Managing immune diseases in the smartphone era: how have apps impacted disease management and their future?

Abstract

Immunology, similar to other areas of clinical science, is a data-rich discipline that involves a great deal of interaction between healthcare professionals and their patients. The focus of this editorial is to review the challenges and opportunities for mobile healthcare applications within immunology. It is clear that further research is required to fully maximize the potential of mobile apps (e.g., regulations and guidelines, electronic health). However, it is equally clear that mobile healthcare applications have had a positive impact on patient outcomes (better response rates, more efficient usage of time and more accurate diagnosis). Overall, healthcare applications have a fundamental role to play in the future management of diseases as they will help to ensure that we deliver more effective patient care.

Keywords:

• healthcare apps
• management of data
• mHealth
• patient care

The development of mobile devices such as smartphones and tablet devices has mirrored the increasing mobility of the present day healthcare system. Healthcare now involves multiple clinical locations from the hospital to the community to the patient’s home itself. The domain of the immunologist has also spread far beyond the laboratory and, in addition to the fields of immunodeficiency and allergy, the immunologist is intricately involved in the management of patients with complex inflammatory diseases and acquired immunodeficiencies such as transplantation. The increase in the use of biological therapies such as monoclonal antibodies and immunoglobulins mean that interactions with specialties such as hematology, oncology, respiratory medicine, rheumatology, neurology, nephrology and dermatology are now a routine part of the clinical immunologist’s workload.

Therefore, the immunologist needs to be able to communicate and collaborate with different specialties and patients who may often be in different hospitals or indeed different parts of the world. There is also a need to be able to access information ‘on the go.’ The wide adoption of smartphones and tablet devices by the general public and clinicians emphasizes the opportunity for these technologies to bridge the gap in these areas.

With the rapid expansion of this field, many devices and apps available are now linked to the term ‘mHealth’. mHealth (mobile Health) is a very broad term and covers medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices and other wireless devices. It also includes apps such as lifestyle and wellbeing that may connect to medical devices or sensors (e.g., bracelets or watches) as well as personal guidance systems, health information and medication reminders provided by text messaging and telemedicine. Linked to this is the concept of eLearning, which is learning conducted via electronic media, typically on the Internet but increasingly via mobile devices and apps.

Mobile apps or mHealth allow for advanced mobile clinical communications between clinicians themselves and between clinicians and patients using multimedia functions. This, in effect, has generated a paradigm shift and enables all key stakeholders to engage with one another in a more dynamic and efficient manner. Web-based interactions between primary care clinicians and specialists have been shown to achieve clinical outcomes for patients with hepatitis C treated by primary care physicians identical to those of specialists at a university medical centre [1]. In one of the author’s institutions, weekly videoconferences held between the specialist heart failure team and primary care physicians have been established to aid in the management of complex patients. Access to this service is through an app on a smartphone or tablet device and physicians receive and send medical images in real-time with a plug and play technical approach. Because of its ease of use and overall benefit, there has been a rapid adoption of this model of virtual shared care using web-based conferences by all clinicians involved. This highlights the level of appetite and drive to adopt mobile apps within a clinical setting.

The use of apps for access to clinical resources has been shown to lead to rapid responses, improved decision-making and reduced numbers of medical errors [2]. This is achieved through their ability to provide access to up-to-date clinical knowledge resources at the point of care, such as evidence-based clinical resources, medical formula calculators, drug reference information and drug interaction checking. In addition, apps can provide secure remote access to real-time patient monitoring system and electronic health record systems for better patient care, particularly for immunologists who may be covering a number of clinical sites. In parallel, eLearning as a mechanism to support both staff and patients to better understand and manage their conditions has been shown to be of benefit.

Patient-oriented care, where patients are directly involved in the process of care, is now recognized as a key component of chronic illness care. Traditionally, this has involved self-care activities but has now expanded to include interaction with clinical teams remotely for monitoring of parameters, such as blood pressure, medication titration and peer-to-peer support. Delivering this care has been challenging. Mobile apps can play a key role in supporting self-care, providing information on diseases, improving disease and drug monitoring, allowing remote monitoring and patient collaboration through online patient groups and forums. This is of particular use to those with rare immunological conditions who may be geographically separated. These apps have been widely embraced by the patients as it helps to improve overall engagement with the healthcare services [3].

