By the Happtique App Certification Program Blue Ribbon Panel:
David Lee Scher, MD, Acting Chair
“e-Patient Dave” deBronkart
Shuvo Roy, PhD
Franklin Shaffer, EdD, RN, FAAN

April 24, 2012

Work on the development of Happtique’s App Certification Program continues.

The standards will encompass the following four areas—functionality, privacy, security, and content. Drafts of these, which are now being developed, will be released for public comment in the next few weeks.

We’ve been focusing on the certification process itself. The process will involve four phases:

1. An app owner will apply for certification. The application will include technical as well as content details of the app.
2. Each app will undergo an initial screening to determine if all the requested information has been provided and its readiness for certification review.
3. Apps that pass the initial screening will be tested first to determine if they meet relevant functionality (e.g., whether the app loads and launches properly), privacy, and security standards.
4. Apps that meet functionality, privacy, and security standards will then undergo content evaluation. Details (such as number of reviewers per app, reviewer credentials, how apps will be assigned to reviewers, what happens if there is disagreement among reviewers about an app, etc.) are being finalized. The content evaluation will focus on whether the content is based on a recognized or reliable source, accurately depicts that source, and produces consistent operational results. The content evaluation will not test efficacy or any outcomes. If an app has been through a clinical or efficacy trial, this information will be submitted as part of the application for certification. Likewise, information about approvals by the FDA or other regulatory bodies will be submitted as part of the certification application process.

Apps that pass all four phases will gain certification status. Feedback will be provided to any developer/owner whose app fails any phase. Length of certification and re-certification requirements and process are still under discussion.

FAQs:
Q: When will the certification program be up and running?
A: We anticipate that the program will start sometime this summer, but we’re committed to developing this program in a deliberative and transparent way, so we’re not operating against any specific deadline. We’re planning to conduct a test with some existing apps to see how the process works from beginning to end.

Q: What are the costs associated with the certification application process?
A: We’re currently analyzing the program costs and will set fees based on this analysis. We are mindful of the need to keep the fees reasonable so that certification is affordable for all developers.

Q: Where will information about the Happtique App Certification Program be available?
A: A dedicated website will be set up to host the application form and instructions for app owners and potential reviewers, pertinent articles and links, press releases, and a categorized list of certified apps.

Q: How long does the submission and review process take?
A: The length of the review process will depend upon the complexity of the app, but is expected to range from one to four weeks, once a complete application for certification is received.

Comments are welcome and may be submitted to appcertification@happtique.com.

By Travis Froehlich, AVP, Corporate Communications
April 13, 2012

Last week, Experian Marketing Services, a digital marketing service, released a report that ranked Pinterest as the third most popular social network in the United States, beating out LinkedIn and Google+. While it seems as though Pinterest just came on the scene, the social networking site was actually launched in March 2010. So, why has it been so successful in such a short time? And what is its potential for mHealth?

Let’s take a step back. For those who don’t know, Pinterest is a virtual pinboard. While browsing the Web, you can “pin” images or videos to your virtual pinboard, which may then be repinned by those with common interests. Their mission is “to connect everyone in the world through the ‘things’ they find interesting.” And it seems to be working. Initially finding a niche among hobbyists, Pinterest became a great way to share common interests, such as weddings, travel, fashion, and other types of visual inspiration.

Research shows that Pinterest is attracting a different demographic than the other social networking sites, which might be what is fueling their rapid growth. On February 11, a TechCrunch article, “Where The Ladies At? Pinterest,” cited Inside Network’s AppData tracking service finding that over 97% of Pinterest’s Facebook fans are women. And clearly Facebook, which initiated an unprecedented $1 billion acquisition of Instagram (the mobile photo sharing app) this week, recognizes the power of photo sharing. Given these statistics, using Pinterest to champion mHealth presents both an opportunity and a challenge.

