mental health, adolescent health, rehabilitation and age care with a focus on the need for rigorous evaluation and efficacy analysis.

1. mHealth: Beyond
Consumer Apps
Jill Freyne, CSIRO
jill.freyne@csiro.au
1

2. Introduction
• Jill Freyne
• PhD Computer Science, University
College Dublin
• IBM Research, Cambridge, MA, USA
• Commonwealth Scientific and Industrial
Research Organisation (CSIRO), Sydney
2

3. 3

4. 4

5. Digital Productivity
5

6. Tutorial Overview
• mHealth
• Consumer Health vs Health Services
• Health Apps
• HealthyWell
• mHealth in Hospitals
• Practice and Clinical
• Patient Apps
• Challenges
• Interactive component
6

7. Global Health Challenge
7

8. Inequality in Service Delivery
Health
Professionals per
10000
Major
cities
Very
Remote
GPs 324 70
Nurses 978 589
Allied Health 354 64
8
http://www.csiro.au/Outcomes/
ICT-and-Services/National-
Challenges/Satellite-
Telehealth.aspx

9. Living Longer
9

10. Great Expectations
http://www.csiro.au/Portals/Partner/Futures/Our-Future-World-report.aspx
10

11. Cost of Living Longer
11

12. Impact of Shrinking
Workforce
Popula'on)Futures)for)Australia:)the)Policy)Alterna'ves),)Professor)Peter)McDonald),)Rebecca)Kippen),)Social)Policy)Group)12)October)
1999))
12

13. Problem
13
Shrinking(Workforce(
• Reduced(tax(base(
• Re7ring(health(workers(
• Less(access(to(services(
Growing(Demands(
• More(pa7ents(
• Increased(costs(
• More(chronic(disease(
• Higher(expecta7ons(

14. mHealth - part of the
solution
the practice of
medicine and public
health supported by
mobile devices
mHealth is the use of mobile and
wireless devices to improve health
outcomes, healthcare services and
health research
mHealth involves the use and capitalization on a
mobile phone’s core utility of voice and short
messaging service (SMS) as well as more complex
functionalities and applications including general
packet radio service (GPRS), third and fourth
generation mobile telecommunications (3G and 4G
systems), global positioning system (GPS), and
Bluetooth technology
14

15. Global penetration of mobile
devices
15

16. Tip of the iceberg
16

17. Roadmap for mHealth
“Smart mobile devices and applications, working in concert
with cloud computing, social networking and big data analytics,
will be at the core of global health care transformation. These
transformative technologies will continue to lead with ways to
help rein in cost, broaden access, change behaviors and improve
outcomes.”
Pat Hyek
The use of mobile and wireless technologies to
support the achievement of health objectives
(mHealth) has the potential to transform the face of
health service delivery across the globe. (WHO
2011)
17

18. WHO mHealth Categories
• health call centres
• emergency toll-free
telephone services
• managing emergencies and
disasters
• mobile telemedicine
• appointment reminders
• community mobilization
and health promotion,
• treatment compliance
• mobile patient records
• information access
• patient monitoring
• health surveys and data
collection
• surveillance
• health awareness raising
• decision support systems
18

19. Uptake of mHealth
mHealth: New horizons for health through mobile technologies: second global survey on eHealth
www.who.int/goe/publications/goe_mhealth_web.19
pdf

20. 20

21. mHealth Barriers
21

22. Take up the challenge
• mHealth programmes require evaluation. This is the
foundation from which mHealth (and eHealth) can be
measured (WHO 2011)
• “Based on these results, we posit that the field is entering a
new ‘era’ where a body of rigorous evaluation of mHealth
strategies is rapidly accumulating. The transition into an era
of evidence-based mHealth supports our position that
innovation in this domain can be evaluated with the same
rigor as other public health strategies, attenuating some of
the hype previously associated with mHealth.” - Alain
Labrique, Johns Hopkins University Global mHealth Initiative
22

