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Mobile apps in ObGyn practice: Tools for enhancing women’s preventive health care
Evolutionary changes in ObGyn
Preventive medicine guidelines have evolved to reflect enhanced cervical cancer screening tests, longer-acting contraceptive options, and better data on the lack of utility of the annual pelvic exam that has changed the focus of the annual visit for both physicians and patients.1 These changes allow us to pivot and leverage the trust we build with our patients to make meaningful impacts in preventing chronic disease, improving prepregnancy health, reducing maternal mortality and morbidity, and improving the quality and longevity of our patients’ lives. New guidelines, coupled with the knowledge of the leading causes of morbidity for women, provide the chance to incorporate areas of screening and intervention that, while we are capable of addressing, we traditionally have not done so for various reasons.
The ACOG Presidential Task Force identified 5 areas of preventive health that significantly influence the long-term morbidity of women: obesity, cardiovascular disease, preconception counseling, diabetes, and cancer risk. ObGyns are uniquely positioned to identify and initiate the conversation and subsequently manage, treat, and address these critical health areas. To make this daunting task more manageable, the Task Force not only published webinars to address the clinical knowledge pertaining to these areas of health but also specifically looked at how to use technology to aid obstetrician-gynecologists in addressing them with patients.
Making use of technology in clinical practice
Technology is emerging as an influential player in health care. Major corporations, such as Amazon, Google, Apple, and Facebook, are making headlines in health care as they consider strategies (moves) to revolutionize technology and, in turn, patient visits like we have never seen before. Examples include incorporating artificial intelligence in a patient’s care and allowing better access for primary care.
The changes that we will see over the next 10 years, influenced by industry, will be more than those seen in our lifetime. To prepare for these changes, we need to incorporate technology into our daily practice. This encompasses much more than just the electronic medical record. Consequently, the Task Force intentionally looked at mobile medical apps to aid physicians in addressing the 5 specific areas of preventive health identified.
While a small step compared with what is to come, apps are a great resource to leverage in making this transition. However, with hundreds of thousands of medical apps available in app stores and the constant updates and iterations of each, it would be impossible to recommend any single app. There is much value in having a framework to use to efficiently measure the benefit of an app that you or your patient comes across in clinical practice. The objective of this series was to provide clinicians with an effective tool to evaluate a medical app that could be used, for example, when addressing obesity or optimizing prepregnancy health.
Continue to: The recommended rubric for evaluating apps...
The recommended rubric for evaluating apps
To evaluate mobile drug information apps, the Task Force members recommend a user-friendly, convenient rubric developed by the American Society of Health-System Pharmacists (ASHP) (see page 35). The rubric can help obstetrician-gynecologists evaluate and compare the value of various medical apps that specifically address obesity, diabetes mellitus, cardiovascular disease, improving maternal morbidity with enhanced preconception counseling, and cancer risk assessment.
The authors of this Task Force series have attempted to highlight the key features of an app as it pertains to a particular area of focus. It is important to keep in mind the primary user and the goal when choosing or recommending an app for practice or for patient use. The ASHP’s rubric is a tool meant to aid clinicians in evaluating medical apps, but it is ultimately the user’s decision to determine if the deficiencies of an app should deter its use. Although all the criteria are relevant and important, as medical experts it is incumbent on us to pay careful attention to the accuracy, authority, objectivity, timeliness, and security of any app we consider incorporating into clinical practice.
While integrating the use of medical apps into clinical practice will be novel for some, for others, junior Fellows in particular, it has become part of their practice and education. Dr. Eva Hoffmann, Chief Resident in the NYU Langone Health System, offers this perspective: “As medical trainees we use mobile apps to enhance our patient interaction and guide high-quality, continuous care. In today’s modern technological world, apps help keep us up to date with the ever-changing guidelines in pregnancy and routine gynecologic care as well as communicate directly and discreetly with a patient whenever the need arises. The most significant apps provide guidance on abnormal Pap results, indicated deliveries prior to 39 weeks, and the ability to respond to obstetrical emergencies. They also allow for quick society-endorsed references in seconds. Apps have changed the way that we practice by providing evidence-based medicine literally at our fingertips—in a shareable and communicable way—making the practice of medicine even more efficient and effective.”
Opportunity to reaffirm expertise
Dr. Chalas’ initiative was meant to shed light on the opportunity obstetrician-gynecologists have to reassert themselves as women’s health experts, to consider redefining their practice by incorporating new preventive guidelines, and to leverage medical apps for achieving better health outcomes for women across their lifetime. We hope that by opening a dialogue about how ubiquitous medical apps are (for both physicians and patients) in today’s health arena, how many apps are inaccurate and/or misused, and how a simple rubric can be used to assess an app’s value, you are inspired and feel more comfortable to incorporate medical apps into your practice.
Health care will continually undergo advancements, and as a specialty we must evolve to address women’s needs. Obstetrician-gynecologists are well suited to contribute significantly to the well-being of women and mothers. We can leverage technology-based apps to help us redefine our roles and priorities at the patient’s annual visit. We can reaffirm ourselves as the leading women’s health care physicians.
An additional resource
To enhance your understanding of apps and how to evaluate them, Dr. Katherine Chen’s App Review series in
In appreciation
The members of this Task Force want to thank the Editorial Board and staff of
- Women’s Preventive Services Initiative website. Recommendations for well-woman care: a well-woman chart. https:// www.womenspreventivehealth.org/wellwomanchart/. Accessed June 11, 2021.
- Chyjek K, Farag S, Chen KT. Rating pregnancy wheel applications using the APPLICATIONS scoring system. Obstet Gynecol. 2015;125:1478-1483.