The opportunity is demographic—reaching affluent women between the ages of 25 and 44. According to a fact sheet posted by the U.S. Department of Labor, women make approximately 80 percent of healthcare decisions for their families and are more likely to be the caregivers when a family member falls ill. Not only is there a gender opportunity, but a geographic one as well. The Experian report also stated that Pinterest has been more successful than its social competitors in capturing more rural users from the Midwest, Northwest, and Southeast.

The challenge lies in the presentation. To play in this social space, healthcare providers, product manufacturers, and even app developers are going to have to find new ways to make their messaging work visually. Healthcare marketers will need to find the right images and infographics in order to make use of this type of social site, once again forcing the industry to think differently.

Is Pinterest of interest to you? What potential mHealth opportunities can you foresee?

By Drew Hickerson, Director, Business Development
March 30, 2012

Innovation that takes place in a vacuum can cripple the very objective it seeks to address.

Oftentimes, healthcare information technology (HIT) start-ups do an excellent job of devising new solutions that solve problems providers didn’t even know they had. However, an innovator’s priorities may not align with those of providers, if innovators lack firsthand day-to-day experience dealing with the challenges of providing care. Their products (although groundbreaking) may not address the most pressing problems in healthcare. That’s why it is critical for HIT start-ups to speak to their target audience—those involved in the treatment of patients—before and during product development, to ensure that they focus on the most pertinent issues.

Although innovations are being developed all the time, they frequently occur behind closed doors. There are a host of reasons why innovators are not sharing ideas. Perhaps the creator: (i) thinks that he/she does not need any guidance from a mentor; (ii) lacks the means and/or access to bounce ideas off the target market; or (iii) believes in first-mover advantage (fears releasing the idea into the public domain before launch).

Regardless, these are not valid excuses for keeping novel ideas away from constructive criticism by industry professionals. Einstein is said to have called compound interest the most powerful force in the universe. HIT start-ups should be mindful of this concept and apply the principle to intellectual equity. As an industry, we should embrace the notion that reinvesting intellectual capital (through feedback, collaboration, and testing), compounded over time, will result in more rapid development and greater outcomes. We need to work together, because it is impossible to tackle the big issues individually.

Many HIT start-ups come to market with grandiose plans of revolutionizing the healthcare system. However, the very problems they seek to address are often multifaceted behemoths, such as readmission reduction, maximizing reimbursements, and increasing reporting efficiency/accuracy. Far too frequently, providers discover that these panaceas need post-hoc modifications, which take a toll on all parties involved. Retrofitting not only results in added costs for the start-up and a delayed release or extended beta test, but it also places a strain on the end users (providers) by requiring them to dedicate their own time and resources to tweak the product in order to implement it.

Providers will not adopt a start-up’s HIT product unless they can seamlessly integrate it into their existing infrastructure and realize a ROI without disrupting workflow. HIT start-ups should do themselves, and providers, a favor by collaborating with stakeholders and seeking input earlier in the development process. This will not only expedite their product’s growth and minimize setbacks, but will also increase their odds of success in achieving meaningful and attainable solutions that fill real voids.

By Travis Froehlich, AVP, Corporate Communications
March 28, 2012

During a recent mHealthZone broadcast, Happtique CEO Ben Chodor asked his guest Robert McCray, President and CEO of Wireless-Life Sciences Alliance, who he felt would benefit most from wireless health, the patients or the providers. McCray replied, “The patients will be the beneficiaries. They’re the focus of it.” While I respect and agree with Mr. McCray’s answer to a point, I think the full story is a little more complicated.

McCray went on to compare the mHealth phenomenon to the music, commerce, and media industries, which have all been turned upside-down by the rise of consumer empowerment. But healthcare is far more complex than any other industry. Unlike song downloads, books, cars, or an endless number of other goods, healthcare “products” (i.e., healthcare services) are not commodity items that can be purchased solely on price and consumer preference. Healthcare services are highly personalized and, in all but the simplest situations, cannot actually be purchased without the guidance or involvement of a trained clinician.

To me, patient empowerment is an idea that, if left to grow unfettered, can create huge problems. For example, this past January, amednews.com (a publication of the American Medical Association) posted an article entitled, Cyberchondria: the one diagnosis patients miss. It states that search engine use has grown from 52% in 2002 to 72% in 2011, and 8 in 10 Americans look for health information online. The result: cyberchondria, which is defined as “an unfounded anxiety concerning one’s wellness brought on by visiting health and medical websites.” According to the article, there is educational value in researching medical concerns on reputable websites, especially for chronic conditions. But because of the growing number of sites, some of which are proving to be unreliable, people are being misled into believing that they may have a medical condition that they, in fact, do not have.

Self-diagnosing as a result of online searches can prove harmful to patients and time-consuming to providers. Worse, constant Web-enabled second-guessing of treatments runs the risk of destroying clinician-patient trust. Cyberchondriacs demand tests and procedures for illnesses from which they mistakenly believe they are suffering—some may even be detrimental to their health. As a result, physicians find themselves spending more time explaining procedures and symptoms (or treating their anxiety), rather than evaluating them appropriately.

That’s not to say I don’t believe in the power of mHealth. Articles about how advances in wireless technology are streamlining patient care and cutting provider costs abound. Tablets and smartphones show great promise for increasing patient access and improving the monitoring of elderly patients or those who live in rural areas with limited access to complex medical care.

I think mHealth will deliver numerous benefits for both patients and providers, but providers must lead the way. When we launched Happtique in 2010, one of our driving principles was creating mHealth solutions for healthcare providers designed and executed by healthcare providers. Healthcare is a specialized, complex discipline that requires clinical and medical education, training, and skills that only licensed practitioners can offer. And mHealth is no exception. As providers go wireless, they should bring their patients with them.

By Travis Froehlich, AVP, Corporate Communications
March 22, 2012

As a long-time marketing and public relations professional, I know that monitoring consumer behavior is a widely accepted practice. However, this acceptance changes vastly the minute you change the word “consumer” to “patient.” While I understand the importance of privacy in healthcare, the idea that we can track unsubstantiated data in order to sell millions of useless, possibly harmful products and services—but we can’t readily use valid and accurate data to save human lives—seems like taking caution to foolhardy proportions.

We give much of our personal information away pretty freely. On February 4, The New York Times published an Op-Ed piece entitled Facebook Is Using You. According to the author, a law professor at Chicago-Kent College of Law, Facebook’s largest commodity is personal data—yours and mine. Facebook uses (and shares) our information to sell targeted advertisements and, in turn, they profit from it. And while Facebook’s advertising revenue represents 85% of their annual revenue, Google’s is even higher. What’s fascinating here is that information represented in your “cyber profile” has the potential to be far less accurate than your healthcare information. Your education, your career, your insurance eligibility, and even your personal relationships can be impacted by your online footprint, which includes comments or posts, photos, reviews, and even search history (and if you share your computer, some of those searches may not be yours). Right now, companies using this type of information have no legal obligation to explain how they collect their data, yet we continue to allow them to harvest and sell our private information every day.

In healthcare, however, you are protected by the Health Information Portability and Accountability Act (HIPAA) of 1996. HIPAA gives you rights over your health information, and sets rules about who can look at and receive your health information. The idea is to protect you from being discriminated against or marketed to based on your health status. Providers go to great lengths and expense to protect your health information, but does this level of protection really matter? Companies are already using other available information to make assumptions about you and the same diagnoses that may or may not appear on your chart.

In another New York Times article, How Companies Learn Your Secrets, Andrew Pole, a statistician for Target, explained how they can use data to determine that a customer is pregnant, even if the customer hasn’t supplied that information. Now some would argue that pregnancy is a medical condition and therefore should be private, protected information. But coming to this conclusion based on your traceable online searches and purchase data is not a breach in confidentiality. Is it?

As mHealth continues to evolve and the use of remote data monitoring continues to grow, we need to know where to draw the line when it comes to using private information. Does that line move if the information is real versus assumed—and does it also move if the information is only used for good?

It’s a fascinating conundrum. We at Happtique would love to know your thoughts.

