Smartphone Applications for Healthcare Professionals: A Systematic Review in Three Platforms

Raja D, Elmutaz Belah Mohammed, Mohamed Elfatih Ali, Manju Rosy Jose, Bijin Kurian, Solomon Reji, Aseem Veeves Singh and Anand Vijaya Kumar^*
*Correspondence: Anand Vijaya Kumar, Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamil Nadu, India, Tel: 9443181573, Email:

Keywords

Smartphone apps • Healthcare apps • Android • Windows • Ios • Drug and poison information centre • Classification of health care apps

Introduction

In the last few years there has been increased utilization of smartphone technology by general public as well as healthcare professional. Now smartphones have totally replaced the functionality of a pager, cell phone and a PDA (Personal Digital Assistance) [1]. In the early years of telephoning and computing, Nikola Tesla and Theodore Paraskevakoc in the year 1909 and 1971 came forward with a device that has the combination of both telephony and computing. The computer dealer’s exhibition (COMDEX) in 1992 showcased IBM’s prototype device named “ANGLER”, first mobile phone with PDA features that allowed the user to make and receive telephone calls, facsimiles and emails. The prototype had many PDA features including a calendar, address book and notepad along with many interesting features such as maps, stocks news, etc. Bellsouth executives introduced “Simon personal communicator” in the market for public use in August 1994. Although the term “smartphone” was not coined until 1995, Simon’s features and capabilities enables to refer it as a first smartphone [2]. Ericsson R380 by Ericsson mobile communication of the early 2000s was the first mobile device termed as “Smartphone” [3].

Smartphones and platforms

Smartphones are essentially cell phone with advanced technology and computing capability. US federal communications commission defines smartphones as mobile devices with cell phone capability having an HTML, browser that allows easy access to open internet; an operating system that provides a standardized interface and platform for application developers; a larger screen size than a traditional handset and touch screens/and or a QWERTY keypad.

Smartphones function on an operating system (OS) that is specially designed to support running third party applications. Six major smartphone OS platforms are Symbian OS, Palm OS, Windows, Blackberry, IOS and Android. In the span of few years, by providing detailed and accurate information the smartphones have explored to their limits [4].

Applications

One of the key features for increasing usage of smartphones is the ability to use applications, commonly termed as Apps. Apps pre-installed or downloadable are applications software that runs on smartphones or tablet devices, developed by third party who can be an individual developer or an organization [1,4].

Owing to half of the healthcare practitioners having smart phones use apps in their day to day practice, there are wide range of healthcare apps providing extensive information to support clinical decision-making and better patient care. Today, healthcare apps have better usage comparing any other source of information and benefitted healthcare professionals due to quicker access to information [1,4].

Drug and poison information centre

Drug and Poison Information Centres (DIC) are the places where registered pharmacists provide any drug related information to healthcare professionals and public for better patient care. The services include collecting, reviewing, evaluating, indexing and distributing information on drugs to health care workers; by accessing to clinical experiences, libraries, research facilities and educational materials.

The main function of Drug and Poison Information Centre is to provide written and/or verbal information or advice related to drugs or therapy to health care providers, organizations, committees, patients and to public in response to their query to help better patient care by all means. WHO supports independent drug and poison information centres as a core component of national programs to promote better healthcare to all [5,6].

The present study aims to find out the available healthcare apps in three platforms (Android, Windows, iOS) and classify them. In addition, we examine the availability of an app for drug and poison information centre to provide drug and poison information services.

Methodology

We performed a broad search for healthcare apps in three main platforms (Android, Windows, iOS), during 29/June/2016 to 31/ December/2016.

Inclusion and exclusion criteria

Two steps selection process was adapted. First step involves the listing of all available apps from the three platforms followed by narrowing down the number of apps.

The apps available under category medical (iOS), health + fitness (Windows), medical (Android), were selected. From this list the apps of the following nature: Workouts, BP measurement, Calorie monitoring, fitness, yoga, ECG view, heart beat rate monitoring, heart sounds, surgical procedure, radiology assistant, vision test, cosmetics, pregnancy guide, dose calculator, IV infusion rate calculator, dental care, human anatomy atlas, hearing check, sleep analysis or aid, blood glucose monitoring, smoking cessation, stress measurement or management, clinical communication, pulse oximeter, body height and weight measurement (fat percentage, BMI, lean body mass), medical dictionary, diagnosis dictionary, medical lectures, blood group detector, acupressure tips, consult doctor, medical abbreviation, lab values, baby care, antimicrobial manual, language therapy, medical handbooks, menstrual calendar, journal club, nutrition checker, medical news, reproductive health, traditional/alternative medicine, apps for medical representatives, drug quiz, were excluded.

