Presentation from Dermot Ryan on the nature of the digital footprint created by remote assessment and monitoring technology for respiratory health.

1. “The bad”:Digital Footprints
A step in which direction?
Dr Dermot Ryan
Honorary Clinical Research Fellow, University of Edinburgh
Director of Clinical Strategy, OPC

2. Some Facts

7. • An App is an intervention
• It provides information
• Is Information a therapy?
• Is an App a therapy?
• Should Apps be subject to
the same rigour as new
medications?

8. Electronic reminders?

9. Compliance
9
This course is supported by an unrestricted
educational grant from U-BIOPRED
Any opinions expressed are those of the
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0098701
Acoustic readings

10. Compliance
10
This course is supported by an unrestricted
educational grant from U-BIOPRED
Any opinions expressed are those of the
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0098701
Acoustic readings

11. DIGITAL DOMAINS

12. DIGITAL DOMAINS

13. Educating
Monitoring
Knowledge
Coaching
Medication
Data Cloud
Skills
Health system
Research
Clinician
EHR
Digital Health and
wellbeing

14. Dosage
Educating
Monitoring
Knowledge
Technique
Coaching
Medication
Reminders
Data Cloud
Prescription
Billing
Skills
Health system
Research
Clinician
EHR
Reminders
Alerting
Follow up
Stratifying
Side effects
Digital Health and
wellbeing

15. • Provider notes
• Clinical Notes
• Guidelines
• CDSS
• Patient ID
• Health Industry
• Health Insurance
• Consent Forms
• Medication Alerts
• Non Shared Personal info
• Self Care trackers
• Audit logs
• Personal library• De identified info
• Mandatory reporting
• Community Profile
• Public Health services
• Survey data
• Inspection Reports
• Public Education
Materials
• Locality Alerts
• Statistics
• Population Health Risks
• Communicable Diseases
• Socioeconomic profile
• Registries
• Infrastucture data
• Planning/polocy docs
• Surveillance systems
• Health disparities data
Personal Health
Dimension
Healthcare Provider
Dimension
Population Health
Dimension

16. Alerting
Searching trends for allergic rhinitis and related queries such as pollen count
and antihistamines such as loratadine and cetirizine USA 01/08-12/13
Allergy 2015

17. How online searching leads to targeted web advertising .
Timothy Libert et al. BMJ 2015;351:bmj.h5974
In the United Kingdom, the NHS homepage
generates third party requests to seven
domains owned by American companies,
including NetIQ, Amazon, and Google.

18. Data security

22. Closed Loop
Patient Clinician
Benefits
• personal
• private
• shareable
Risks
• limited functionality
• limited benefit/feedback
• ( hidden transmittability)

23. Benefits
• Records compliance
• GPS location
• Circumstances
• Identify triggers
• Opt out
• Public Health:
asthma clusters
Harms
• Tracking
• Third party sharing
• Privacy/hacking
• Health system oversight
• Penalties
Open Systems

26. van Boven JF, Towards tailored and targeted adherence assessment to optimise asthma
management. NPJ primary care respiratory medicine. 2015;25:15046.
A different model?

27. Putting the Patient at the Centre
Continuity of Care

28. • Incorporating patient centred perspective
• Understanding what matters to patients
• A voice for patients in guidelines
• Engaging patients in clinical research
Ann Am Thorac Soc Vol 11, Supplement 2, pp S112–S117, Feb 2014
Regulatory
Agencies
Industry
Research
Successful
Patient Engagement
=
Successful research
/trial process
Patient
Advocacy Groups

29. • Incorporating patient centred perspective
• Understanding what matters to patients
• A voice for patients in guidelines
• Engaging patients in clinical research
Ann Am Thorac Soc Vol 11, Supplement 2, pp S112–S117, Feb 2014
Regulatory
Agencies
Industry
Research
Successful
Patient Engagement
=
Successful research
/trial process
Patient
Advocacy Groups
But:
Including integration
and interoperability

30. The Past
• Extracting productivity improvements
• Focused on improving transactions,
• Removing duplication,
• Increasing back-office efficiency
• Streamlining certain processes
Imison C, Castle-Clarke S, Watson R and Edwards N (2016) Delivering
the benefits of digital health care. Research summary. Nuffield Trust

31. Patient Passive
The past

32. The Future
Triple aim: improving
• Quality
• Efficiency
• Population Health
Not about replacing analogue or paper or clinician processes
with digital ones
Rethinking what work is done, re-engineering how it is done
and capitalising on opportunities afforded by data to learn
and adapt

33. The Future
Designed around
the patient

34. The Future
Designed with
the patient

35. The Future
Adapted around
the patient

37. The right information, to the right person(s), in the right format
via the right channel, at the right time

38. Risk Assessment Functionality Medical App/Risk
assessment model
A Low risk: little potential harm BMI, Activity
monitors, calory
counters, education,
formulary
Clinician self
assessment
B May cause harm without training or
used innappropriately. Should be
risk assessed prior to use
Inter professional
consultation or
referral; drug
conversion apps
self certification
peer review
C Significant risk due to inherent
complexity or potential for harm if
misused
Diagnostic support,
patient decision
support, medical
calculators
Best Practice
guidelines. Assessed by
local health
organisation
D Significant risk to patients due to
combi of inherent complexity,
functionality> Potential for medical
harm: Any app that turns the
platform into a regulated medical
deice
CDSS tools,
control devices
formal assessment and
regulation
Lewis TL, Wyatt JC. mHealth and mobile medical apps: a framework to assess risk
and promote safer use. Journal of medical Internet research. 2014;16(9):e210.

39. Lewis TL, Wyatt JC. mHealth and mobile medical apps: a framework to assess risk
and promote safer use. Journal of medical Internet research. 2014;16(9):e210.

40. mERA checklist domains
Infrastructure Cost assessment
Technology platform Adoption input: awareness, training
Interoperability Scalability
Intervention delivery Contextual adaptability
Intervention content Replicability
Usability/content testing Data security
User feedback Regulatory Compliance
Participant access Fidelity of intervention
Agarwal, Smisha, et al. "Guidelines for reporting of health interventions using
mobile phones: mobile health (mHealth) evidence reporting and assessment
(mERA) checklist." bmj 352 (2016): i1174.

41. Key messages
• Digital footprints from activities like internet browsing
inadvertently reveal a great deal about our health
• Despite strict regulation of clinical information, health
information obtained through digital activities is now
widely available to marketers with little protection
• Such information also has potential to advance
individual and population health
• We need to tighten access to information used for
marketing while discussing with patients how these
methods could be borrowed by healthcare and public
health organisations
Timothy Libert et al. BMJ 2015;351:bmj.h5974

42. eHealth: The icing on the cake of healthcare