23. Consumer Health vs
Health Services
23

24. Healthy Well
• Focus on Individual
• Encourage Behaviour Change
• Self awareness/monitoring
• Gamification/Competition
• Social support
• Education
• Persuasive
24

25. drugs.com
• Free
• Education
• Impact: increased
understanding,
confidence, self
management
25

26. 26 http://www.csiro.au/digitalhealth

27. Kids Doc
27

28. Premium Content
28

29. Food Switch -
Behaviour Change
29

30. FoodSwitch has empowered Australian consumers
seeking to make better food choices. In parallel,
the huge volume of crowdsourced data has
provided a novel means for low-cost, real-time
tracking of the nutritional composition of
Australian foods. There appears to be significant
opportunity for this approach in many other
countries.
30

31. Symple
• Self Monitoring/
Reflection
• $5.99
• Impact: Self
awareness, self
management, data
collection
31

32. Education Apps
…. 55 unique apps met the inclusion criteria…. Only 6 apps
(11%) covered all 4 of these prevention areas. Eight apps
(15%) provided tools or resources specifically for HIV/STD
positive persons. Ten apps included information for a range of
sexual orientations, 9 apps appeared to be designed for
racially/ethnically diverse audiences, and 15 apps featured
interactive components. Apps were infrequently downloaded
… and not 32
highly rated

33. Fitness
33

34. Designed for Impact
• Behavioural Science
• goal setting
• behaviour change theory
• user perception
• tailoring and personalisation
34

35. !
!
!
40 Apps - 20 free, 20 paid. The most frequently included
BCTs were “provide instruction” (83% of the apps), “set
graded tasks” (70%), and “prompt self-monitoring” (60%).
Techniques Presence of such BCTs as “varied teach by to use app prompts/type and cues”, price; “however,
agree on
BCTs behavioural associated contract”, with increased “relapse intervention prevention” effectiveness
and “time
management” were in general were not more present common in the in apps paid apps.
reviewed.
!
!
35

36. The present study demonstrated that apps promoting physical
activity applied an average of 5 out of 23 possible behavior
change techniques. This number was not different for paid and
free apps or between app stores. The most frequently used
behavior change techniques in apps were similar to those
most frequently used in other types of physical activity
promotion interventions.
36

37. Diets
37

38. Obesity is common,
serious and costly
• More than one-third (or 78.6 million) of U.S.
adults are obese (JAMA. 2014;311(8):806-814.)
• Obesity-related conditions include heart disease,
stroke, type 2 diabetes and certain types of cancer,
some of the leading causes of preventable death.
• The estimated annual medical cost of obesity in
the U.S. was $147 billion in 2008 U.S. dollars; the
medical costs for people who are obese were
$1,429 higher than those of normal weight.
38

39. Obesity
39

40. Evidence base…..
Text ……messaging We identified interventions 75 trials. Fifty-increased nine trials adherence investigated to ART the
and
smoking use of mobile cessation technologies and should to be improve considered disease for management
inclusion in
services. and 26 Although trials investigated there is suggestive their use evidence to change of health
benefit in
behaviours. some other Nearly areas, high all trials quality were adequately conducted powered in high-trials income
of
optimised interventions are required to evaluate effects on
countries……
objective outcomes.
40

41. Impromy
41

42. Informed Program
42

43. Impromy Clinical trial
• Behaviour change focussed app - push
notifications, tasks, rewards, self monitoring
• Randomised Control Trial in clinical setting
• 100 participants per group
• 3 and 6 months follow up
• Validated weight loss, improvements in mood,
attitude change, positivity toward continuing
43

44. Impromy Community
Trial
• 4000+ participants
• data from app usage, pharmacy database
and social media monitoring
• real world impact of program
• insight into weight loss shake programs
44

45. BrainHQ Science
• Posit Science
45

46. 46
IMPACT Study

47. Lumocity
47

48. mHealth in Hospitals
48

49. Epocrates
• 1 million
healthcare
professionals
nationwide
• 50% of users use
for 20 minutes
each day
• Decision support
• Drug Interaction
49