By Paul Nerger, Chief Technology Officer
March 12, 2012

In the daytime, I’m the Chief Technical Officer of Happtique but at night I go wild. Well, not really wild, but I do things that I’m very passionate about. First of all, I’m an Industry Fellow at the University of California at Berkeley and, in addition to lecturing and doing some research, I’m the founder and board member of a non-profit called the Berkeley Mobile International Collaborative or as we call it, BMIC. It may not be a household word, but we do some very cool things in the area of mobile health and higher education.

We built BMIC around some core ideas:

First, we believe that it is a strong possibility that next great mHealth app and company will come out of a university. After all, university students started some of today’s great companies: Apple, Microsoft, Sun Microsystems, Google, Facebook, Cisco, Polaroid…and the list goes on.

Second, universities realize that they need to do a better job of educating the next generation of entrepreneurs. Specifically, they need to prepare students to take their ideas and passions to build the products and companies that will change the world.

Third, entrepreneurship is really hard to teach in a classroom—to learn it, you need to go out and do it.

Thus, BMIC was born. Our task was to take the model of teaching entrepreneurship at Berkeley: creating teams of students to compete in sports-like competitions, and expand to a global, inter-university competition. We started by contacting faculty at other universities in the Global Venture Lab network; Stanford, Harvard, Michigan, Texas, Florida State, John Hopkins, MIT, Oxford, Cambridge, Singapore, Hong Kong, Polytechnic Turino, Polytechnic Milano, India Institute of Technology, King Saud, Tsinghua and many others. Next, we brought together teams from many of these universities for a competition we called the Annual University Mobile Challenge. Such a challenge would not only provide positive visibility for these fledging student companies (one of which might be the next Facebook), but it would also be a hands-on lesson in entrepreneurship. And because students would compete with each other globally, students from around the world would be able to step-up their game.

Our first University Mobile Challenge was in February 2011 and we just finished the Second Annual University Mobile last week. Both were held in Barcelona, Spain in partnership with the GSM Association (the standards body for mobile phones). The first year we had 11 teams from seven countries and this year we had 16 teams from 11 countries competing. And in both years, the apps that caught everyone’s imagination were dealing with mobile health.

I’ve always thought that mobile health is different. The secret to a successful company is diversity and thus you need both engineering and business students on the team to succeed. But mobile health requires the added dimension of medicine and adding this extra dimension makes it more complicated. Thus we decided to hold mobile health specific events.

And in only two months time, at the end of May 2012, we will be running the GSMA Mobile Health University Challenge in Cape Town, South Africa. As the name implies it focuses on mHealth. And the reaction from university students from around the globe has been fantastic. So far, we have 19 teams who have registered to compete from every continent except Australia. We have some of the oldest universities in the world (University of Oxford) to some of the newest (Amrita University in India). But regardless of the country or region that the students come from, they come with a passion to strut their stuff by showing their new products they think will change the world of healthcare through the use of mobile technology.

And because of the mHealth focus, Happtique is involved. Each student mHealth app will be featured in the in Happtique Professional catalog and thus you will be able to download it to your own mobile phone once you sign up for an account on this site. Additionally, we have offered each student team a free mHealth app certification. It should be one competition that proves a win-win for everyone.

If you would like to learn more about the BMIC, please visit the website at www.bmic.org.

Oh, one last thing. If you would like to help sponsor the competition, we would more than welcome that. The funds that we raise are used for scholarships to the students to help get them to the event and any sponsorship money that we raise is tax deductible in the U.S.

By the Happtique App Certification Program Blue Ribbon Panel:
Howard Luks, MD, Chairman
“e-Patient Dave” deBronkart
Shuvo Roy, PhD
Franklin Shaffer, EdD, RN, FAAN

March 5, 2012

On Friday, February 17, the Happtique App Certification Program Blue Ribbon Panel held its first meeting and began formulating a set of issues that need to be addressed as we embark on the development of Happtique’s certification program. The panel reviewed the processes necessary to ensure success and began to lay out a framework to solicit feedback from all members of the mHealth community.