Hartaj K. Powell, MD, MPH
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
Matthew Wells, MD, MBA
Dr. Wells is Attending Physician, Women and Children’s Services, NYU Langone Health Hospital, and Unified Women’s Healthcare, Mineola, New York
Eva Hoffmann, MD
Dr. Hoffmann is Resident Physician, Department of Obstetrics and Gynecology, NYU Langone Hospital–Long Island, Long Island School of Medicine, Mineola, New York.
The authors report no financial relationships relevant to this article.
Hartaj K. Powell, MD, MPH
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
Matthew Wells, MD, MBA
Dr. Wells is Attending Physician, Women and Children’s Services, NYU Langone Health Hospital, and Unified Women’s Healthcare, Mineola, New York
Eva Hoffmann, MD
Dr. Hoffmann is Resident Physician, Department of Obstetrics and Gynecology, NYU Langone Hospital–Long Island, Long Island School of Medicine, Mineola, New York.
The authors report no financial relationships relevant to this article.
Hartaj K. Powell, MD, MPH
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
Matthew Wells, MD, MBA
Dr. Wells is Attending Physician, Women and Children’s Services, NYU Langone Health Hospital, and Unified Women’s Healthcare, Mineola, New York
Eva Hoffmann, MD
Dr. Hoffmann is Resident Physician, Department of Obstetrics and Gynecology, NYU Langone Hospital–Long Island, Long Island School of Medicine, Mineola, New York.
The authors report no financial relationships relevant to this article.
Evolutionary changes in ObGyn
Preventive medicine guidelines have evolved to reflect enhanced cervical cancer screening tests, longer-acting contraceptive options, and better data on the lack of utility of the annual pelvic exam that has changed the focus of the annual visit for both physicians and patients.1 These changes allow us to pivot and leverage the trust we build with our patients to make meaningful impacts in preventing chronic disease, improving prepregnancy health, reducing maternal mortality and morbidity, and improving the quality and longevity of our patients’ lives. New guidelines, coupled with the knowledge of the leading causes of morbidity for women, provide the chance to incorporate areas of screening and intervention that, while we are capable of addressing, we traditionally have not done so for various reasons.
The ACOG Presidential Task Force identified 5 areas of preventive health that significantly influence the long-term morbidity of women: obesity, cardiovascular disease, preconception counseling, diabetes, and cancer risk. ObGyns are uniquely positioned to identify and initiate the conversation and subsequently manage, treat, and address these critical health areas. To make this daunting task more manageable, the Task Force not only published webinars to address the clinical knowledge pertaining to these areas of health but also specifically looked at how to use technology to aid obstetrician-gynecologists in addressing them with patients.
Making use of technology in clinical practice
Technology is emerging as an influential player in health care. Major corporations, such as Amazon, Google, Apple, and Facebook, are making headlines in health care as they consider strategies (moves) to revolutionize technology and, in turn, patient visits like we have never seen before. Examples include incorporating artificial intelligence in a patient’s care and allowing better access for primary care.
The changes that we will see over the next 10 years, influenced by industry, will be more than those seen in our lifetime. To prepare for these changes, we need to incorporate technology into our daily practice. This encompasses much more than just the electronic medical record. Consequently, the Task Force intentionally looked at mobile medical apps to aid physicians in addressing the 5 specific areas of preventive health identified.
While a small step compared with what is to come, apps are a great resource to leverage in making this transition. However, with hundreds of thousands of medical apps available in app stores and the constant updates and iterations of each, it would be impossible to recommend any single app. There is much value in having a framework to use to efficiently measure the benefit of an app that you or your patient comes across in clinical practice. The objective of this series was to provide clinicians with an effective tool to evaluate a medical app that could be used, for example, when addressing obesity or optimizing prepregnancy health.
Continue to: The recommended rubric for evaluating apps...
The recommended rubric for evaluating apps
To evaluate mobile drug information apps, the Task Force members recommend a user-friendly, convenient rubric developed by the American Society of Health-System Pharmacists (ASHP) (see page 35). The rubric can help obstetrician-gynecologists evaluate and compare the value of various medical apps that specifically address obesity, diabetes mellitus, cardiovascular disease, improving maternal morbidity with enhanced preconception counseling, and cancer risk assessment.
The authors of this Task Force series have attempted to highlight the key features of an app as it pertains to a particular area of focus. It is important to keep in mind the primary user and the goal when choosing or recommending an app for practice or for patient use. The ASHP’s rubric is a tool meant to aid clinicians in evaluating medical apps, but it is ultimately the user’s decision to determine if the deficiencies of an app should deter its use. Although all the criteria are relevant and important, as medical experts it is incumbent on us to pay careful attention to the accuracy, authority, objectivity, timeliness, and security of any app we consider incorporating into clinical practice.
While integrating the use of medical apps into clinical practice will be novel for some, for others, junior Fellows in particular, it has become part of their practice and education. Dr. Eva Hoffmann, Chief Resident in the NYU Langone Health System, offers this perspective: “As medical trainees we use mobile apps to enhance our patient interaction and guide high-quality, continuous care. In today’s modern technological world, apps help keep us up to date with the ever-changing guidelines in pregnancy and routine gynecologic care as well as communicate directly and discreetly with a patient whenever the need arises. The most significant apps provide guidance on abnormal Pap results, indicated deliveries prior to 39 weeks, and the ability to respond to obstetrical emergencies. They also allow for quick society-endorsed references in seconds. Apps have changed the way that we practice by providing evidence-based medicine literally at our fingertips—in a shareable and communicable way—making the practice of medicine even more efficient and effective.”
Opportunity to reaffirm expertise
Dr. Chalas’ initiative was meant to shed light on the opportunity obstetrician-gynecologists have to reassert themselves as women’s health experts, to consider redefining their practice by incorporating new preventive guidelines, and to leverage medical apps for achieving better health outcomes for women across their lifetime. We hope that by opening a dialogue about how ubiquitous medical apps are (for both physicians and patients) in today’s health arena, how many apps are inaccurate and/or misused, and how a simple rubric can be used to assess an app’s value, you are inspired and feel more comfortable to incorporate medical apps into your practice.
