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2. + Evaluating Mobile Medical Applications For Utilization By Pharmacy Students Timothy Dy Aungst, PharmD MCPHS University

3. + Presenter Information Email: Timothy.Aungst@MCPHS.edu Twitter: @TDAungst Affiliations: Assistant Professor, MCPHS University Editor, iMedicalApps LLC Disclosure: The presenter is an editor for iMedicalApps.com, a website that reviews mobile medical applications. The site and authors do not represent or consult for any app developers, do not receive funding or financial reimbursement for reviews, and do not advertise for any mobile apps.

4. + Objectives Discuss growing size of medical apps currently available on the market Identify what medical apps may be of use to pharmacy students in the classroom and during clinical rotations for professional development Identify qualities of an app that would be preferential to use in practice based upon key characteristics Discuss changes that may occur in medical app development due to Federal oversight and outside organization intervention

5. + Mobile Application Explosion Substantial growth of mobile applications Two largest platforms for medical apps are Google Android and Apple iOS Medical Applications Pure Oxygen. How many apps are in each store? 148biz.com. App Store Metrics. AppBrain.com Number of available Android Applications.

6. + Role of Mobile Medical Apps Point-of-Care Tool Clinical Reference Medical Education Patient Education Communication Telehealth EHR Integration Social Media/News Ozdalga E, et al. J Med Internet Res. 2012;14(5):e128.

7. + Benefits of mobile medical apps Clinician Tools Helps increase access to clinical information for point-of-care Communication Sharing of data Workflow Increase productivity Integration into EHR Education Students and Practitioners use apps differently Students use educational and clinical apps Docs use clinical calculators and drug information Payne KB, et al. BMC Med Inform Decis Mak. 2012;12:121 Patient Engagement Education Data collection and feedback Goldbach H, et al. J Am Med Inform Assoc. 2013; In Press.

8. + Drug Reference Many references provided by commonly used companies in pharmacy Not all information available via app is as complete as that provided through a browser based system

9. + Clinical Reference Many references available via web-based browsers are available via mobile apps Information can be completely downloaded to device negating any online connection Many apps are created by renowned institutions for clinical purposes

10. + News and Reading Medical news websites have apps available for recent news for pharmacists Integration of CE/CME Portals to institution libraries for medical journal access

11. + Issues with current mobile app development – Lack of evidence-based information Reviews have demonstrated that apps identified often lack medical references Lack of accuracy Dermatological apps have range of specificity and sensitivity Opioid conversion apps are not uniformly accurate Lack of clinical input into design Multiple apps have no input by medical professionals Many Startups have no medical staff Maintaining Privacy Password Protection Breach of data Data – will it be sold? Mosa A, et al. BMC Med Inform Decis Mak. 2012;12:67. Wolf JA, et al. JAMA Dermatol. 2013;1-4. Haffey F, et al. Drug Saf. 2013;36(2):111-7 Ferrero NA, et al. J Am Acad Dermatol. 2013;68(3):515-6

12. + Implication for Pharmacy Practice – What applications should be taught or advised for students to use? Is the information provided via an app sufficient for clinical reference? Lack of standardized education for future pharmacists No infrastructure in place by most colleges No requirement to educate students on rising use of mobile technology Development of best practice for education of students is required

13. + Evaluating Medical Applications Information provided Is it accurate or verifiable? Developer background Who made it? Relevancy Does the app do anything to benefit practice? Efficacy Does the app perform its intended goal? Support Is the app continually updated? Is there a way to communicate with the developer? Usability Does the app function correctly for intended purpose? Content RequirementsTechnical Requirements

14. + App Checklist CriteriaY/N Information is verifiable and of sound background and cited within application App is developed by refutable company or discloses authors of clinical expert background Information is time-stamped and updated on reasonable schedule App is has dedicated support, and there is a mechanism to report errors App meets regulatory compliance where applicable App discloses any conflicts of interest App has mechanism in place to secure privacy where relevant Ultimately a Medical Application should demonstrate several key features Apps for a specialized purpose may require further analysis Misra S, et al. JAMA Dermatol. 2013;In-Press.

15. + App Review #1

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18. + App Review #2

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20. + Putting it into Practice Classroom Conducted an interactive lecture on med apps Review what to look for in an app Clinical Site Involvement Identify what apps supported at a clinical site Preceptor identifies what is appropriate utilization Library Support Create a dedicated website listing supported apps by the school Infographic Professionalism Teach students when is an appropriate time to use a device for support

21. + Library Infographic

22. + Future Regulations Certification Independent organizations have created methods to ensure app quality Happtique, mHimms Regulatory Oversight FDA has a Draft Guidance Has already made interventions on questionable apps Areas currently covered: …are used as an accessory to a regulated device; or transform a mobile platform into a regulated medical device. Medical Society Involvement Medical groups may stake a claim in certain areas and provide oversight Food and Drug Administration. Draft Guidance for Industry and Food and Drug Administration Staff - Mobile Medical Applications

23. + Conclusion Mobile medical applications will play a substantial role in pharmacy practice Many apps are readily available across multiple OS Not all apps are created equal Pharmacists must be made aware of pros/cons of med apps Apps need to be properly identified for use Opportunity presents itself to educate students on app use Classroom, clinical site, workshops Future oversight may present itself to help regulate medical apps FDA, FTC, App Certification Programs

24. + References 148biz.com. App Store Metrics. http://148apps.biz/app-store-metrics/ (accessed 10 June 2013).http://148apps.biz/app-store-metrics/ AppBrain. Number of available Android applications. http://www.appbrain.com/stats/number-of-android-apps (accessed 10 June 2013). Pure Oxygen. How many apps are in each app store? http://www.pureoxygenmobile.com/how-many-apps-in-each-app-store/ (accessed 10 June 2013). Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res. 2012;14(5):e128. Mosa AS, Yoo I, Sheets L. A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak. 2012;12:67. Wolf JA, Moreau J, Akilov O, et al. Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection. JAMA Dermatol. 2013;:1- 4. Ferrero NA, Morrell DS, Burkhart CN. Skin scan: a demonstration of the need for FDA regulation of medical apps on iPhone. J Am Acad Dermatol. 2013;68(3):515-6. Haffey F, Brady RR, Maxwell S. A comparison of the reliability of smartphone apps for opioid conversion. Drug Saf. 2013;36(2):111-7. Misra S, Lewis T, Aungst TD. Medical application use and the need for further research and assessment for clinical practice. JAMA Dermatol. 2013;In-Press. Food and Drug Administration. Draft Guidance for Industry and Food and Drug Administration Staff - Mobile Medical Applications.http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf (accessed 31 May 2013).http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf