When an app becomes a care plan and a pathway co-ordinator; Asthma AWA

This is a guest blog post from Howard Last. He contacted me after my spate of reviews about healthcare apps. He's provided more information about the asthma web app AWA.  If you'd also like to guest blog then please contact me.

Putting the ‘technology horse’ before the cart was our aim in developing the asthma ‘web app’ (AWA). It is, regrettably, so often the other way round. I work as a GP in an inner city area and was acutely aware of the needs of patients with asthma and the shortcomings in provision of asthma care. I also have an interest in I.T. so it wasn’t long before I wondered how we could use I.T. to address these clinical needs. Making use of Web 2.0 we developed an ‘app’ which tackles the major issues contributing to poor asthma control: inhaler technique, patient education and provision of a care plan.

The provision of a care plan in particular is one area which needs improvement. The AWA control plan is the key component in the application. Patients without a care plan are four times more likely to need an acute admission with poorly controlled asthma. Yet, only one third of asthmatics have a plan. The AWA makes it much easier for a GP or asthma nurse to provide a personalised plan for a patient during a consultation. Subsequently, patients have access to a web-based version of their care plan either through PC or mobile devices. But it goes one step further. The AWA care plan, unlike a paper-based version, adapts dependent on the patients asthma control, prompting an increase in treatment with poor control or allowing a ‘step-down’ with good control. In other words it promotes self-care.

The AWA also provides an alternative healthcare pathway to the traditional model where patient care takes place in GP surgeries or hospitals. The AWA allows the healthcare professional and patients to interact remotely. This is particularly valuable for the ‘difficult to engage’ patient. In asthma care this translates into teenagers. This is a group who are always resistant to invitations to asthma clinics but for who the use of a mobile phone or tablet is second nature.

I think the success of an ‘app’ depends on two simple principles based on need and data handling. First, there has to be a clear clinical need for an ‘app’. Secondly, collecting data is not in itself sufficient.  Doing something useful with the data for the benefit of patients is the crucial step. I believe the AWA passes these tests. Whether it is innovative, I will leave you to decide.

Howard is happy to be contacted if anyone would like more information about the AWA.

Review of iPhone apps for patients in England

I chose to find and check out apps that patients in England can use – though I did find some excellent ones for patients in other countries  We have some catching up to do…. This is not a comprehensive list and I looked at those that interested me. I've avoided ones that are specifically disease related as I will review those separately. I've also not repeated the apps in my review of iPhone apps for the NHS.

All apps are free, unless specified, and I have no links or specific benefits from any organisation listed in this post.

RCP Stroke Guidelines 2012 – Patient and Carer

Another great title. This is patient specific advice from the Royal College of Physicians and I LOVE the fact it is based on the Guidelines published in 2012. This is a proper app, with a proper evidence base, doing something proper. It would be great to see apps like these for all clinical guidelines. It’s well designed and easy to navigate. And includes links to stroke clubs and other services. Why this works is it is not just a sales pitch for one service or organisation – it is designed around the patient. The first truly patient centred app that I've come across.

Patient.co.uk

This is an information based app with all their leaflets on health, conditions and diseases.  You can also find services close to you. Useful, though I’m not certain about the advertising. Others have reviewed the app as having some technical difficulties and the disadvantage of not being able to store a leaflet for viewing offline.

Communicating with foreign language speaking patients (in English, German, French, Japanese): A guide for doctors and nurses

Wonderful title that explains all. Although this is targeted at doctors and nurses, the app is also useful for patients. Of course there is Google Translate which is probably the best app for language translation as it includes all known languages – though this app does cover some of the more complex medical terminology.

GP Ratings £0.69

A simple app locating GP surgeries and giving you their ratings by using the open data available. It’s a useful way to make data useful, though as the data is made available free of charge some may prefer not to pay. What I liked is the way I could see the details of ratings for my own practice. But would I want to pay 69p to see this once, as I would be unlikely to use it again, as I have little option for changing to another GP.

Five iPhone apps the NHS can learn from

Many healthcare organisations are getting on the “app-wagon” by repackaging some of their regular website material.  In most cases, the “innovative” bit is the use of the iPhone’s GPS function for maps. Is this innovation? Not for me.

I’m on the lookout for apps which redesign interaction with health services, that support patients in caring for themselves and their families – and basically, ones which have an underlying brilliant idea that can only be implemented on a smartphone. 

In the end I didn't find any apps that lit me up – though I did find some that gave me ideas for apps that could be developed.

Wounds by BSN Medical Ltd, May 2012, UK only, FREE

You use your iphone camera to take a snapshot of the wound, then use the symbols to categorise it by wound need, depth and exudate level (for the non-clinical this means how bad, deep and weepy it is).  Then the appropriate dressing is suggested – and of course, this is their own brand of dressings. I’m not into promoting one type of dressing but this app is IDEAL for the NHS. Why hasn’t anyone produced this for the reduction of pressure ulcers – linking to the NHS Supplies dressings?  What I like about this is no improvement project is required – implementing an app will redesign the process of assessing and treating wounds/ulcers in the most fundamental way.

iScrub Lite, Free, May 2010

The premise is good hygiene and this app records observations and lets you email those observations. Whilst I am sure this is for audit folk, I can imagine that in the hands of patients (maybe lend them an iPhone while they are in hospital) it would have a big impact.  This would be fabulous if it was populated with the addresses for the contacts in each healthcare organisation in the NHS.

MedCrowd, Oct 2010, Free

This is an app designed to crowdsource medical opinions. I suspect it’s not really taken off but the concept is excellent.

