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Research: Commercially Available Health Apps Not Consistently Usable, Accessible for Low-Income and Elderly Patients

August 1, 2016
by Heather Landi
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While mobile health applications have the potential to help patients manage chronic conditions, commercially available health apps are not designed with the most vulnerable patients in mind, according to a recent Commonwealth Fund-supported research study.

For the study, published in the Journal of General Internal Medicine, David Bates, M.D., chief innovation officer and senior vice president, Brigham and Women’s Hospital, as well as researchers at the Center for Vulnerable Populations at San Francisco General Hospital, University of California, sought to examine mobile health apps’ acceptability and usability for low-income, racially/ethnically diverse populations who experience a disproportionate burden of chronic disease and its complications.

According to the study authors, as currently designed, “health apps can present challenges to the vulnerable populations who would likely benefit the most, including the poor and patients with low levels of health literacy.”

The study authors note the potential for mobile health apps to help patients monitor things such as changes to diet, exchange and medication as it relates to managing chronic conditions, such as diabetes and depression. “These tasks that can be made easier by mobile apps that provide patients with reminders and education about caring for their conditions. Apps also can help patients and providers track health data over time, helping to reveal how changes in behavior and medication influence outcomes.”

For the study, researchers observed patients using several commercially available apps for diabetes and depression. The researchers also studied the usability of apps for elderly patients’ caregivers, who are often geographically dispersed and need to share medical information.

The researches selected 11 popular mobile health apps to manage diabetes, depression, and caregiving and observed 26 patients using them. The study participants were racially/ethnically diverse with either diabetes, depression or were caregivers. Nearly 70 percent were deemed to have limited health literacy. For the study, each participant was given condition-specific data entry and data-retrieval tasks, such as entering blood glucose values into a diabetes app or recording medication instructions.

According to the study authors, the study results indicated that all the apps required significant manual data entry and progression through multiple screens and steps, making it difficult for patients and caregivers to complete basic, yet critical, tasks. “In all, participants were able to complete only half of the data entry tasks—such as entering a blood glucose level—without assistance. Many were hampered by unclear explanations of what needed to be entered,” the study authors wrote.

And, patients struggled with retrieving data, such as information about upcoming appointments that had been entered into caregiving apps. Participants completed only 79 out of 185 tasks (43 percent), across 11 apps, without assistance, according to the study findings.

And, study authors noted that none of the apps had simple interfaces with large buttons and easy-to-follow instructions and navigation. “In general, the apps lacked explanations of the relevance of various functions—for instance, why a diabetic patient might wish to look back at a prior meal,” the study authors stated.

According to the study, three themes emerged from participant comments: lack of confidence with technology, frustration with design features and navigation, and interest in having technology to support their self-management.

The study authors concluded that while patients express interest in using technologies for self-management, current tools are not consistently usable for diverse patients.

App developers need to engage a diverse set of patients in the design and testing of their products and should employ participatory design strategies in order to have an impact on chronic conditions such as diabetes and depression that disproportionately affect vulnerable populations, according to the study authors.

“In addition, the apps should be able to remind users of the rationale for each task and should integrate data from other sources, such as pharmacies, to reduce the need for manual data entry,” the study authors wrote.

The bottom line, according to the study authors, is that to reduce health disparities, app developers must ensure their products are tailored to the needs of the populations that are likely to benefit the most from their use. Moving forward, research on the impact of such apps on uptake, use, self-management behaviors, and health outcomes also is needed, the study authors stated.

 

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LabCorp Joins Apple Health Records Project

November 5, 2018
by Rajiv Leventhal, Managing Editor
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LabCorp, a provider of clinical laboratory and end-to-end drug development services, has announced that it has enabled Apple’s Health Records feature for its patients.

This iPhone feature aims to make it easier for LabCorp patients to access their LabCorp laboratory test results, along with other available medical data from multiple providers, whenever they choose, according to officials.

In January, Apple announced that it would be testing the Health Records feature out with 12 hospitals, inclusive of some of the most prominent healthcare institutions in the U.S. Since that time, more than 100 new organizations have joined the project,  according to Apple.

LabCorp test results are viewable in the Apple Health app for LabCorp patients who have an account with the company, and enable integration with the Health Records app. In addition to their LabCorp test results, patients will have information from participating healthcare institutions organized into one view, covering allergies, medical conditions, immunizations, lab results, medications, procedures and vitals.

Patients will receive notifications when their data is updated, and the Health Records data is encrypted and protected with the user’s iPhone passcode, Touch ID or Face ID, according to officials.

“LabCorp on Health Records will help provide healthcare consumers with a more holistic view of their health. Laboratory test results are central to medical decision making, and broadening access to this information will help patients take charge of their health and wellness, and lead to more informed dialogues between patients and their healthcare providers,” David P. King, chairman and CEO of LabCorp, said in a statement.

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HIMSS Analytics Introduces Infrastructure Adoption Model for Health Systems

October 25, 2018
by Rajiv Leventhal, Managing Editor
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HIMSS Analytics, the research arm of the Healthcare Information and Management Systems Society, announced the introduction of the Infrastructure Adoption Model, or INFRAM, which is designed to measure the technical infrastructure used within a health system.

The INFRAM focuses on five technical subdomains, allowing organizations to benchmark how their infrastructure operates within the following areas: mobility; security; collaboration; transport; and data center.

Similar to HIMSS Analytics’ well-known Electronic Medical Record Adoption Model, or, EMRAM, the INFRAM is an eight-stage model (0 – 7) that allows healthcare IT leaders to map the technology infrastructure capabilities required to reach their facility’s clinical and operational goals, while meeting industry benchmarks and standards.  The final stage, Stage 7, guides organizations towards optimized information integration, contextualization and orchestration essential for the delivery of higher order local and virtualized care processes.

For reference purposes, Stage 0 on the model represents that an organization does not have a VPN, intrusion detection/prevention, security policy, data center or compute architecture. Stage 3 signifies that an organization has an advanced intrusion prevention system, while Stage 5 represents having video on mobile devices, location-based messaging, firewall with advanced malware protection, and real-time scanning of email hyperlinks.

HIMSS officials note that by identifying specific benchmarks for organizations to reach before they go live with EMR, systems, the INFRAM aims to ensure that a health system’s infrastructure is stable, manageable and extensible. Through this, organizations can ideally improve care delivery and create a pathway for infrastructure development tied to business and clinical outcomes.

 “The INFRAM is a welcome addition to our maturity model suite and addresses a longstanding need – guiding healthcare organizations in securely implementing the infrastructure with which their EMRs are built upon,” Blain Newton, executive vice president, HIMSS Analytics, said in a statement. “We have seen health systems engage with advanced clinical applications, only for them to ‘glitch’ under infrastructure that isn't powerful enough to support their tools. With the INFRAM, healthcare providers can develop a detailed, strategic technology plan that defines their organization's current state, desired future state, and each stage in between to achieve their clinical and operational goals.”

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Clinical Team Communication and Data Access in the Palm of Your Hand

Thursday, October 25, 2018 | 1:00 p.m. ET, 12:00 p.m. CT

Eisenhower Health, a west coast-based Magnet Hospital, implemented an enterprise-wide solution enabling mobile communications and collaboration across all care teams, linking the entire enterprise, advancing its communications capabilities, creating access to an enterprise directory, and improving care team response and turnaround times.

Additionally, the system provided extensive and comprehensive reporting with data analytics showing where and to what extent response improvements were made, but also providing the information the hospital needed to better utilize the system and make adjustments to improve results.

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