Mobile phone apps and web services are commonly used by people to improve their health and wellbeing, and triage, monitor and manage their condition when unwell. Doctors also increasingly rely on medical apps running on smartphones or tablet computers to support their work. However, these apps vary hugely in the quality of their data input screens, internal data processing, the methods used to handle sensitive patient data and how they communicate their output to the user.
There is EU guidance requiring apps used for medical purposes to be CE marked. The HIU has produced guidance on this. CE marking provides a basic standard level of assurance but does not mean that an app is high quality or suitable for a specific purpose. The HIU has produced a checklist to help clinicians assess the structure, functions and impact of medical apps. Use of this checklist should help clinicians to feel more confident about using medical apps themselves, about recommending them to their staff or prescribing them for patients.
Personal health records and patient portals
Personal health records (PHRs) are a key part of person centred care and shared decision making. They are digital tools, which help people to maintain their health and manage their care. They may do this by enabling people to capture their own health and care data, to communicate with their healthcare team, and/or to have access to their healthcare record. They can reduce clinic visits by helping people with long-term conditions to monitor their test results at home. They can also provide an alternative way for people to communicate with their clinicians via messaging, which can again reduce clinic visits while providing the patient with quick and easy access to clinical advice. They can help people share their record across different care providers.
Clinicians are key to the success of PHRs, both in encouraging and supporting patients to use them and also adapting their own ways of working to make best use of the technology. The HIU has produced a landscape review of PHRs, including six case studies from leading sites. These identify current types of PHRs, the benefits being obtained, the issues or barriers holding back progress and the evidence of good practice.
Telemedicine and e-consultations
Telemedicine is the delivery of healthcare services, often where distance is a critical factor, by using technology to exchange information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for continuing professional education. For example, providing access to specialist care through virtual consultations and use of devices (eg blood pressure, weight, urine), for monitoring long-term conditions.
The evidence surrounding use of telemedicine in the UK varies. There are many examples where it has been used successfully and resulted in cost savings, better patient outcomes and improved quality of life, and other examples where it has not been deemed cost-effective and has increased healthcare activity without generating an improvement in quality of life for the patient. An evaluation of the Whole Systems Demonstrator Programme (opens PDF, 430.64KB) provides some evidence-based examples.
The evidence identifies common themes relating to the implementation and use of telemedicine. These include the need to adopt a user-centred approach to design and delivery, the need for service interoperability across health and social care organisations, adequate resources for implementation and adaptations for targeting different diseases and conditions, for example focusing a telemedicine resource on a particular subgroup of patients with chronic respiratory disease rather than an unfocused widespread application.
Information governance applies to remotely provided services in the same way as services provided in a more traditional way. The NHS Digital Information Governance Toolkit is the main source of guidance.