Patient Journal, Free, June 2010

I like this because it is a place I can keep all the notes about being in hospital. The only problem is it really needs to be managed by the carer as the patient may be too ill to use it.  I think this would be good for longer temr patients or just for patients in general to keep track of their interactions with healthcare.  It works because it provides a structure only and doesn’t try to give me advice.

Mixed Messages, Free, June 2012

This is a training app aournd doctor-patient communication. I like the concept and it makes sense for much of the training programs that go on in the NHS to be put into a format like this. It’s simple, focused and not overworked.  No more books, manuals, workshops or PowerPoints!

Review of NHS iPhone apps

A number of NHS “innovators” are up there with their iPhone apps. I say “innovators” loosely as most of the apps are no more than websites in an app – useful but hardly innovative.  What’s more interesting is the lack of apps, even the most basic ones, from one of the world’s largest systems.

The NHS brand is one of the most well known in the UK, and using it and looking after it is important. There is now even a Brand Manager (c.£90k post) on the National Commissioning Board. From my days as the advertising manager in Esso, I know how important it is to make sure logos and accreditations are used properly.  My review of apps discovered many people using the NHS brand when they are not the NHS, and others in the NHS are not using their brand at all.

I chose the apps that appeared under a search for “NHS” on iTunes AND where there was NHS in the logo or title of the app.,The apps listed are all free.  

  

NHS Direct’ health & symptom checker

One of my favourite NHS apps and one I have used. It feels like the whole of NHS Direct is in my pocket. The feature of finding, for example, a pharmacy nearest to where I am standing is very useful. Comprehensive, easy to use and a flag bearer for app quality.

NHS Drinks Tracker

Not entirely clear but I think this is from NHS Choices (they could use their branding on the app logo perhaps?). Interesting to play with but it looks like it lacks flexibility to suit a wide range of users – as verified in the comments for the app.  Maybe an update is required? There’s also a Dept of Health Change for Life Drinks Tracker (do we need duplication?).

NHS Quit Smoking

Branded in the app as NHS Choices. I like the way it counts the amount of money saved according to the number of days you go without smoking.

NHS BMI healthy weight calculator and tracker

Another NHS Choices app. Clear and easy to use. Like the other apps in the series, it looks from the comments, like it could do with an upgrade.  There is stuff competition in app-world for BMI calculators and food intake / exercise trackers, so there needs to be a good reason for someone to use this one.

NHS Give Blood

From the NHS Blood and Transplant service, though confusingly the app logo doesn’t use the NHS branding. It’s a map function of where to give blood locally. I can see this being very useful in a crisis.

NHS 24 MSK help

Hmmmm, pink logo and very strange branding. Developer is NHS 24. Looks like an exercise app. Didn’t inspire me to download it and try it.

UK Clinical Trials Gateway (NHS Institute for Health Research)

Nice – I like it when the name of the app says what it is about and who it is from. As they say in their blurb, it’s for everyone, patients included, and covers the portfolio of clinical trials registered in the UK. I expect I can also get this off a website somewhere, so the innovation here is packaging it all up – a but like NHS Direct.  There is evidence of the app being updated which also enhances its credibility with me.

NHS Moodometer

This one took some detective work to understand. It’s an app to measure your moods. Useful if you’re in the process of understanding your own moods. It has the NHS logo on it. It comes from 2together NHS Foundation Trust – which I found out is in Gloucestershire – not obvious at all who they are and what they do from their name!  If they are using this app with staff then we need to know about this innovative use of it…

NHS Bristol and NHS Yorks & Humber

This is a well-designed organisational app that looks like it can be a standard one for many NHS areas. It’s more than a replication of their website and it is wonderfully designed for us.  It covers ICE (in case of emergency), your personal reminders and notes, where to find which service and cleverly uses the clour coding of the campaign to reduce A&E attendances (the thermometer). This app has a purpose which goes beyond advertising services.   Will need an update after all the structural changes.

My visit to Guys’s and St Thomas’ NHS Foundation Trust

Excellent. Designed for the patient, this app covers appointments, hospital information and maps.  I like the fact the name of the app says what it is for, and the integration with GPS on the phone is useful.

NHS Tameside and Glossop

Not certain about the logo use but the app is one that has broken away from the regular brochure / map / information approach.  Instead it is disease based giving information about conditions and pathways. I am not sure who is the intended audience? The name of the app left me thinking this was about the organisation but the contents are something different.

Welcome to St George’s Hospital

Another one with an app name that is useful. This is another information type app. I found some of the colouring a bit difficult to read and the design is rather poor. There’s a nice facility for providing feedback to the Trust – though I haven’t tested this.

NHS ActiveME

An app from the Royal Hospital for Rheumatic Diseases NHS Foundation Trust allowing the monitoring of daily activity levels.  Nice. Nice. Nice!  Beautiful design, easy to use and I love the graphic reports.

NHSCovWarks

Hmmmm apart from the rather short hand title, I’d not know this was an NHS app. The app logo is coloured stripes – which become obvious when you look at the app – it’s another one of the “ where do I go for what” apps”. 

Northumbria Healthcare’s GP Clinical Information Exchange

OK, so this is something different. Also has CiiX on the app logo. Says it gives real-time infomration about services, clinics and consultants  Not sure what it means by real-time, but what I like is it moves beyond being an directory to adding in some information about what to do if certain thing happen – and that’s good. I’m just not sure we need to add another acronym to the business.

NHSSC Health & Safety Awareness

Logo alert here, if only for adding SC to the NHS. It’s South Central (will need to update (or delete) app when the structural shifts happen). Seem to be aimed at staff though not entirely clear. I like the content but the title, logo and framing is poor.