If mobile apps are to become a key aid in the day-to-day management of patients then clinicians will need to be assured that the information contained in healthcare applications is accurate [4]. In general, app users must agree with the terms and conditions to use the applications, and the users are mainly liable for utilizing the information in the applications. As a result, incorrect or outdated information from healthcare applications may lead to medico-legal consequences and users instead of software companies are responsible for them. This problem may affect many healthcare apps, including disease diagnosis, drug reference and medical calculator apps. Peer-reviewed apps have been shown to be more reliable than non-peer-reviewed applications [5] but these are still only a minority of apps. For example, of 94 microbiology-themed apps identified, only 34% had stated medical professional involvement [6]. The accuracy of apps also poses a concern [4,6,7]. A study of apps for opioid dose conversions showed only 48% of apps provided direct references to primary sources for their opioid conversion ratios with wide ranges in the conversion doses between apps also. Although many smartphone-based medical applications are available through online application stores (e.g., Apple’s App Store and Google Play), most of them have not undergone clinical trial or regulatory evaluation as is required of medical devices. The US FDA has published a list of the groups of apps it intends to regulate [8]. Medical bodies should lead the way in developing peer review and accreditation processes for medical apps relevant to their areas to ensure they are clinically accurate. In the interim, we suggest that clinicians should utilize clinical apps based on a checklist of:

• Were clinicians involved in their development?

• Have they been peer reviewed?

• Is there evidence of their effectiveness from clinical studies?

• Is the app developed by a widely recognized and trusted source?

Healthcare organizations themselves also need to consider the risk of fragmenting clinical practice within the organization as a result of too many apps being developed or used, as well as mechanisms for app integration into the hospital’s wider electronic health records. Moving forward, platform agnostic apps will be crucial. Platform agnostic apps run on any combination of operating systems (e.g., iOS or android) without adaptation and may also be referred to as ‘cross-platform’. This will lead to better data integration and help clinicians gain a more holistic picture of the patient’s health. It will also build on the growing services offered by cloud-based information and communication technologies providers. Organizations will also need to consider registering all devices interacting with their systems, providing individual user logins, the use of encryption for stored patient data, remote wiping to destroy all data on a device in case of loss or theft, and securely encrypted wireless data transmission to ensure data security. These are all solutions that can be implemented immediately and should not hamper the deployment of these initiatives.

Digital technologies are developing rapidly and it is likely that current devices will be superseded, as suggested by the advent of wearable devices such as Google Glass and smartwatches. This needs to be considered by healthcare professionals and organizations when developing or integrating apps into their systems. Similarly, social media (SoMe) use, such as Facebook and Twitter, is increasing rapidly in healthcare delivery. Evidence-based SoMe use may improve patient engagement and communication, leading to better outcomes. A study demonstrated that patients wanted providers to use SoMe for appointment setting and reminders, reporting diagnostic test results, prescription notifications, providing health information and as a forum for asking general questions [9].

The potential for apps to aid clinical immunologists in their clinical work, education and research is apparent. For patients, they provide a new way to participate in their healthcare. Studies on the cost–effectiveness and clinical effectiveness of apps over usual care are lacking and, as for all medical interventions, these are crucial for both clinicians and policy makers. The widespread adoption of this technology by both patients and clinicians mandates that studies are undertaken urgently to assess the clinical impact of apps. However, it is also important that innovation is not stifled, as this technology evolves rapidly and opportunities to fundamentally impact healthcare delivery may be lost. We call on immunologists to continue to develop apps and models of care relevant to this new technology and to undertake and publish clinical impact studies. Only by considering these issues can we be sure that the real potential of apps to impact disease management in a meaningful way is being achieved. Mobile apps have the potential to revolutionize how immunologists deliver healthcare in the future. This is an exciting period for immunology as there is scope to generate innovative research within this domain. Further research is urgently needed within this domain to help ensure that that we appropriately maximize the full benefits of mobile healthcare apps for more efficient and improved patient outcomes.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.