Health care will continually undergo advancements, and as a specialty we must evolve to address women’s needs. Obstetrician-gynecologists are well suited to contribute significantly to the well-being of women and mothers. We can leverage technology-based apps to help us redefine our roles and priorities at the patient’s annual visit. We can reaffirm ourselves as the leading women’s health care physicians.
An additional resource
To enhance your understanding of apps and how to evaluate them, Dr. Katherine Chen’s App Review series in
In appreciation
The members of this Task Force want to thank the Editorial Board and staff of
Evolutionary changes in ObGyn
Preventive medicine guidelines have evolved to reflect enhanced cervical cancer screening tests, longer-acting contraceptive options, and better data on the lack of utility of the annual pelvic exam that has changed the focus of the annual visit for both physicians and patients.1 These changes allow us to pivot and leverage the trust we build with our patients to make meaningful impacts in preventing chronic disease, improving prepregnancy health, reducing maternal mortality and morbidity, and improving the quality and longevity of our patients’ lives. New guidelines, coupled with the knowledge of the leading causes of morbidity for women, provide the chance to incorporate areas of screening and intervention that, while we are capable of addressing, we traditionally have not done so for various reasons.
The ACOG Presidential Task Force identified 5 areas of preventive health that significantly influence the long-term morbidity of women: obesity, cardiovascular disease, preconception counseling, diabetes, and cancer risk. ObGyns are uniquely positioned to identify and initiate the conversation and subsequently manage, treat, and address these critical health areas. To make this daunting task more manageable, the Task Force not only published webinars to address the clinical knowledge pertaining to these areas of health but also specifically looked at how to use technology to aid obstetrician-gynecologists in addressing them with patients.
Making use of technology in clinical practice
Technology is emerging as an influential player in health care. Major corporations, such as Amazon, Google, Apple, and Facebook, are making headlines in health care as they consider strategies (moves) to revolutionize technology and, in turn, patient visits like we have never seen before. Examples include incorporating artificial intelligence in a patient’s care and allowing better access for primary care.
The changes that we will see over the next 10 years, influenced by industry, will be more than those seen in our lifetime. To prepare for these changes, we need to incorporate technology into our daily practice. This encompasses much more than just the electronic medical record. Consequently, the Task Force intentionally looked at mobile medical apps to aid physicians in addressing the 5 specific areas of preventive health identified.
While a small step compared with what is to come, apps are a great resource to leverage in making this transition. However, with hundreds of thousands of medical apps available in app stores and the constant updates and iterations of each, it would be impossible to recommend any single app. There is much value in having a framework to use to efficiently measure the benefit of an app that you or your patient comes across in clinical practice. The objective of this series was to provide clinicians with an effective tool to evaluate a medical app that could be used, for example, when addressing obesity or optimizing prepregnancy health.
Continue to: The recommended rubric for evaluating apps...
The recommended rubric for evaluating apps
To evaluate mobile drug information apps, the Task Force members recommend a user-friendly, convenient rubric developed by the American Society of Health-System Pharmacists (ASHP) (see page 35). The rubric can help obstetrician-gynecologists evaluate and compare the value of various medical apps that specifically address obesity, diabetes mellitus, cardiovascular disease, improving maternal morbidity with enhanced preconception counseling, and cancer risk assessment.
The authors of this Task Force series have attempted to highlight the key features of an app as it pertains to a particular area of focus. It is important to keep in mind the primary user and the goal when choosing or recommending an app for practice or for patient use. The ASHP’s rubric is a tool meant to aid clinicians in evaluating medical apps, but it is ultimately the user’s decision to determine if the deficiencies of an app should deter its use. Although all the criteria are relevant and important, as medical experts it is incumbent on us to pay careful attention to the accuracy, authority, objectivity, timeliness, and security of any app we consider incorporating into clinical practice.
While integrating the use of medical apps into clinical practice will be novel for some, for others, junior Fellows in particular, it has become part of their practice and education. Dr. Eva Hoffmann, Chief Resident in the NYU Langone Health System, offers this perspective: “As medical trainees we use mobile apps to enhance our patient interaction and guide high-quality, continuous care. In today’s modern technological world, apps help keep us up to date with the ever-changing guidelines in pregnancy and routine gynecologic care as well as communicate directly and discreetly with a patient whenever the need arises. The most significant apps provide guidance on abnormal Pap results, indicated deliveries prior to 39 weeks, and the ability to respond to obstetrical emergencies. They also allow for quick society-endorsed references in seconds. Apps have changed the way that we practice by providing evidence-based medicine literally at our fingertips—in a shareable and communicable way—making the practice of medicine even more efficient and effective.”
Opportunity to reaffirm expertise
Dr. Chalas’ initiative was meant to shed light on the opportunity obstetrician-gynecologists have to reassert themselves as women’s health experts, to consider redefining their practice by incorporating new preventive guidelines, and to leverage medical apps for achieving better health outcomes for women across their lifetime. We hope that by opening a dialogue about how ubiquitous medical apps are (for both physicians and patients) in today’s health arena, how many apps are inaccurate and/or misused, and how a simple rubric can be used to assess an app’s value, you are inspired and feel more comfortable to incorporate medical apps into your practice.
Health care will continually undergo advancements, and as a specialty we must evolve to address women’s needs. Obstetrician-gynecologists are well suited to contribute significantly to the well-being of women and mothers. We can leverage technology-based apps to help us redefine our roles and priorities at the patient’s annual visit. We can reaffirm ourselves as the leading women’s health care physicians.
