Pharma and the iPhone: there’s an app for that
pharmafile | September 1, 2010 | Feature | Medical Communications, Research and Development, Sales and Marketing | ipad, iphone
The iPhone and its new, larger cousin the iPad, have captured the hearts of many technology lovers, and have ushered in a new age of mobile communication, putting a world of information at the fingertips of users.
What makes these devices indispenable are the apps – there are thousands of these downloadable (and usually free) software applications which can help you find out what the weather’s like on the othe side of the world, translate text, play games, and much more.
So how is this revolution touching the medical and pharmaceutical worlds? There are already thousands of iPhone/iPad medical apps, and a handful of these have been produced by pharma companies. The first appeared last year, with Sanofi-Aventis’ GoMeals and Novartis’ VaxTrak apps among the earliest examples, but pharma is now starting to realise that (in Apple’s words) ‘there’s an app for that’.
Apple’s products aren’t the only smartphone devices on the market, of course. Blackberry, Nokia, Palm and Google’s Nexus One are all major competitors. In fact, in the first three months of this year, the iPhone accounted for only 15% of global smartphone sales, ahead of Nexus One (10%) but behind Blackberry (19%) and Nokia’s Symbian operating system which accounted for a full 44 per cent.
Smartphone ownership is already common among doctors, but use is currently often restricted to accessing clinical content and performing simple tasks. However, industry analysts Manhattan Research say that within the next two years 81% of US doctors will own a smartphone (up from 64% in 2009), and that about half of this group will use their devices for administrative functions, learning, and patient care.
Most apps are free from Apple’s iTunes store, with a handful of exceptions, such as Merck’s Vree for Diabetes app which has a $4.99 price tag. We counted a total of 39 apps produced by the 11 largest pharma companies, revealing branded and unbranded apps, patients and healthcare professional apps, and apps aimed at a variety of markets, including the US, UK, France and Turkey.
Overall, the number of apps from pharma clearly isn’t huge so far, but they do show that the industry is willing to experiment with this emergent new technology.
Can technology improve patient care?
Let’s not lose sight of what should be the ultimate aim of all this new technology in healthcare – to improve patient care. The million dollar question then, is this – can all this technological innovation really improve the lot of patients? And how, exactly, do smartphones fit into a meaningful digital revolution in healthcare?
It is clear that smartphones won’t bring revolutionary practice on their own – rather they will converge with other digital systems and technologies (possibly in unforseen ways).
Probably the most significant private enterprise players are the online medical reference and resources sites such as Epocrates and Medscape’s eMedicine. Epocrates was first launched in 1998 as a mobile medical information and resource portal for doctors, and now claims that 40% of US doctors actively use its products and services.
The arrival of the smartphone has made the role of Epocrates and its rivals look even more important. Now available as a smartphone app, Epocrates says one million doctors worldwide use its products, and that one in five US doctors actively use its app on their iPhone or iPod touch. Other companies, including all of the large medical publishing and data companies are now trying to gain a foothold in this field.
Thomson Reuters and its Micromedex service, and Elsevier’s MD Consult and First Consult are competing to provide their resources in convenient formats so that doctors can use them as ‘decision support’.
Epocrates has also just launched a collaboration with Pfizer to allow users to view some 40 Pfizer drug profiles, and contact the pharma company directly if they have any questions about them.
International authorities are now recognising the importance of the platform. The UK’s cost and clinical effectiveness body NICE has launched a mobile version of its online clinical evidence portal for healthcare professionals, NHS Evidence. The service pools clinical data from trusted sources, including the Cochrane Collaboration and UK pharma body the ABPI. Overall, then, the conceptual promise of all these mobile-enabled sites is clear – having clinical evidence at their fingertips will mean doctors are able to make better (evidence-based) clinical decisions – although proof of this is a long way off.
Meanwhile, the need for an online system for reporting adverse events is also being met by regulators – the FDA and the National Institutes of Health recently launched their joint Electronic Safety Reporting Portal: (https://www.safetyreporting.hhs.gov). The new site, called the Safety Reporting Portal (SRP), provides greater and easier access to online reporting.
Electronic medical records
The single most important innovation in the field of healthcare technology will be the use of electronic patient records – and the US is about to make that step forward and transform its paper-based medical records system into a state-of-the-art electronic system.
The US government estimates that just 20% of doctors and 10% of hospitals use electronic health records (EHR) systems with the majority still reliant on paper records.
Numerous factors have held back adoption of electronic records so far, not least the cost and complexity of introducing such a major IT project across the country’s fragmented health system. Doctors and hospitals in the US will have to adopt new digital technology and change the way they work in order to secure payments from a $27 billion government fund.
The project to introduce electronic patient records to the NHS in England should provide a salutory lesson for the Americans, however. Part of the biggest civilian IT project ever, the project is six years behind schedule and millions over its budget. Not expected to be complete before 2015, several independent investigations have also raised doubts about whether it can produce meaningful benefits for patients once complete. In the US, Epocrates is trying to provide a shortcut solution, by offering its own electronic health record software to doctors. However it envisages it only being used by primary care doctors who work alone or in small group practices. Clearly, with such complexity and fragmentation in the field, it could be a decade before EHR systems are in place around the world, and beginning to demonstrate their potential for improving patient care.
Are smartphones medical devices?
As in other emerging areas of digital media, such as social networking, the question of regulating pharma’s involvement is never far away.
So are iPhones and their apps actual medical devices, and thus should they be regulated by the FDA and equivalent bodies?
The question might seem absurd at first glance, but when you consider the important role that some diagnostic apps already play in treating patients, the question is clearly a reasonable one.