50. Drip Infusion - IV Drip
Rate Calculator &
50

51. iCombat HAIs
51

52. PicSafe Medi
52

53. Cultural Key Phrases
53

54. Paramedic Protocol Provider
By Acid Remap LLC
54

55. Clean Me
55

56. mHealth for Patients
56

57. Emergency ID
57

58. PSA (Psychological
Symptoms Analyzer)
58

59. Recovery Record Clinician
- Eating Disorder
59

60. AliveECG
60

61. Accuracy and Precision
61

62. Diabetes Self Management
Adults with type 2 diabetes using WellDoc's software achieved
statistically significant improvements in A1c. HCP and patient
satisfaction with the system was clinically and statistically
significant.
62

63. While a wide selection of mobile applications seems to be
available for people with diabetes, this study shows there are
obvious gaps between the evidence-based recommendations
and the functionality used in study interventions or found in
online markets. Current results confirm personalized
education as an underrepresented feature in diabetes mobile
applications. We found no studies evaluating social media
concepts in diabetes self-management on mobile devices, and
its potential remains largely unexplored.
63

64. Melanoma Detection
64

65. Melanoma detection
Sensitivity of the four tested applications ranged from 6.8% to
98.1%. Specificity ranged from 30.4% to 93.7%. Positive
predictive value ranged from 33.3% to 42.1%, and negative
predictive value ranged from 65.4% to 97.0%. The highest
sensitivity for melanoma diagnosis was observed for an
application that sends the image directly to a board-certified
dermatologist for analysis and the lowest sensitivity was
observed for applications that use automated algorithms to
analyze 65
images.

66. mHealth for Clinics
66

67. Self Check in
67

68. Peek Vision
68

69. Peak Vision
69

70. Cardiac Assessment
Platform
70

71. Cardiac Assessment
Platform
71

72. This smartphone-based home care CR programme improved
post-MI CR uptake, adherence and completion. The home-based
CR programme was as effective in improving
physiological and psychological health outcomes as traditional
CR. CAP-CR is a viable option towards optimising use of CR
services.
72

73. 73

74. Primary Outcomes
Par$cipa$on**in*Cardiac*Rehabilita$on*
74
100"
90"
80"
70"
60"
50"
40"
30"
20"
10"
0"
Uptake" Adherence" Comple<on"
CAP"Interven<on"
Centre@based"CR"

75. iMims
75

76. UpToDate
76

77. 77

78. 78

79. mHealth Barriers
79

80. More pilots than an
airline
80

81. 81

82. Clinical Trials
• Can it work
• Controlled
environment
• Accurate data
• Low attrition rates
• Costly - hard to
justify to grant
agencies
• Research Focussed
82

83. Community Trial
• Will it work
• Cost effective
• Risk of failure
• Self report data
• fewer opportunities
to ask questions
• High impact
• Uptake challenges
• High attrition
83

84. [Health Data is] the
most valuable
information in the
digital age, bar none. Deborah
Peel, Patient Privacy Rights
84

85. Regulation
85

86. http://www.slideshare.net/RockHealth/fda-101-a-guide-to-the-fda-for-digital-health-
entrepreneurs

87. Return on Investment
87

88. Roadmap for mHealth
“Smart mobile devices and applications, working in concert
with cloud computing, social networking and big data analytics,
will be at the core of global health care transformation. These
transformative technologies will continue to lead with ways to
help rein in cost, broaden access, change behaviors and improve
outcomes.”
Pat Hyek
The use of mobile and wireless technologies to
support the achievement of health objectives
(mHealth) has the potential to transform the face of
health service delivery across the globe. (WHO
2011)
88

89. • What’s the aim of your app?
• Condi'on
• Specifica'ons
• Partners
• Users
•Who
would
invest
in
its
development?
(Government,
health
insurance,
corporate?)
•Who
will
benefit
from
it
(financially
and
health
outcomes)
•How
will
you
show
its
value?
• Trial?
• Timeframe?
• Key
Performance
Indicators?
• Costs?
! •Key
Challenges
you
will
face
89