Apps were included if they contained information or tools concerned with drug safety, drug information, contraindication, mechanism of action, pharmacokinetic, disease information and management, drug interactions, apps for drug and poison information centre, therapeutic information and medication reminder. Among them apps in IOS with content rating less than 10+ and Android apps of total downloads less than 500 were excluded.

The available healthcare apps were categorized based on their fundamental function into six categories. The description, download size, rating, and cost of individual apps were collected from individual app description or associated webpage [7-9].

Results and Discussion

The flow diagram of the review process is shown in Figure 1. One hundred and twenty-four (44.77%) apps were available in Google Play store, whilst twenty-seven (9.74%) apps were available in Microsoft store (Windows Phone Apps), and one hundred and twenty-six (45.49%) apps were available in iOS (Apple Store). Healthcare apps available both in offline and online in various platforms are represented in Figure 2. The comprehensive review of these healthcare apps is given in Table 1.

Categorization of health care application

Presently there is wide range of healthcare applications for different platforms of smartphones available to aid health care providers and patients, by providing accurate evidence-based medicine information, easy access, and clinical decision-making support at their palm to achieve better health care. To enable better understanding of the apps we categorized them in to Drug information, Disease information and management, Drug interactions, Prescription manager, Multifunctional apps, and apps for Drug and poison information centre. Figure 3 show the detail of the classifications.

Drug information apps: These includes eighty-two (29.6%) apps providing information by drug names search on dosing, contraindication or warnings, adverse effects, mechanism of action, pharmacokinetics, indication, lab test interferences, adverse drug reactions, precautions, patient care consideration, storage of drugs, clinical information and patient education. The advantage of these apps includes comprehensive and up-to-date drug information. Many apps have search features that allow the user to search for any drug by generic or brand name. Some of these apps provide medical substitutes.

Disease information and management Apps: One hundred and twenty-three (44.4%) apps providing in-depth and consultative information about diseases, signs and symptoms, risk factors, causes, complications, abnormalities in lab values, management according to recent guidelines, or evidence based medicine (EMB) were categorized as disease information and management apps.

These apps help the healthcare professionals to find reliable information for evidence-based medicine to maintain safe and effective drug therapy for patients. It allows clinicians to minimize errors in the vulnerable patient population, and to provide preventive care to the patient which further helps to avoid complications.

Drug interactions apps: One of the most frequently useful situations of apps for healthcare professionals is detecting drug interactions. Six (2.16%) apps were identified to be directly useful in providing drug interactions among drugs, herbal supplements, food and even drug lab test values interferences. They also provide the mechanism, severity, onset, clinical management and monitoring parameters.

This kind of apps allows clinicians to check a patient’s entire medication list for potentially harmful interactions and view severity ratings ranging from minor to major can eventually prevent or reduce greater number of clinically significant drug interactions.

Prescription manager: Forty-six (16.6%) apps provide prescription cost service, help consumer to locate store for medicine at lowest price, identify pill by colour, shape, and imprint.

These apps help patients mainly by medication management and believed to increase medication adherence and produce better outcomes.

Multifunctional apps: We classified the apps that has two or more overlapping functions as specified in methodology into this category. Seventeen (6.13%) of such apps provide a combinational health care services like drug information, disease information and management, drug interactions and prescription manager. The advantage these apps have, are the centralization of many important services in a single app, to enable mainly healthcare professionals and public for information gathering to aid in clinical decision-making and practice of evidence based medicine at the point of care (Tables 2-4).

Apps for Drug and Poison Information Centre: After a careful search, we couldn’t find any apps for drug and poison information centre providing drug and poison information service meeting our inclusion and exclusion criteria.

Need of the Drug and Poison Information Services: [10-13] Promotion and provision of independent unbiased drug information and poison management options to improve patient care.

Fundamental activity of growth of clinical pharmacy education and practice

• Provide accurate and appropriate drug information for the patient specific queries.

• Drug information services provide healthcare practitioner with timely, evidence-based drug information to promote safe and rationale use of medications.

• Drug information services assist in variety of other situations like: development of therapeutic guideline, antibiotic guidelines and formulary preparation.

• By providing drug information it is reported to prevent adverse drug events.

• In a world where over a million formulations are available in the market, practitioners have limited access to reference books or computer based databases resources easy access to reliable and independent information is fundamental for the rationale and effective use of drugs.