An additional resource
To enhance your understanding of apps and how to evaluate them, Dr. Katherine Chen’s App Review series in
In appreciation
The members of this Task Force want to thank the Editorial Board and staff of
- Women’s Preventive Services Initiative website. Recommendations for well-woman care: a well-woman chart. https:// www.womenspreventivehealth.org/wellwomanchart/. Accessed June 11, 2021.
- Chyjek K, Farag S, Chen KT. Rating pregnancy wheel applications using the APPLICATIONS scoring system. Obstet Gynecol. 2015;125:1478-1483.
- Women’s Preventive Services Initiative website. Recommendations for well-woman care: a well-woman chart. https:// www.womenspreventivehealth.org/wellwomanchart/. Accessed June 11, 2021.
- Chyjek K, Farag S, Chen KT. Rating pregnancy wheel applications using the APPLICATIONS scoring system. Obstet Gynecol. 2015;125:1478-1483.
Focus on diabetes mellitus
Diabetes mellitus affects 10% of the US population, and as many as one-third of US adults have prediabetes, according to the National Diabetes Statistics Report 2020 from the Centers for Disease Control and Prevention. While diabetes is associated with significant long-term morbidity and mortality, with early identification and interventions, lifestyle modifications can significantly improve long-term health.
As with obesity (see “Focus on obesity” in OBG Management, May 2021), it is difficult to address lifestyle modifications with patients who have diabetes. However, many apps can be leveraged to aid physicians in this effort.
Diabetes app considerations
Obstetrician-gynecologists can play a pivotal role in helping to screen women for diabetes. When applying the ACOG-recommended rubric to evaluate the quality of an app that is targeted to address screening and diagnosing diabetes, it’s important to consider the app’s timeliness, authority, usefulness, and design.
There are point-of-care apps that include a few simple questions that can quickly identify which women should be screened. Some apps combine screening questions with testing results to streamline screening and diagnosis of diabetes and prediabetes. These apps also provide clinical content to help physicians educate, initiate, and even treat diabetes if they desire.
A wealth of patient-centered apps are available to help patients address a diagnosis of diabetes. Apps that provide real-time feedback, motivational features to engage the user, and links to nutritional, fitness, and diabetic goals provide a woman with a comprehensive and personalized experience that can considerably improve health.
By incorporating apps and engaging with our patients on app technology, ObGyns can successfully partner with women to decrease morbidity with respect to diabetes mellitus and its long-term implications. ●
Hartaj K. Powell, MD, MPH
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
The author reports no financial relationships relevant to this article.
Hartaj K. Powell, MD, MPH
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
The author reports no financial relationships relevant to this article.
Hartaj K. Powell, MD, MPH
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
The author reports no financial relationships relevant to this article.
Diabetes mellitus affects 10% of the US population, and as many as one-third of US adults have prediabetes, according to the National Diabetes Statistics Report 2020 from the Centers for Disease Control and Prevention. While diabetes is associated with significant long-term morbidity and mortality, with early identification and interventions, lifestyle modifications can significantly improve long-term health.
As with obesity (see “Focus on obesity” in OBG Management, May 2021), it is difficult to address lifestyle modifications with patients who have diabetes. However, many apps can be leveraged to aid physicians in this effort.
Diabetes app considerations
Obstetrician-gynecologists can play a pivotal role in helping to screen women for diabetes. When applying the ACOG-recommended rubric to evaluate the quality of an app that is targeted to address screening and diagnosing diabetes, it’s important to consider the app’s timeliness, authority, usefulness, and design.
There are point-of-care apps that include a few simple questions that can quickly identify which women should be screened. Some apps combine screening questions with testing results to streamline screening and diagnosis of diabetes and prediabetes. These apps also provide clinical content to help physicians educate, initiate, and even treat diabetes if they desire.
A wealth of patient-centered apps are available to help patients address a diagnosis of diabetes. Apps that provide real-time feedback, motivational features to engage the user, and links to nutritional, fitness, and diabetic goals provide a woman with a comprehensive and personalized experience that can considerably improve health.
By incorporating apps and engaging with our patients on app technology, ObGyns can successfully partner with women to decrease morbidity with respect to diabetes mellitus and its long-term implications. ●
Diabetes mellitus affects 10% of the US population, and as many as one-third of US adults have prediabetes, according to the National Diabetes Statistics Report 2020 from the Centers for Disease Control and Prevention. While diabetes is associated with significant long-term morbidity and mortality, with early identification and interventions, lifestyle modifications can significantly improve long-term health.
As with obesity (see “Focus on obesity” in OBG Management, May 2021), it is difficult to address lifestyle modifications with patients who have diabetes. However, many apps can be leveraged to aid physicians in this effort.
Diabetes app considerations
Obstetrician-gynecologists can play a pivotal role in helping to screen women for diabetes. When applying the ACOG-recommended rubric to evaluate the quality of an app that is targeted to address screening and diagnosing diabetes, it’s important to consider the app’s timeliness, authority, usefulness, and design.
There are point-of-care apps that include a few simple questions that can quickly identify which women should be screened. Some apps combine screening questions with testing results to streamline screening and diagnosis of diabetes and prediabetes. These apps also provide clinical content to help physicians educate, initiate, and even treat diabetes if they desire.
A wealth of patient-centered apps are available to help patients address a diagnosis of diabetes. Apps that provide real-time feedback, motivational features to engage the user, and links to nutritional, fitness, and diabetic goals provide a woman with a comprehensive and personalized experience that can considerably improve health.
