WHAT CONCERNS USERS OF MEDICAL APPS? EXPLORING NON-FUNCTIONAL REQUIREMENTS OF MEDICAL MOBILE APPLICATIONS

The increased use of internet through smartphones and tablets enables the development of new consumer-focused mobile applications (apps) in health care. Concerns including these apps´ safety, usability, privacy, and dependability have been raised. In this paper the authors present the results of a grounded theory-approach to finding what non-functional requirements of medical apps potential users view as most important. A document study and interviews with stakeholders yielded nine non-functional requirements for medical apps: accessibility, certifiability, portability, privacy, safety, security, stability, trustability, and usability. Six of these were evaluated with two groups (differing by age) of potential users through a vignette study. This revealed differences between the age groups regarding the importance each attributed to apps´ usability and certifiability. Furthermore, and contrary to consensus in literature, privacy was considered one of the least important attributes for medical apps by both groups. Trustability, security, and, for the younger group, certifiability, were considered the most important non-functional requirements for medical apps. The implications of these results for developing medical mobile applications are briefly visited

STRIPA: A Rule-Based Decision Support System for Medication Reviews in Primary Care

The chronic use of multiple medicinal drugs is growing, partly because individual patients’ drugs have not been adequately prescribed by primary care physicians. In order to reduce these polypharmacy problems, the Systematic Tool to Reduce Inappropriate Prescribing (STRIP) has been created. To facilitate physicians’ use of the STRIP method, the STRIP Assistant (STRIPA) has been developed. STRIPA is a stand-alone web-based decision support system that advices physicians during the pharmacotherapeutic analysis of patients’ health records. In this paper the application’s architecture and rule engine, and the design decisions relating to the user interface and semantic interoperability, are described. An experimental validation of the prototype by general practitioners and pharmacists showed that users perform significantly better when optimizing medication with STRIPA than without. This leads the authors to believe that one process-oriented decision support system, built around a context-aware rule engine, operated through an intuitive user interface, is able to contribute to improving drug prescription practices

The STRIPassistant: a Digital Tool to Optimize Polypharmacy

The Structured Tool to Reduce Inappropriate Prescribing (STRIP) is a method to perform a medication review. Part of this method is the pharmaceutical analysis that is digitalized into the STRIPassistant (demo: www.ephor.eu). The effectiveness and time-efficiency of the STRIPassistant will be presented

Usability aspects of medication-related decision support systems in the outpatient setting: A systematic literature review

In this study, we evaluated the usability aspects of medication-related clinical decision support systems in the outpatient setting. Articles published

Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial.

OBJECTIVE To examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital. DESIGN Cluster randomised controlled trial. SETTING 110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors. PARTICIPANTS 2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term). INTERVENTION Clinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing. MAIN OUTCOME MEASURE Primary outcome was first drug related hospital admission within 12 months. RESULTS 2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The hazard ratio for first fall was 0.96 (0.79 to 1.15; 237 v 263 first falls) and for death was 0.90 (0.71 to 1.13; 172 v 203 deaths). CONCLUSIONS Inappropriate prescribing was common in older adults with multimorbidity and polypharmacy admitted to hospital and was reduced through an intervention to optimise pharmacotherapy, but without effect on drug related hospital admissions. Additional efforts are needed to identify pharmacotherapy optimisation interventions that reduce inappropriate prescribing and improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02986425

Risk Mediation in Association Rules : Application Examples

This technical report presents example cases for the algorithm introduced in our paper Risk Mediation in Association Rules: The Case of Decision Support in Medication Review

A FEDERATED INFORMATION ARCHITECTURE FOR MULTINATIONAL CLINICAL TRIALS: STRIPA REVISITED

The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) is a clinical intervention method crafted to deal with polypharmacy problems which are incurred by the concurrent use of multiple drugs. STRIP has been proven to be effective and is included in the Dutch national guideline for polypharmacy. To boost the usage of STRIP in clinical practices, a web application called the STRIP Assistant (STRIPA) was developed and further evaluated as user-friendly, efficient and effective by Dutch physicians. STRIPA has now evolved into a software tool that supports a large multinational randomized clinical trial (RCT). However, in order to successfully implement and use the application in such an RCT, several issues, including multilingual support, clinical data security, data accessibil-ity and consistency, need to be addressed. In this paper, we present an overhauled STRIPA prototype with an lightweight data integration component that supports multinational implementations, ensures data consistency across countries, and maintains data accessibility and security. The component in-cludes a high-level information architecture, data models redesigned to generalize data entities from all countries, and the ETL processes that integrate diverse data sources and transfer data between databases. Technical features of the application are tested during the implementation, and it also is about to be evaluated empirically as part of the RCT across four European countries

Risk Mediation in Association Rules: Application Examples

This technical report presents example cases for the algorithm introduced in our paper Risk Mediation in Association Rules: The Case of Decision Support in Medication Review

AmI in good care? Developing design principles for ambient intelligent domotics for elderly

The combination of ambient intelligence (AmI) and domotics has the potential to respond to elderly people's desire to live independent from extensive forms of care. Their slow adoption of technological aids shows reluctance, though. This article investigates their motivations to adopt ambient intelligent domotics, and proposes design principles specifically based on their preferences and experiences. Respondents appeared to be more acceptive of tangible problems they expected with AmI domotics than intangible ones. In addition, their opinions seemed to be profoundly influenced by the way they perceived their psychological quality of life, while their physical conditions did not seem to have noticeable impacts