V O L 3 2 I S S U E 1 / 2 3 • M a r c h 2 0 2 3 T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K Existing solutions need to mature, experts find Interactive mobile cancer apps: promising, but formative Interactive mobile apps have become ubiquitous in daily life. The Covid-19 pandemic has escalated the use of disease-specific mon- itoring apps. Mobile apps enabling cancer patients to self-manage their physical condition and symptoms can help them to evaluate toxic side effects of their treatments, offer artificial intelligence (AI)- generated recommendations to minimize them, and alert them to symptom severity requiring medical intervention. patients to input data related to symptoms they were experiencing, but only six analysed this data and provided medical advice based on users’ answers. Only five apps allowed patients to input their own symptoms in addition to the aver- l y g o o e r a C © Mobile apps enable cancer patients to self-manage their physical condition and symptoms. But these apps have not become commonplace just yet. Today, most cancer patients receiving chemo- therapy and/or radiotherapy treat- ments rely on their phones to provide patient-reported outcome (PRO) data, calling a 24-hour can- cer treatment centre hotline. When recording details on the patients’ electronic health records (EHR), this data can enable symptom tracking and surveillance, increase quality and data management, and improve productivity and efficien- cy for healthcare providers. Timely PROs can also help reduce healthcare costs. Clinical studies show that standardized adop- tion and routine use of PROs can improve early identification of patient symptoms and their severi- ty and can trigger human and/or AI interventions. Cancer Care Ontario, an early pioneer, launched a PRO programme for ambulatory cancer patients in 2007. Patients receiving treatment between 2007 and 2015 who actively participated were 8% less likely to visit emergency departments and 14% less likely to be hospitalized, according to a www.healthcare-in-europe.com study published in JCO Oncology Practice. UK cancer app analysis The ability of mobile apps to integrate with EHRs is essential. Researchers at the Christie NHS Foundation Trust in Manchester, UK, conducted a study to determine how many cancer apps available for use in the United Kingdom that focused on systemic anti-cancer therapy (SACT) collected data for multiple types of cancer from adult patients and transmitted the data to a healthcare provider. The research- ers excluded apps from their study if they were for a single type of cancer, diagnostic-specific, associat- ed with a single cancer centre only, required a password-protected log- in with a healthcare provider, and/ or unable to input data. Out of 405 apps identified by UK Apple App and Google Play, only 12 met the researchers’ eligibility criteria. None interfaced to EHRs; today, several have connectivity to some EHRs. Lead author Amy Vercell and col- leagues evaluated the purpose, functionality, and quality of the twelve apps. All of them enabled age 45 symptoms listed by apps. Ten apps generated reminders. Only five provided general cancer and cancer treatment information. None had been tested in clini- cal feasibility trials. The top-rated apps were Careology, ChemoWave, Liyfe, and Vinehealth. Writing International Journal of Medical Informatics, the researchers concluded, ‘There does not appear to be a high-quali- ty patient-facing app available for patients with any cancer type which enables electronic PRO measures (ePROMs) to be documented and analysed, with findings integrating into the patient’s EHR.’ the in Prof. Philip Payne, PhD, the founding director of the Institute for Informatics at Washington University in St. Louis, US, tells European Hospital that ‘the cur- rent state of mobile app devel- opment in the cancer domain is quite formative. There remains substantial opportunity to mature and improve such apps and both improve human-computer interac- tion as well as the quality and com- pleteness of ensuing data.’ He sug- gests that increased focus on the cancer patient experience beyond the clinic and hospital is required. ‘We need to better understand the lived experience, environment, and behaviours of our patients before and after cancer treatment, so that we can assess and predict “trajec- tories” of care. Mobile apps are ideally positioned to allow for the collection of such data both pas- sively and actively.’ Here to stay? A look ahead ‘The goals of integrating digital health tools like mobile health applications and cancer care is five- fold: to improve access, enhance patient and clinician experience, improve outcomes, enhance equi- table care, and foster a more effi- cient care system,’ comments Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation at the Abramson Cancer Center at Penn Medicine in Philadelphia, US. ‘Going forward, we need inno- vation on how these tools are deployed and through what chan- nels. Is text messaging best? Apps? Internet connected speakers? The basic telephone? Which is best, for whom and under what conditions? And on how care teams incorpo- rate the data that ensues into their workflows in order to change the course of care meaningfully for patients? Digital health tools in cancer care are now here to stay.’ UK developer Careology launched its eponymous patient-focused app in 2019, after registering with the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) as a class I medical device, with all Careology’s products UKCA marked. Careology Professional, a “virtual ward” technology, pro- vides a real-time visual dashboard, enabling triage teams to monitor patient vital signs, SACT toxicities, and medication adherence. In 2022, the London-headquartered compa- ny announced a collaborative part- nership with Guy’s Cancer of Guy’s and St. Thomas NHS Foundation Trust, to add features and stream- lined functionality, such as collec- ting data through wearable devices. Careology has announced plans to expand beyond EHR functionality to take care beyond a hospital’s four walls. 'Individual hospitals utilize many different EHRs, and tradition- ally this has presented challenges regarding integration across health- care systems,’ explains Paul Landau, founder and CEO. ‘We have built digital cancer care solutions that allow patient record data and infor- mation to flow securely and effec- tively between systems. A seamless digital cancer care pathway is now vital for our healthcare system.’ Carevive, an oncology-focused health tech company headquartered in Boston, US, licenses its mul- ti-tiered configurable ePROM cancer app to cancer centres in the US for their patients’ use. The app provides automated personalized care plans for patients regarding self-care, can- cer centre resources and feedback, and emergency guidance. It offers remote symptom monitoring and management features to proactively address cancer symptoms before they become severe. The company offers various level of integration of patient-inputted data to cancer centres, depending on the EHR in use. ‘EHR integra- tion is dependent on the desired clinical workflow and IT resources. Not all cancer centres define inte- gration as the same,’ says Madelyn Trupkin Herzfeld, Carevive founder and Vice Chairman. ‘Our deepest integration is with Oracle Health (Cerner), where data are shared bidirectionally, and workflow tools are integrated.’ For sites that have built workflow integrations, the care team can access the Carevive tab in the EHR to view a dashboard of longitudi- nal week-to-week trends of patient symptoms. PRO data is also popu- lated on the EHR’s oncology flow sheets. For symptoms that may require a clinical intervention, a message is sent to the EHR mes- sage center. Interventions are auto  documented in the EHR. Report: Cynthia E. Keen CONTENTS 1-4 5-11 HEALTH IT EH@ECR LABORATORY/ PATHOLOGY 12-16 SURGERY/ENDOSCOPY17-20 www.healthcare-in-europe.com