By incorporating apps and engaging with our patients on app technology, ObGyns can successfully partner with women to decrease morbidity with respect to diabetes mellitus and its long-term implications. ●
Championing preventive care in ObGyn: A tool to evaluate for useful medical apps
Personalizing care is at the heart of the American College of Obstetricians and Gynecologists (ACOG) 2020–2021 President Dr. Eva Chalas’ initiative to “Revisit the Visit.” As obstetrician-gynecologists, we care for patients across the entirety of their life. This role gives us the opportunity to form long-term partnerships with women to address important preventive health care measures.
Dr. Chalas established a Presidential Task Force that identified 5 areas of preventive health that significantly influence the long-term morbidity of women: obesity, cardiovascular disease, preconception counseling, diabetes, and cancer risk. The annual visit can serve as a particularly impactful point of care to achieve specific preventive care objectives and offer mitigation strategies based on patient-specific risk factors. We are uniquely positioned to identify and initiate the conversation and subsequently manage, treat, and address these critical health areas.
Harnessing modern technology
To adopt these health topics into practice, we need improved, more effective tools both to increase productivity during the office visit and to provide more personalized care. Notably, the widespread adoption of and proliferation of mobile devices—and the medical apps accessible on them—is creating new and innovative ways to improve health and health care delivery. More than 90% of physicians use a smartphone at work, and 62% of smartphone users have used their device to gather health data.1
In addition, according to a US Food and Drug Administration (FDA) report, in 2017, 325,000 health care applications were available on smartphones; this equates to an expected 3.7 billion mobile health application downloads that year by 1.7 billion smartphone users worldwide.2 As of October 2020, 48,000-plus health apps were available on the iOS mobile operating system alone.3
For patients and clinicians, picking the most suitable apps can be challenging in the face of evolving clinical evidence, emerging privacy risks, functionality concerns, and the fact that apps constantly update and change. Many have relied on star rating systems and user reviews in app stores to guide their selection process despite mounting evidence that suggests that such evaluation methods are misleading, not always addressing such important parameters as usability, validity, security, and privacy.4,5
Approaches for evaluating medical apps
Many app evaluation frameworks have emerged, but none is universally accepted within the health care field.
The American Psychiatric Association’s (APA) App Evaluation Model represents a comprehensive resource to consider when evaluating medical apps. It stratifies numerous variables into 5 levels that form a pyramid. In this model, background information forms the base of this pyramid and includes factors such as business model, credibility, cost, and advertising of the app. The top of the pyramid is comprised of data integration that considers data ownership and therapeutic alliance.6 Although this model is beneficial in that it provides a framework, it is not practical for point-of-care purposes as it offers no objective way to rate or score an app for quick and easy comparison.
The privately owned and operated Health On the Net (HON) Foundation is well known for its HONcode, an ethical standard for quality medical information on the internet. It uses 8 principles to certify a health website. However, the HON website itself states that it cannot guarantee the accuracy or completeness of medical information presented by a site.7 Although HON certification by a website is a sign of good intention, it is not beneficial to the practicing clinician who is looking to use an app to directly assist in clinical care.
The Agency for Healthcare Research and Quality (AHRQ) is another well-respected body that has delineated essential details to consider when using a health website. The AHRQ identifies features (similar to those of the APA pyramid and HONcode) for users to consider, such as credibility, content, design, and disclosures.8 However, this model too lacks a concise user-friendly evaluating system.
Although the FDA plans to apply some regulatory authority to the evaluation of a certain subset of high-risk mobile medical apps, it is not planning to evaluate or regulate many of the medical apps that clinicians use in daily practice. This leaves us, and our patients, to be guided by the principle of caveat emptor, or “let the buyer beware.”
Thus, Dr. Chalas’ Presidential Task Force carefully considered various resources to provide a useful tool that would help obstetrician-gynecologists objectively vet a medical app in practice.
Continue to: The Task Force’s recommended rubric...
The Task Force’s recommended rubric
The rubric shown for evaluating mobile drug information apps was developed by the American Society of Health-System Pharmacists (ASHP). The ASHP rubric takes into account the criteria recognized by the APA pyramid, the HON Foundation, and the AHRQ and incorporates them into a user-friendly tool and scoring system that can be applied as an evaluation checklist.9 This tool is meant to aid clinicians in evaluating medical apps, but it ultimately is the user’s decision to determine if an app’s deficiencies should deter its use.
While all of the criteria are relevant and important, it is incumbent on us as medical experts to pay careful attention to the accuracy, authority, objectivity, timeliness, and security of any app we consider incorporating into clinical practice. A low score on these criteria would belie any perceived usefulness or value the app may have.
When applying the rubric to evaluate the quality of an app, we should be mindful of the primary user and which characteristics are more important than others to effect positive changes in health. For example, in addressing obesity, it is the patient who will be interacting with the app. Therefore, it’s important that the app should score, on a 1- to 4-point scale (1 point being major deficiencies, 4 points being no deficiencies), a 4 out of 4 on features like usefulness, functionality, and design. Coveted design features that enhance the user’s experience will appeal to patients and keep them engaged and motivated. However, when addressing a woman’s health with respect to cancer risk, the principal features on which the app should score 4 out of 4 would be authority, objectivity, timeliness, and accuracy.
In the upcoming articles in this series, a member of the Presidential Task Force will reference the ASHP rubric to guide clinicians in choosing apps to address one of the critical health areas with their patients. The author of the piece will highlight key features of an app to consider what would add the most value in incorporating its use in clinical practice.
It would be impossible to evaluate all health care apps even if we focused only on the medical apps relevant to obstetrics and gynecology. There is much value in having a framework for efficiently measuring an app’s benefit in clinical practice. The objective of this article series is to help clinicians Revisit the Visit by providing an effective tool to evaluate a medical app. ●
- Mobius MD website. 11 Surprising mobile health statistics. http://www.mobius.md/blog/2019/03/11-mobile-health -statistics/. Accessed January 19, 2021.