Advantages of smartphone app

Overall there are a wide number of health care applications for smartphones in different platforms that demonstrate comprehensive medical information leading to achieve appropriate clinical decisions and deliver healthcare services with better accuracy and confidence. Also, certain apps make patients comfortable with their treatment by improving their overall experience and health and become engaged participants in the process

Mobile devices and apps provide many benefits for healthcare professionals perhaps most significantly increased access to point of care that has been shown to support better clinical decision-making and improved patient outcomes [1]. The use of mobile devices by health care professionals has transformed many aspects of clinical practice [1]. Mobile devices have become common place in health care settings, leading to rapid growth in the development of healthcare apps for many OS platforms [1,4]. Numerous apps are now available to assist healthcare professionals with many important tasks such as, information and time management, health record maintenance and access, communications and consulting, reference and information gathering, patient management and monitoring, clinical decisionmaking, medical education and training [1]. Also, healthcare apps are routinely useful in two situations:

Updating knowledge: The smartphone healthcare apps are helpful for healthcare professionals to maintain up-to-date knowledge about the growing medical industry and provide information about the new drugs.

Emergency time: The smartphone healthcare apps provide flexible information anywhere at any time to healthcare professionals and patients [14].

Advantages of mobile apps

Benefit by reducing time: [1,15] The smartphone healthcare apps are helpful for healthcare professionals in reducing time spent in accessing information and it also fosters better communication that can result in success and potentially increased patient outcome. The research found that 86 percent of healthcare professionals believe that healthcare apps will increase their knowledge of patients’ conditions. 96 percent of users think that healthcare apps help to improve patients’ quality of life, and 72 percent of healthcare professionals believe that healthcare apps will encourage patients to take more responsibility for their health.

Benefits in providing quality care: [16] Health care information access, affordability, and quality are problems all around the world. Mobile technology offers ways to help with these challenges. Through mobile health care applications, sensors, medical devices, and remote patient monitoring products, there are avenues through which health care delivery can be improved. These technologies can help lower costs by facilitating the delivery of care, and connecting people to their health care providers. Applications allow both providers and patients to have access to reference materials, lab tests, and medical records using mobile devices.

Benefits to healthcare professionals: [9,14,17,18] Ideally, healthcare professionals require access to many types of resources in a clinical setting, which can also be easier by using smartphone healthcare apps.

Communication capabilities like voice calling, video conferencing, text, and email.

Hospital information systems (like electronic health records (EHRs), electronic medical records (EMRs), clinical decision support systems (CDSSs), picture archiving and communication systems (PACSs), and laboratory information systems (LISs).

Informational resource like textbooks, guidelines, medical literature, drug references.

Clinical applications software like disease diagnosis aids, medical calculators.

Benefits to patients: [4,9,19,20] “Mobile apps for smartphones are changing the way doctors and their patients approach medicine and health issues” said by Vincent De Robertis, Senior Vice President of Global Health Care at Research Now, patients with heart disease can send information about their heart rate straight to their doctors, accessories allow diabetics to monitor their blood glucose levels by sending the results straight to their smartphone, and nutritionists can see trends in patients caloric intake and exercise patterns. Apps are improving healthcare professional’s knowledge of their patients, while patients feel a lift in their quality of life.

Safety and quality

Medical apps are the most dynamic field in medicine system and are widely used as a quick reference by a majority of healthcare providers and patients. Their faster accessibility makes them a vital tool in gathering and analyzing an information resulting in better clinical practice, system consistency, and convenient communications [21]. Though, studies stated that more than 85% of healthcare professionals own a smartphone and among them nearly 50% utilize the medical apps in the point of patient care [1,22,23], unfortunately, there has been minimal illustration of the safety of medical apps [22]. Some numerous strategies are to be established to develop evidence-based medical apps while withholding their open nature [22]. As medical apps allow the user to feed the patient information along with medical tests results to automatically provide the management plans., therefore, providing the appropriate utilization of the information technology is exigency.

Fortunately, the previous studies have not been reported any danger to patients by medical apps [22]. Accordingly, the FDA took step-up and published a general guideline to regulate the quality and safety of a certain medical apps. The FDA described the apps to be under the concern such as, apps that regulate and control the medical devices and also apps that deliver the patient specific medical data device such as electrocardiographic. Moreover, apps that involve in generating diagnosis and treatment recommendation, additionally apps that provide medical measurements through using attachments or sensors [24]. Predominately, medical professional’s involvement is mandatory in developing accurate evidence-based and reliable medical apps.

