Wearables and mobile apps
Wearables and mobile apps
Mobile phone and tablet computer apps are software applications, usually designed to run on smartphones and tablet devices e.g. iPads.
Wearables are wearable health-tracking technology items such as smartwatches and fitness trackers.
Background and app types
An ‘app’ is a digital application. It could be run on a smartphone or another device. It could be a web-based application, or a digital service used to support health and care. Recommending that patients use high-quality apps may become a common activity for pharmacy staff in the future.
In some cases, appropriate data sharing agreements might allow patients to choose to have data from their app or wearable integrated with their health records which can be shared with healthcare professionals such as community pharmacists.
Common types of health apps include:
- Medical apps, which involve a medical purpose, such as diagnosis or treatment decisions (e.g. a dosage calculator app that recommends a medicine dose based on a patient’s details). Medical apps are medical devices and therefore should be CE marked if sold or distributed within the UK. The MHRA has published app guidance and a flow chart that provides further information on apps and how to determine whether an app involves a medical purpose;
- Medical device accessory apps are apps which work in association with a CE marked medical device, and so do not need their own CE mark, e.g. an app which connects to a blood pressure monitor; and
- Health apps which are not classified as medical devices which might, for example, help to support a discussion with a clinician, but would not determine the treatment decision, e.g. an app that recorded or accessed data without complex calculations (e.g. an electronic health record or a simple step-monitoring app).
In the future the recommendation to a patient to use a high quality app may be as common an occurrence in
pharmacies as provision of verbal advice on lifestyle or a patient’s medicines.
Considerations if recommending or working with patient apps
If recommending apps to patients, you should consider:
- Read our briefing Features of higher quality health apps, and how to give app feedback. This provides pharmacy contractors and pharmacy teams with information about health apps which may be used by patients or health and care workers. It explores the features of higher quality apps and more;
- Consent and patient considerations: Informed consent from the patient is required for their use of an app. You must never sign the app terms and conditions on patients’ behalf to avoid liability issues. Patients should be aware that some terms and conditions state the data they input into the app could be seen by others. You could give advice about higher quality features to help them to make informed choices, considering the potential benefits as well as the risks;
- The importance of human touch alongside the digital interactions which apps can offer – clinicians and support networks can have a powerful impact on wellness. Some apps could underestimate the importance of patient/clinician relationships and more generally the patient’s wider human relationships; and
- Maintaining your awareness of current lists of apps: Ensure that you are aware of the commonly used app stores lists outlined below.
Patient app lists
NHS Apps Library
The NHS Apps library (beta ‘test’ version) includes a selection of tools that have met some NHS-set standards.
Apps with pharmacy-related functionality
These include but are not limited to:
|App/website name||Order repeat medicines from GP||Access health information||Book GP &/or pharmacy appointments||Notifications about prescriptions being dispensed / ready for collection||Reminders to take medicines||Notes / functionality|
|DIMEC*||Patients can use the DIMEC app to order NHS repeat prescriptions with smart devices. They can sync medicines history with their GP record, order NHS repeat prescriptions, and receive notifications on the status of requests. Medicines can be arranged to be ready for collection from the pharmacy of their choice.|
|Engage Consult*||(GP)||Engage Consult allows patients and carers to connect with their GP practice and access services online from a PC, tablet or smartphone. It can be used to order repeat prescriptions, book appointments, and have an online consultation.|
|Evergreen Life*||(GP)||Evergreen Life is a personal health record app that stores patients’ health information in one place. Patients can also create an account on the Evergreen Life website. It enables patients to actively manage their health, fitness and wellbeing. For example, they can order repeat medication, track their lifestyle goals, book GP appointments, and view and download their medical record using either the app or the website.|
|Healthera*||(GP)||The Healthera app aims to help patients use their local pharmacy services. They can use it to manage their repeat prescriptions and medication, book appointments and contact their pharmacist for clinical advice.|
|NHS App||(GP)||Scheduled for release in December 2018 after some piloting is completed. The NHS App will enable: accessing NHS 111 Online and the NHS website symptom checker; booking GP practice appointments and receiving reminders; ordering their repeat prescriptions; viewing GP medical record; ability to register as an organ donor; and setting national data sharing preferences. Further features will be added over time.|
|Now Patient and Now GP apps||These apps are associated with the Now Healthcare Group and the Now distance selling pharmacy. Now GP offers GP consultations.|
|Patient Access||(GP/pharmacy)||An app related to the EMIS GP clinical system. It supports ordering of repeat medicines, viewing of health record information and booking of GP or pharmacy appointments.|
|Patient Services||(GP)||A website related to the Vision (INPS) GP clinical system. It supports ordering of repeat medicines, viewing of health record information and booking of GP appointment prescribing system.|
|An app related to the SystmOne (TPP) GP clinical system. It may support ordering of repeat medicines, viewing of health record information and booking of GP appointments.|
*Listed within NHS Apps beta library
Patient apps and pharmacy appointment features
Some pharmacy contractors may choose to enable relevant patients to book a pharmacy appointment with the pharmacy, using a patient app. See above within the ‘Patient app lists‘ and the column relating to ‘Book GP or pharmacy appointments‘.