In general, we view our task as evolving into two broad areas—process and standards.

For the app review process, we will be considering a range of issues, including how apps will be submitted for review; how apps will be assigned to reviewers, as well as reviewer credentials, recruitment, and compensation; length of certification and requirements (if any) for recertification; feedback on apps that don’t qualify for certification; and certification fees.

With respect to performance standards, we will be focusing on such issues as the source of the app’s content (e.g., clinical/evidence basis and/or sponsor); the extent to which the app does what it’s designed to do; how well the app functions from a technical perspective (e.g., reliability, usability, malware); if relevant, how well the app addresses security and privacy issues; and value from the end-user perspective (e.g., healthcare professionals, patients).

We at Happtique want this to be an open and transparent process. The panel includes a practicing physician, nurse, patient, technologist, and experts in healthcare credentialing and certification—key perspectives necessary to make this project a success. As we proceed, we will solicit feedback on the elements of this program from all participants in the mHealth community—healthcare professionals and organizations, developers, patients, caregivers, and anyone else with good ideas. In that spirit, we welcome comments on the issues that we should be considering regarding the app review process and performance standards. Please submit them to appcertification@happtique.com.

By Barbara A. Green, Ph.D., Senior Vice President
February 16, 2012 

About a year ago, Happtique embarked on a mission to develop an app catalog designed to make it easier for healthcare providers and consumers to find medical and health apps—or hApps, as we call them at Happtique. Our participation in the Apple Store^® Affiliate Program affords us the ability to organize and display iOS apps in Happtique. Although we can categorize any app, under Apple’s program, we get a feed from the iTunes^® store, which, thankfully, greatly facilitates the process. Consequently, to date we’ve concentrated on categorizing iOS apps.

As we have reported previously, a team consisting of a nationally renowned medical librarian, a physician, and a nurse developed our classification system, which today consists of 319 categories divided into three major areas – Apps by Profession (155 categories), Apps for Professionals by Topic (70 categories), and Apps for Patients and Consumers (94 categories). This classification system was devised using a bottom-up approach—meaning that our team reviewed thousands of apps to get a comprehensive picture of the topics they address—coupled with a top-down approach—meaning that the team also reviewed outside references, such as physician and nurse specialties designated by the American Board of Medical Specialties and various state Boards of Nursing. Blending the two approaches led to the categories we now have in place. Going forward, we will refine the categories as needed and have plans to add subcategories under additional professions, such as Administrator, Dentist/Dental Professional, Pharmacist, and Social Worker.

Since defining the categories, Happtique has retained a team of curators—mostly physicians and nurses—who have been systematically reviewing and classifying apps into these categories. To date, we have curated 7,775 individual apps, hope to hit 10,000 by the end of February, and expect to have the remaining 15,000+ iOS apps completed in a few more months. Thereafter, we’ll classify any new iOS apps while we begin categorizing and displaying apps for Android^™ and other platforms.

Thus far, our experience shows that each app is assigned to an average of four categories. So, while the numbers change daily due to ongoing classification, Happtique’s 319 categories currently display a total of 29,751 apps. Admittedly, this is a time-consuming and resource-intensive process, but our hope is that this effort makes finding apps significantly easier and more intuitive.

Oh, and by the way, if you’re an iOS medical or health app developer and don’t see your app in Happtique, it could be because it’s in the queue waiting to be classified. But, if you drop me a note (bgreen@happtique.com), I’ll see what I can do to move it up!  Likewise, if your app is already in Happtique and you think we either overlooked a category or included it in a category that’s not the right fit, please send me a note with your suggestions and we’ll be happy to review our categorization.

By Susan Zhu, Assistant Director, Corporate Communications
January 31, 2012

I’m a huge proponent of education, which is why I applaud Apple’s initiative to make educational resources more accessible through the iBook 2 for the iPad. Apparently others share my enthusiasm as evidenced by the 350,000+ textbook downloads from the iBookstore within 3 days of launch (according to Global Equities Research).

iBooks offer full-screen textbooks with features such as interactive animations, diagrams, quizzes, review questions, and annotation tools. Content can be updated easily, and iBooks make backpacks considerably lighter. Additionally, leading education services companies—like Houghton Mifflin Harcourt, McGraw-Hill, and Pearson—will offer educational titles for under $15.00, which is significantly less expensive than current mainstream medical textbooks. Just imagine how this will revolutionize the way medicine is taught and studied.