- US Food and Drug Administration website. Device software functions including medical applications. November 5, 2019. https://www.fda.gov/medical-devices/digital-health-center -excellence/device-software-functions-including-mobile -medical-applications. Accessed March 10, 2021.
- Statista website. Number of mHealth apps available in the Apple App Store from 1st quarter 2015 to 4th quarter 2020. https://www.statista.com/statistics/779910/health-apps -available-ios-worldwide/. Accessed January 19, 2021.
- Campbell L. Using star ratings to choose a medical app? There’s a better way. Healthline website. Updated August 3, 2018. http://healthline.com/health-news/using-ratings-to -choose-medical-app-theres-a-better-way. Accessed April 22, 2021.
- Levine DM, Co Z, Newmark LP, et al. Design and testing of a mobile health application rating tool. NPJ Digit Med. 2020;3:74.
- Torous JB, Chan SR, Gipson SY, et al. A hierarchical framework for evaluation and informed decision making regarding smartphone apps for clinical care. Psychiatr Serv. 2018;69:498-500.
- Health On the Net website. The commitment to reliable health and medical information on the internet. https:// www.hon.ch/HONcode/Patients/Visitor/visitor.html. Accessed January 19, 2021.
- Agency for Healthcare Research and Quality. Assessing the quality of internet health information. June 1999. http:// www.ahrq.gov/research/data/infoqual.html. Accessed April 22, 2021.
- Hanrahan C, Aungst TD, Cole S. Evaluating mobile medical applications. American Society of Health-System Pharmacists eReports. https://www.ashp.org/-/media/store-files /mobile-medical-apps.ashx. Accessed January 22, 2021.
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
Dr. Kulbida is Chair, Department of Obstetrics and Gynecology, Ellis Medicine, and Medical Director, Bellevue Woman’s Care Center, Schenectady, New York, and OB Hospitalist Group, Greenville, South Carolina.
The authors report no financial relationships relevant to this article.
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
Dr. Kulbida is Chair, Department of Obstetrics and Gynecology, Ellis Medicine, and Medical Director, Bellevue Woman’s Care Center, Schenectady, New York, and OB Hospitalist Group, Greenville, South Carolina.
The authors report no financial relationships relevant to this article.
Dr. Powell is OB Hospitalist, Ascension Saint Agnes Hospital, Baltimore, Maryland.
Dr. Kulbida is Chair, Department of Obstetrics and Gynecology, Ellis Medicine, and Medical Director, Bellevue Woman’s Care Center, Schenectady, New York, and OB Hospitalist Group, Greenville, South Carolina.
The authors report no financial relationships relevant to this article.
Personalizing care is at the heart of the American College of Obstetricians and Gynecologists (ACOG) 2020–2021 President Dr. Eva Chalas’ initiative to “Revisit the Visit.” As obstetrician-gynecologists, we care for patients across the entirety of their life. This role gives us the opportunity to form long-term partnerships with women to address important preventive health care measures.
Dr. Chalas established a Presidential Task Force that identified 5 areas of preventive health that significantly influence the long-term morbidity of women: obesity, cardiovascular disease, preconception counseling, diabetes, and cancer risk. The annual visit can serve as a particularly impactful point of care to achieve specific preventive care objectives and offer mitigation strategies based on patient-specific risk factors. We are uniquely positioned to identify and initiate the conversation and subsequently manage, treat, and address these critical health areas.
Harnessing modern technology
To adopt these health topics into practice, we need improved, more effective tools both to increase productivity during the office visit and to provide more personalized care. Notably, the widespread adoption of and proliferation of mobile devices—and the medical apps accessible on them—is creating new and innovative ways to improve health and health care delivery. More than 90% of physicians use a smartphone at work, and 62% of smartphone users have used their device to gather health data.1
In addition, according to a US Food and Drug Administration (FDA) report, in 2017, 325,000 health care applications were available on smartphones; this equates to an expected 3.7 billion mobile health application downloads that year by 1.7 billion smartphone users worldwide.2 As of October 2020, 48,000-plus health apps were available on the iOS mobile operating system alone.3
For patients and clinicians, picking the most suitable apps can be challenging in the face of evolving clinical evidence, emerging privacy risks, functionality concerns, and the fact that apps constantly update and change. Many have relied on star rating systems and user reviews in app stores to guide their selection process despite mounting evidence that suggests that such evaluation methods are misleading, not always addressing such important parameters as usability, validity, security, and privacy.4,5
Approaches for evaluating medical apps
Many app evaluation frameworks have emerged, but none is universally accepted within the health care field.
The American Psychiatric Association’s (APA) App Evaluation Model represents a comprehensive resource to consider when evaluating medical apps. It stratifies numerous variables into 5 levels that form a pyramid. In this model, background information forms the base of this pyramid and includes factors such as business model, credibility, cost, and advertising of the app. The top of the pyramid is comprised of data integration that considers data ownership and therapeutic alliance.6 Although this model is beneficial in that it provides a framework, it is not practical for point-of-care purposes as it offers no objective way to rate or score an app for quick and easy comparison.
The privately owned and operated Health On the Net (HON) Foundation is well known for its HONcode, an ethical standard for quality medical information on the internet. It uses 8 principles to certify a health website. However, the HON website itself states that it cannot guarantee the accuracy or completeness of medical information presented by a site.7 Although HON certification by a website is a sign of good intention, it is not beneficial to the practicing clinician who is looking to use an app to directly assist in clinical care.
The Agency for Healthcare Research and Quality (AHRQ) is another well-respected body that has delineated essential details to consider when using a health website. The AHRQ identifies features (similar to those of the APA pyramid and HONcode) for users to consider, such as credibility, content, design, and disclosures.8 However, this model too lacks a concise user-friendly evaluating system.