In the US, the FDA is already pondering this question – and certainly, by many definitions, smartphones would qualify as medical devices.
Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health (CDRH), went on record earlier this year saying that the FDA was now “reviewing the use of applications on mobile technologies for the screening, diagnosis, prevention and treatment of diseases and injuries”.
In the meantime, the pharma industry in the US, Europe and elsewhere will just have to engage in the new technology without formal guidance on what can and cannot be done with smartphones. If only there was an app for that…
PHARMA APPS FOR DOCTORS
Dosing Calculators: The most common app now being created for pharma for healthcare professionals are simple calculator based programs. The dose calculator is the most common – relatively easy to create, and hopefully specific and handy enough for doctors to keep using.
The following are just a handful of the many variations on this theme which have been developed.
Schering-Plough UK (now part of Merck) has developed several apps. One is the DAS28 Calculator for Healthcare Professionals: it calculates a patient’s Disease Activity Score (DAS) score which uses a complex mathematical formula, and factors in the tender and swollen joints (out of a total of 28), the erythrocyte sedimentation rate (ESR, a blood marker of inflammation), and the patient’s ‘global assessment of global health’. It also includes prescribing information for Remicade and a facility for adverse event reporting. This consists of a link to the MHRA’s Yellow Card adverse events reporting site and a UK telephone number of Schering-Plough.
Remicade Dosage Calculator for Healthcare Professionals: a branded UK dosing calculator, it also includes UK prescribing information for Remicade and the same facility for adverse event reporting.
CL PASI Calculator for UK healthcare professionals is prod-uced by Janssen-Cilag. The disease calculator helps determine how severely a patient has been affected. Priced at £4.99 at the iTunes store, it’s based on the Psoriasis Area Severity Index (PASI).
Novartis’ GIST Calculator, an app for Canadian doctors to calculate their patients’ risk of recurrence for GastroIntestinal Stromal Tumours (GIST).
Novartis Oncology Medical Information: US app for healthcare professionals to view and download standard response documents to many medical inquiries. Can also be used to submit a medical inquiry directly to Novartis.
Pfizer Oncology has produced a prognosis calculator for UK doctors diagnosing and treating patients with metastatic renal cell carcinoma (mRCC). The app requires a ‘yes’ or ‘no’ to five key mRCC risk factors and produces a favourable, intermediate or poor prognosis based on the answers.
Healthcare professional portals: In France, Wyeth was been particularly bold in launching its own general site for doctors DocteurWWW.com, (and Pfizer is now pursuing the strategy following its takeover of Wyeth in 2009). A mobile app has now been launched that includes its RSS feeds and podcasts. There is also clinical content themed around oncology, rheumatology and haematology.
Ortho-McNeil-Janssen’s Blackbag app is similar: it offers medical news, tools and resources for US healthcare professionals working across multiple specialties and therapy areas. It includes medical news, conference coverage, journal summaries, videos, podcasts and FDA MedWatch safety alerts.
Maps and locators: Another common type of app being developed are those using maps or geographical searches. GSK Oncology has produced a US app in collaboration with MedTrust Online for patients and doctors to find cancer trials within 150 miles of their current location.
The app links to MedTrust Online’s trial database, which originates from the US national ClinicalTrials.gov database, and is updated bi-weekly.
Doktor Bul is a Turkish app to help the public find local paediatricians and obs/gyn specialists, which is developed as a tie-in with GSK’s Turkish public-facing websiteAsiDunyasi.com.
HELPING PATIENTS MANAGE CHRONIC DISEASE
Many organisations are now realising the potential of smartphones in helping people with chronic diseases to manage their condition. So-called ‘telehealth’ has been talked about for a number of years, but smartphones could make it a reality. For instance, the convenience of mobile devices could help diabetes patients maintain closer control of blood glucose levels and other metrics, and share these records with their doctor.
In March 2009, Lifescan (part of the J&J group) unveiled a prototype iPhone app that would allow users to connect their blood glucose monitors to their iPhone, and from there manage their records electronically. This is one of the most advanced concepts in the field, but has yet to be launched.
In the meantime, there are many diabetes apps which allow patients to manually input their blood glucose reading into their smartphone and keep track that way. Merck’s Vree for Diabetes is a US patient app that allows patients to track blood glucose, nutrition, activity, medical contact and progress charts. It comes with a $4.99 price tag – a marked contrast from other big pharma apps featured here, which are free to download and use.
One of the most popular apps developed by pharma is GoMeals – a US app by Sanofi-Aventis, it combines three tools – a nutritional database, a food-tracking tool to record meals and a restaurant locator. The app is for anyone interested in healthy eating, but is especially useful for diabetes patients, who should keep a close eye on their diet.
Other apps
Merck’s iManage Migraine: this app is for migraine sufferers, and includes a patient diary, educational elements and analytical tools for the patient and doctor to better understand the information entered into the diary. Merck have also developed iChemoDiary: a patient diary for US chemotherapy patients, it allows users to record their chemotherapy schedule, treatments, and symptoms.
Mon Krono Santé is a French health record for chronic disease sufferers. Users can store their personal medical information, including medical advice given to them, and synchronise the data with a computer – their own or their doctor’s. Also available in an iPad version.
Factor Track: US app for patients to record their haemophilia A Factor VIII infusions, whether on a prophylaxis or on-demand basis. Part of Bayer’s Living Fit programme, the app allows users to receive infusion reminders, track infusions and doses, add notes related to the location of their bleeds or changes in dose, and email this to themselves or to their healthcare team.
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