Currently better standards and validation practices regarding mobile apps need to be established to ensure the authenticity of information/function delivered by healthcare apps. By doing so a barrier can be created to the entry of mobile apps into the market, increasing the quality and safety of the apps use for the healthcare professionals.

Transformation

Kathleen Sebelius, Secretary of US health and human services in her keynote address at the 2011 annual Health summit in the Washington stated about health as the biggest technology breakthrough of this time, used to address the nation’s greatest challenge [25]. There are numerous reasons for the high degree of exuberance for the concept of medical apps which include the high capital being spent on health care every year, rapid and substantial increase in the mobile phones and the need for delivering an evidence-based medicine and individualized patient care. Medical apps benefit the health care providers and the consumers in numerous ways such as disease diagnosis and management, drug information, patient education [25]. These provide enough evidence that mobile apps can transform the current medical system and be a remarkable service. Medical apps usage has its ability in analyzing, tracking of medical information and eliminating some numerous unwanted medical emergencies. A wide range of medical apps are developed for treating acute as well as chronic diseases. Hypertension, Diabetes mellitus and other chronic conditions which accounts for about 90% of health care spending can be appropriately treated and well monitored through medical apps which in turn reduce the rush at the emergency departments of hospitals [25,26]. Medical apps have transformed the system to a self-care and self-management platform to a patient, while the physician can deliver a needful service to the patients who need critical care [26]. Additionally, clinicians can have reduced time demands and focus on another field of medicines which need more efforts and researches. Medical apps hence continue to revolutionize the current healthcare system.

Future trends

The rapid advancement in medical apps and their increased usage turns medical apps into an integral part of the daily health care practice in coming up future. It’s growing accessibility and updated medical information delivery has dragged it to play a substantial role in clinical care system already. Moreover, its widespread usage give way to its bright future a head [4,14,27]. Recent studies showed that junior doctors (two years of their practice) have caused prescription errors that varied from almost 7-10%. Nevertheless, significant error rates occur also among expert doctors. Adoption of medical apps by healthcare professionals have shown to significantly reduce medication errors [28]. Medical apps avoiding errors or providing potential solution for practicing errors have marked its place in future healthcare technology [8]. Accurate, updated, safe, cost-effective and scientifically sound medical apps facilitate its acceptance among the health care professionals [22]. However, it is an inevitable fact that medical apps hold potential dangers. Healthcare authorities, regulatory bodies and other accrediting bodies should take enough responsibilities in assessing the quality of medical apps. Looking forward, it is expected that since medical apps successfully established in the medical world, there should be more efforts and research on selection, implementation and usage of quality medical apps [22]. Hence the effective and timely use of medical apps not only has a huge role in self-care of patients but also it hones skills of a physician.

Expansion challenges

Though medical apps are trending in the current healthcare system, its open nature withholds a few challenges for its growth. While medical apps continue to improve the healthcare system through its convenient usage, better clinical decision-making, high accuracy and productivity, there are several disputes arising ranging from immense support to strong objection [9,27]. Challenges include the questionable reliability in clinical decisions made through medical apps and questions are often raised regarding the reliability and appropriateness of a generated care plans. Another concern of debate about medical apps usage is the confidentiality of patient data with respect to privacy. The ethical issue arising out of the protection of patient data is worth considering [14,28]. In addition, medical apps are observed to create a care gap between patient and physicians as they do not keep often a direct doctor-patient relationship. Therefore, lack of a doctor-patient rapport is suspected to reduce the quality of patient care. Nevertheless, the rapid development and increased use of medical apps in the present medical system has disadvantaged the older health care professionals who are not so familiar to adopting mobile devices [29]. Moreover, significant objection has aroused against medical apps because of their continuous use in personal and professional lives of physicians. Many medical, legal, and ethical issues have been raised and put as a challenge to the acceptance of medical apps in healthcare setup [9,27]. Overall, a transparent and standard conduct is necessary for bringing up high quality medical apps that encourage a comprehensive healthcare system.

Conclusion

Medical apps are already valuable and inevitable tools for healthcare professional in this century of advanced technology. Numerous apps are available to assist healthcare professional in many tasks. Moreover, these applications help to bridge the gap between the healthcare providers and patients. However rigorous and critical evaluation, validation is required to improve the quality and safety of these tools. Medical apps that provide accurate, timely meaningful guidance information are likely to transform the healthcare from episodic and reactive to continuous and proactive. Comprehensive review that includes description, logo, platform, download size, rating and cost of 277 included apps from a total of 9178 identified healthcare apps was prepared. Further this systematic and comprehensive review process in main three platforms shows there is no app for drug and poison information centre to provide drug and poison information service.

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