App developers that report such functionality currently include:
- Patient Access (an app related to the EMIS GP clinical system)
Community Pharmacy IT Group received feedback from some pharmacy contractors that it would be helpful if NHS App could enable such a feature. If you would like to share views with PSNC about this, or report other apps which start to provide this functionality please contact PSNC’s IT team.
Patient apps and patient choice of pharmacy
Patient apps and EPS nomination
A poster which sets out the right for patients to make their own choice has been produced and pharmacies are asked to display this prominently and as close as practicable to the location where patients receive prescriptions. Distance selling pharmacies and apps which allow nomination-setting should display this information prominently on their websites/apps and take reasonable steps to bring this notice to the attention of all patients, for example by including a copy of this notice with dispensed medicines that are delivered to patients.
Patient app developers can also add functionality to enable patients to be able to change their EPS nomination. This may be directly within the app or it may be through an indirect process in which the patient expresses a wish to change nomination using the app, and the relevant EPS user acts on this and uses their system to make the change. EPS users should make changes to nomination settings in accordance with the expected guidelines.
Feeding back or reporting about apps
Give positive and negative feedback to app developers to help them improve their apps. Contact them using either their link at their app store listing, or using contact information from the developer’s website.
Reviews can be left at the app store listing or elsewhere online. If reviewing apps then consider whether the app demonstrates the features of higher quality apps described earlier.
If you have concerns about a health app, you can report it to:
- Information Commissioners Office (ICO) – those UK apps which might be misusing data.
- National Reporting and Learning Service (NRLS) – those apps which may be contributing to the occurrence of patient safety incidents.
- NHS England Identity team – those app developers which may be contravening NHS identity/logo guidance e.g. use of the NHS logo to suggest that the app developer or their product is allowing a free and fair choice of pharmacy. If the choice is limited then this should be clear to all patients.
- The app developer – you may email the app developer to ask your question if their contact details are included on their website.
- NHS Digital – those apps listed in the NHS Apps beta library. NHS Digital request that if you would like to report an issue with any individual library-listed app, please contact the app provider directly but also email NHS Digital.
- The app store company – those apps which might be failing to meet expected standards e.g. Apple App store or Google Play.
Apps for pharmacy staff
The Centre for Pharmacy Postgraduate Education (CPPE) maintains a list of apps that may be useful for pharmacy staff. Some of the listed apps are sources of information, some can be used during consultations with patients and some are for signposting to support healthy lifestyles and self-care. The sixth edition of the list was updated in December 2016.
Healthcare professionals are increasingly turning to apps such as: drug reference guides, medical calculators, clinical guidelines and other decision support aids, textbooks and literature search portals.
Patient journeys with apps (NHS Digital study)
NHS Digital, as part of a “Patient Enablement” project within the “Digital Medicines” domain of work, investigated ways of improving the repeat prescription process for patients. Through user research they were able to look at the issues patients could face with the current repeat prescription process and consider solutions to those issues. NHS Digital have published: Patient facing applications and prescribed medications – Outputs from discovery work to help those working within the healthcare space.
Information about and for app developers
NHS Developers Network health apps hub provides further information about developing useful health apps for patients and pharmacies. The assessment framework is also explained there.
Guidance about emails: If pharmacy app developers, or others acting on their behalf, send out electronic marketing e-mails to individuals, it should be recorded how and when consent was obtained where consent was captured. As part of the NHS Apps library assessment questionnaire app developers are asked to confirm that they “can evidence that the individual gave their valid consent to the processing [of data] i.e. how and when consent was obtained and the information provided to the individual (data subject) at the time“. The Information Commissioner’s Office (ICO) also provide guidance about appropriate use of email which pharmacy app developers can review to understand their obligations in relation to electronic marketing e-mails to individuals.
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