Blog: Assessment of apps for use by NHS patients
Patients now have access to a large number of apps to manage or monitor their health. However, whilst some apps have been developed by clinicians who have ensured that the app is effective and safe; others have not been developed so rigorously. Hence, patients need a way of identifying those apps that are fit for purpose and don’t expose them to unnecessary risk.
The NHS has recently soft launched its new NHS Apps Library (in beta-test phase). This lists apps that have been developed by third parties and assessed as being suitable for use by the general public, to improve and manage their health. Current apps listed include: ‘myCOPD’ for managing chronic obstructive pulmonary disease and ‘MyChoicePad’ which helps people with learning disabilities to communicate better.
Some apps in the library will be labelled as either ‘being tested in the NHS’ or ‘NHS approved’ (which means that there is clinical evidence that supports the app’s clinical outcomes). Those being tested will have data collected, to determine the effectiveness of the apps in achieving their stated aim.
However, the NHS Apps Library is not the only place where patients can go to find apps that have been assessed by healthcare professionals. My therappy is a new web site that offers a database of apps aimed at stroke and brain injury recovery and rehabilitation. Each app has been tested by a network of expert NHS therapists and patients from around the UK, using a unique 50 point testing system. The tests cover everything from data protection and digital safety, to clinical value and evidence. My therappy is the only app review service to have mixture of digital experts, clinicians and patients involved in the testing.
The apps listed on the web site have a star rating and genuine user feedback. Each app is also given a profile of information to help the patient, family member or clinician decide if it suits the needs of the patient. This includes: cost; clinician rating; user rating; app description; feedback from users; and a named category that shows what the app can help with.
The web site was part funded by the South West Academic Health Science Network and by its founding organisation, Northern Devon Healthcare Trust. Since its launch in November 2016, it has been utilised by thousands of people worldwide and is now recommended by national charities such as The Stroke Association, Headway and the UKABIF.
iMedicalapps is run by clinicians in the US and provides reviews of medical apps for us by both patients and/or professionals. The review method is not publicised and no ‘score’ is provided, but the reviewers all have relevant clinical experience. Whilst the site lists some apps for patients, it is more geared towards advising other clinicians.
The OTs with apps web site provides a list of apps covering areas such as handwriting, for use by occupational therapists working with children and adults. The recommended apps have been assessed by clinicians, although no information about the assessment process is given.
The North West based company, ORCHA, provides a service assessing both the side effects (risks) and benefits of health apps, giving clinicians, patients and the public informed choice about the apps they may be empowered to use.
Whilst the NHS library reviews only clinically trialled apps, ORCHA looks at all health and care apps that are on the market – updated each week – to give an objective view via a simple scoring system of each app’s plus and minus points in terms of the value it provides (e.g. usefulness, easy to use, helpful features) and the risk of using the app (e.g. whether advice is verified, whether personal data is secure). ORCHA welcomes the NHS focus on apps, and share the vision that proper use of apps will be a significant and growing benefit to healthcare and patients. ORCHA also collaborates with NHS organisations and has worked with Lancashire Care NHS Foundation Trust to identify how apps could be used by various patients – these will be recommended by the local clinicians through a dedicated ORCHA Pro web site.
In the future, apps that can lead to a reduction in healthcare costs (e.g. reducing the number of hospital appointments) may be covered by a NICE Health App Briefing. This will set out the evidence for the app, but will not be accompanied by a recommendation (as this will be up to the patient’s clinician).
The NICE review will consist of 4 stages: (i) the app developer’s self-assessment against defined criteria; (ii) a community evaluation involving crowd-sourced feedback from professionals, the public and local commissioners; (iii) preparation of a benefit case; and (iv)an independent impact evaluation, considering both efficacy and cost-effectiveness. Five apps are currently being reviewed under this new process, and going forward, the focus will be on apps for mental health and chronic conditions.
Developers looking to create apps for the NHS market can benefit from the NHS mobile health space, which contains a large number of resources relating to testing, accessing NHS data, and NHS standards. The site also includes a list of Digital Assessment Questions (beta version) that cover clinical and technical standards, questions and best practice, which developers can use to inform the creation of new apps to the required standard.
It will be interesting to see how the above routes for evaluating healthcare apps develop over the next few years, and whether, in the future, there is an established standard to which all such apps must demonstrate compliance.
 http://www.digitalhealthdownload.com/2017/02/nice-introduce-hta-style-app-assessment-process-march-2017/ accessed 24/5/17