According to iMedicalApps, iBooks textbooks offer a study cards feature, which allows users to create their own personalized flashcards based on the textbook. Medical students can highlight material and then use it later for reference or self-quizzing.

What’s even more exciting is that the iBook Author, a free authoring app, allows medical educators to create textbooks to complement their own courses. This facilitates a much more personalized, hands-on approach to teaching.

Apple also announced a new iTunes U app, which, according to Apple, gives “educators and students everything they need on their iPad, iPhone, and iPod touch to teach and take entire courses.” iMedicalApps predicts that this suite of media content could “become a ‘hub’ for students to engage and learn interactively—something certain to catch the eye of advanced medical educators.”

Let’s also not forget the money that tablets can save on printing and paper costs. The Yale School of Medicine provided its students with iPads and was able to save $100,000 annually by eliminating copying, collating, and distribution costs. As an added bonus, e-textbooks are also environmentally friendly.     

Since the iPad is currently the most expensive consumer tablet, starting at $499, I’d love to see other companies build on what Apple has started but with a lower price point. Wouldn’t it be great if tablets such as the NOVO7 Basic tablet at $99 and the Kindle Fire at $199 provided similar interactive educational tools? Perhaps we can also hope that future innovators will embrace an open Web standard so that the ability to experience this new way of learning will not be restricted by income.

I’m excited about the benefits that e-textbooks and tablets will provide for our education system. Bravo, Apple, for leading the way.

By Paul Nerger, Senior Advisor
January 23, 2012

I’m proud to be associated with a company like Happtique, which has the courage to stand up and take on what will be one of the toughest jobs in the mHealth industry. What am I talking about? The recent announcement by Happtique to tackle the issue of app certification. It is estimated that 12% of medical apps in the marketplace could be classified as medical devices and thus be subject to FDA approval. But what about the other 88%? A few of these apps will be shut down by the Federal Trade Commission, which recently forced Apple to remove 2 apps that claimed to cure acne through the use of the iPhone’s built-in flash, but these will be the exception rather than the rule. The vast majority of apps simply would not have enough independent information about them to allow consumers or clinicians to make an informed decision as to whether the app is worthwhile.

So, how does Happtique propose to do this? First, we have formed a blue-ribbon panel of experts. The panel will have representatives from the physician, nursing, technology, and patient communities. Their goal is to develop open standards for evaluating mHealth apps, which means open feedback and open for improvement. Standards in healthcare accreditation and certification programs have always been open and it’s important for the technology community to embrace a similar criteria. Most app markets have an approval process, but the process is not transparent. Developers might be told why their app was approved, but they are often held to a non-disclosure agreement as to why their app was denied. An open standard allows everyone to improve.

As I mentioned previously, the panel will be multi-disciplinary. The members include:

• Howard J. Luks, MD, a surgeon who has made a reputation for using social media to improve the quality of healthcare
• Franklin A. Shaffer, EdD, RN, a professor of nursing who plays a vital role in certifying global nursing programs
• Shuvo Roy, PhD, a professor who is part of an MD and Engineering PhD program that is laying the groundwork for using technology to solve real-world medical problems
• Dave deBronkart, widely known as e-Patient Dave, who—as a cancer patient and blogger—became a key activist in the field of participatory medicine and personal health-data rights

This panel is uniquely equipped with both expertise and diverse perspectives, which combined with the familiar principles for accreditation and certification, can professionally address our industry’s need for self-regulation. If we get this right, not only will the entire mHealth industry benefit, but the ultimate goal of mHealth—to reduce costs while improving the quality of care—will move closer to realization. They certainly have my support. I hope that they have yours.