Although the FDA plans to apply some regulatory authority to the evaluation of a certain subset of high-risk mobile medical apps, it is not planning to evaluate or regulate many of the medical apps that clinicians use in daily practice. This leaves us, and our patients, to be guided by the principle of caveat emptor, or “let the buyer beware.”
Thus, Dr. Chalas’ Presidential Task Force carefully considered various resources to provide a useful tool that would help obstetrician-gynecologists objectively vet a medical app in practice.
Continue to: The Task Force’s recommended rubric...
The Task Force’s recommended rubric
The rubric shown for evaluating mobile drug information apps was developed by the American Society of Health-System Pharmacists (ASHP). The ASHP rubric takes into account the criteria recognized by the APA pyramid, the HON Foundation, and the AHRQ and incorporates them into a user-friendly tool and scoring system that can be applied as an evaluation checklist.9 This tool is meant to aid clinicians in evaluating medical apps, but it ultimately is the user’s decision to determine if an app’s deficiencies should deter its use.
While all of the criteria are relevant and important, it is incumbent on us as medical experts to pay careful attention to the accuracy, authority, objectivity, timeliness, and security of any app we consider incorporating into clinical practice. A low score on these criteria would belie any perceived usefulness or value the app may have.
When applying the rubric to evaluate the quality of an app, we should be mindful of the primary user and which characteristics are more important than others to effect positive changes in health. For example, in addressing obesity, it is the patient who will be interacting with the app. Therefore, it’s important that the app should score, on a 1- to 4-point scale (1 point being major deficiencies, 4 points being no deficiencies), a 4 out of 4 on features like usefulness, functionality, and design. Coveted design features that enhance the user’s experience will appeal to patients and keep them engaged and motivated. However, when addressing a woman’s health with respect to cancer risk, the principal features on which the app should score 4 out of 4 would be authority, objectivity, timeliness, and accuracy.
In the upcoming articles in this series, a member of the Presidential Task Force will reference the ASHP rubric to guide clinicians in choosing apps to address one of the critical health areas with their patients. The author of the piece will highlight key features of an app to consider what would add the most value in incorporating its use in clinical practice.
It would be impossible to evaluate all health care apps even if we focused only on the medical apps relevant to obstetrics and gynecology. There is much value in having a framework for efficiently measuring an app’s benefit in clinical practice. The objective of this article series is to help clinicians Revisit the Visit by providing an effective tool to evaluate a medical app. ●
Personalizing care is at the heart of the American College of Obstetricians and Gynecologists (ACOG) 2020–2021 President Dr. Eva Chalas’ initiative to “Revisit the Visit.” As obstetrician-gynecologists, we care for patients across the entirety of their life. This role gives us the opportunity to form long-term partnerships with women to address important preventive health care measures.
Dr. Chalas established a Presidential Task Force that identified 5 areas of preventive health that significantly influence the long-term morbidity of women: obesity, cardiovascular disease, preconception counseling, diabetes, and cancer risk. The annual visit can serve as a particularly impactful point of care to achieve specific preventive care objectives and offer mitigation strategies based on patient-specific risk factors. We are uniquely positioned to identify and initiate the conversation and subsequently manage, treat, and address these critical health areas.
Harnessing modern technology
To adopt these health topics into practice, we need improved, more effective tools both to increase productivity during the office visit and to provide more personalized care. Notably, the widespread adoption of and proliferation of mobile devices—and the medical apps accessible on them—is creating new and innovative ways to improve health and health care delivery. More than 90% of physicians use a smartphone at work, and 62% of smartphone users have used their device to gather health data.1
In addition, according to a US Food and Drug Administration (FDA) report, in 2017, 325,000 health care applications were available on smartphones; this equates to an expected 3.7 billion mobile health application downloads that year by 1.7 billion smartphone users worldwide.2 As of October 2020, 48,000-plus health apps were available on the iOS mobile operating system alone.3
For patients and clinicians, picking the most suitable apps can be challenging in the face of evolving clinical evidence, emerging privacy risks, functionality concerns, and the fact that apps constantly update and change. Many have relied on star rating systems and user reviews in app stores to guide their selection process despite mounting evidence that suggests that such evaluation methods are misleading, not always addressing such important parameters as usability, validity, security, and privacy.4,5
Approaches for evaluating medical apps
Many app evaluation frameworks have emerged, but none is universally accepted within the health care field.
The American Psychiatric Association’s (APA) App Evaluation Model represents a comprehensive resource to consider when evaluating medical apps. It stratifies numerous variables into 5 levels that form a pyramid. In this model, background information forms the base of this pyramid and includes factors such as business model, credibility, cost, and advertising of the app. The top of the pyramid is comprised of data integration that considers data ownership and therapeutic alliance.6 Although this model is beneficial in that it provides a framework, it is not practical for point-of-care purposes as it offers no objective way to rate or score an app for quick and easy comparison.
The privately owned and operated Health On the Net (HON) Foundation is well known for its HONcode, an ethical standard for quality medical information on the internet. It uses 8 principles to certify a health website. However, the HON website itself states that it cannot guarantee the accuracy or completeness of medical information presented by a site.7 Although HON certification by a website is a sign of good intention, it is not beneficial to the practicing clinician who is looking to use an app to directly assist in clinical care.
The Agency for Healthcare Research and Quality (AHRQ) is another well-respected body that has delineated essential details to consider when using a health website. The AHRQ identifies features (similar to those of the APA pyramid and HONcode) for users to consider, such as credibility, content, design, and disclosures.8 However, this model too lacks a concise user-friendly evaluating system.
Although the FDA plans to apply some regulatory authority to the evaluation of a certain subset of high-risk mobile medical apps, it is not planning to evaluate or regulate many of the medical apps that clinicians use in daily practice. This leaves us, and our patients, to be guided by the principle of caveat emptor, or “let the buyer beware.”
Thus, Dr. Chalas’ Presidential Task Force carefully considered various resources to provide a useful tool that would help obstetrician-gynecologists objectively vet a medical app in practice.
Continue to: The Task Force’s recommended rubric...
The Task Force’s recommended rubric
The rubric shown for evaluating mobile drug information apps was developed by the American Society of Health-System Pharmacists (ASHP). The ASHP rubric takes into account the criteria recognized by the APA pyramid, the HON Foundation, and the AHRQ and incorporates them into a user-friendly tool and scoring system that can be applied as an evaluation checklist.9 This tool is meant to aid clinicians in evaluating medical apps, but it ultimately is the user’s decision to determine if an app’s deficiencies should deter its use.
While all of the criteria are relevant and important, it is incumbent on us as medical experts to pay careful attention to the accuracy, authority, objectivity, timeliness, and security of any app we consider incorporating into clinical practice. A low score on these criteria would belie any perceived usefulness or value the app may have.
When applying the rubric to evaluate the quality of an app, we should be mindful of the primary user and which characteristics are more important than others to effect positive changes in health. For example, in addressing obesity, it is the patient who will be interacting with the app. Therefore, it’s important that the app should score, on a 1- to 4-point scale (1 point being major deficiencies, 4 points being no deficiencies), a 4 out of 4 on features like usefulness, functionality, and design. Coveted design features that enhance the user’s experience will appeal to patients and keep them engaged and motivated. However, when addressing a woman’s health with respect to cancer risk, the principal features on which the app should score 4 out of 4 would be authority, objectivity, timeliness, and accuracy.
In the upcoming articles in this series, a member of the Presidential Task Force will reference the ASHP rubric to guide clinicians in choosing apps to address one of the critical health areas with their patients. The author of the piece will highlight key features of an app to consider what would add the most value in incorporating its use in clinical practice.
It would be impossible to evaluate all health care apps even if we focused only on the medical apps relevant to obstetrics and gynecology. There is much value in having a framework for efficiently measuring an app’s benefit in clinical practice. The objective of this article series is to help clinicians Revisit the Visit by providing an effective tool to evaluate a medical app. ●
- Mobius MD website. 11 Surprising mobile health statistics. http://www.mobius.md/blog/2019/03/11-mobile-health -statistics/. Accessed January 19, 2021.
- US Food and Drug Administration website. Device software functions including medical applications. November 5, 2019. https://www.fda.gov/medical-devices/digital-health-center -excellence/device-software-functions-including-mobile -medical-applications. Accessed March 10, 2021.
- Statista website. Number of mHealth apps available in the Apple App Store from 1st quarter 2015 to 4th quarter 2020. https://www.statista.com/statistics/779910/health-apps -available-ios-worldwide/. Accessed January 19, 2021.
- Campbell L. Using star ratings to choose a medical app? There’s a better way. Healthline website. Updated August 3, 2018. http://healthline.com/health-news/using-ratings-to -choose-medical-app-theres-a-better-way. Accessed April 22, 2021.
- Levine DM, Co Z, Newmark LP, et al. Design and testing of a mobile health application rating tool. NPJ Digit Med. 2020;3:74.
- Torous JB, Chan SR, Gipson SY, et al. A hierarchical framework for evaluation and informed decision making regarding smartphone apps for clinical care. Psychiatr Serv. 2018;69:498-500.
- Health On the Net website. The commitment to reliable health and medical information on the internet. https:// www.hon.ch/HONcode/Patients/Visitor/visitor.html. Accessed January 19, 2021.
- Agency for Healthcare Research and Quality. Assessing the quality of internet health information. June 1999. http:// www.ahrq.gov/research/data/infoqual.html. Accessed April 22, 2021.
- Hanrahan C, Aungst TD, Cole S. Evaluating mobile medical applications. American Society of Health-System Pharmacists eReports. https://www.ashp.org/-/media/store-files /mobile-medical-apps.ashx. Accessed January 22, 2021.
- Mobius MD website. 11 Surprising mobile health statistics. http://www.mobius.md/blog/2019/03/11-mobile-health -statistics/. Accessed January 19, 2021.
- US Food and Drug Administration website. Device software functions including medical applications. November 5, 2019. https://www.fda.gov/medical-devices/digital-health-center -excellence/device-software-functions-including-mobile -medical-applications. Accessed March 10, 2021.
- Statista website. Number of mHealth apps available in the Apple App Store from 1st quarter 2015 to 4th quarter 2020. https://www.statista.com/statistics/779910/health-apps -available-ios-worldwide/. Accessed January 19, 2021.
- Campbell L. Using star ratings to choose a medical app? There’s a better way. Healthline website. Updated August 3, 2018. http://healthline.com/health-news/using-ratings-to -choose-medical-app-theres-a-better-way. Accessed April 22, 2021.
- Levine DM, Co Z, Newmark LP, et al. Design and testing of a mobile health application rating tool. NPJ Digit Med. 2020;3:74.
- Torous JB, Chan SR, Gipson SY, et al. A hierarchical framework for evaluation and informed decision making regarding smartphone apps for clinical care. Psychiatr Serv. 2018;69:498-500.
- Health On the Net website. The commitment to reliable health and medical information on the internet. https:// www.hon.ch/HONcode/Patients/Visitor/visitor.html. Accessed January 19, 2021.
- Agency for Healthcare Research and Quality. Assessing the quality of internet health information. June 1999. http:// www.ahrq.gov/research/data/infoqual.html. Accessed April 22, 2021.
- Hanrahan C, Aungst TD, Cole S. Evaluating mobile medical applications. American Society of Health-System Pharmacists eReports. https://www.ashp.org/-/media/store-files /mobile-medical-apps.ashx. Accessed January 22, 2021.