Featured image: ORCHA report on data security in period tracker apps

A research team at ORCHA, the Organisation for the Review of Care and Health Apps, has examined the privacy policies of 25 period tracker apps and revealed significant flaws.

This follows the US Supreme Court’s decision to overturn the constitutional right to an abortion, leaving privacy experts concerned that data from period-tracking apps could be used to penalise anyone seeking to terminate a pregnancy.

Intimate data stored in some of these apps can show details of sexual activity, contraception used, and when the user’s period stops and starts.

Amongst the 25 period tracker apps from 24 app developers it examined, ORCHA discovered only one single app which kept all the sensitive data on the mobile phone or device owned by the user.

The rest shared it with the app developer.

Furthermore 84% of the apps allowed the sharing of personal and sensitive health data beyond the developer’s system, with third parties. At 68%, the majority did so for marketing, 40% for research and 40% for improving developer services of the app itself.

Amongst those sharing data with third parties, only one single app demonstrated best practice by explicitly asking users for permission within the app itself, rather than bundling this into the Terms and Conditions, which very few people read.

ORCHA believes there is an industry-wide issue with where and when users are asked for their permission to share their data.  This often comes at the beginning of the app registration process, with new users being asked to tick overall consent to Terms and Conditions and the Privacy Policy. Having signed away control of their personal data within minutes of downloading a new app, it then becomes hard to regain control.  Five of the apps tested offered no email address or telephone number for the app developer, which would have allowed users to request that their data be deleted, although this is a legal requirement.

 Tim Andrews, COO of ORCHA, said:

“It would be best practice for an app to have a ‘consent’ page that’s easily accessed from the main menu. Each individual permission could then be ticked or unticked at any time. So, a user wanting to guarantee privacy, could easily change their mind and untick the permission to share with third parties.”

 Beyond sharing data with third parties, ORCHA found other data security concerns including:

•       Almost half of the apps tested which processed personal and sensitive data, demonstrated poor compliance with GDPR.
•       Only two showed evidence of conformity to best practice certifications including ISO27001 and Cyber Essentials.
•       Eighty per cent of the apps reviewed did not meet the wider quality standards needed for them to be included on ORCHA Health App Libraries for NHS providers.

Fatima Ahmed, Registrar in Obstetrics & Gynaecology and ORCHA’s clinical lead for maternity and women’s health, said:

“Period tracker apps have come into sharp focus for alarming reasons – but they are probably the tip of the iceberg when it comes to data security. And even app developers who promise to stop sharing names and addresses, for example, should be aware that people can be identified by an IP address.”

To find out more details and discover two best practice apps, access the full report here.

Feature image: Shot of a young businesswoman using a smartphone in a modern office stock photo

Today (20 July) the first ever government-led Women’s Health Strategy for England today has been published.

A CALL TO ACTION FOR THE FEMTECH INDUSTRY

A statement from Liz Ashall-Payne, founding CEO of ORCHA

This is a day to celebrate. A recognition, finally, that women have unique needs and that decades of under-funding, coupled with the pandemic, have left women’s health services reeling.

Yes, we desperately need to tackle ‘deep-rooted and systemic issues’: undiagnosed endometriosis, poor uptake of breast screening and lack of support for women who’ve experienced domestic abuse, to name a few.  But how?

In short, through innovation.

The proposed leap forward in women’s services means thinking differently. In his June 2022 PLAN FOR DIGITAL HEALTH AND SOCIAL CARE, the then Secretary of State for Health and Social Care, Sajid Javid, said that digital transformation would be the linchpin upon which reforms should be based.

We agree. There are many health apps, often designed by NHS clinicians and backed with clinical evidence, to help address women’s health issues and improve the efficiency of the NHS.

And recent independent research we commissioned from OnePoll has shown that 59% of women believe digital health can alleviate the burden on the NHS, with 43% already using a health app. Women are increasingly recognising the flexibility and convenience of being supported by digital technology.

But here’s the problem: according to this same research, only 17% of women are being recommended these health apps by a healthcare professional. This leaves the majority of women to find a digital solution from Google searches or the recommendations of friends. We certainly wouldn’t expect anyone to find their own medicines via a Google search.

Added to this concern, ORCHA has assessed more than 200 FemTech apps, testing each against 350 criteria, and discovered that only 20% of these meet thresholds for quality, safety or effectiveness. In particular, our research into the privacy policies of 25 leading period tracker apps leaves us gravely worried.

We call on the FemTech industry to recognise that this is the hour to act, and to raise standards. ORCHA is here to support you.

And doctors, nurses and clinicians: digital health can support your work in a myriad of ways – and much of this great innovation is coming from your colleagues within the NHS. We recognise that this is a period of massive change, so we’ve set up a free and CPD-accredited online Digital Health Academy to support you. The Academy can be accessed here or on the NHS Learning Portal here.

Situation

In 2019, Humber, Coast and Vale Integrated Care System (ICS) (now Humber and North Yorkshire ICS) set out their Strategy for Digital Transformation. At the time, the population served by the ICS was 1.4 million people, with 23% of the population living in the most deprived areas of the UK, and a high proportion of this population living in extremely rural and isolated areas. 

The ICS was under a great deal of pressure. If no transformational changes took place, the Humber, Coast and Vale ICS expected a budget deficit of at least £420 million by 2020/21. 

Digital transformation was fundamental to improving the health of both citizens and the system itself. During the process of developing its digital strategy, the ICS commissioned a public survey to ensure any digital transformation was aligned with their citizens’ needs. Amongst the responses to questions on digital improvements to the patient experience were several requests for patient-related healthcare apps.

Despite the fact that the growing adoption of digital health was clear, many health and care professionals had difficulty knowing how to incorporate it into their service delivery. Staff reported it was hard to tell which of the hundreds of thousands of them available would be relevant and beneficial to the vulnerable people they support.

Solution

The Humber, Coast and Vale ORCHA Digital Health Library launched in 2019 at hcv.orcha.co.uk (now at hny.orcha.co.uk), with the intention of delivering quality-assured digital health to their population. The Library contained only apps compliant with safety standards, and provided an easy way to search for the highest rated apps across a wide range of issues. 

In 2020, the project team chose supporting healthy living and long-term condition management as key focus areas for their population, particularly with face-to-face services being halted during the COVID-19 pandemic. The team identified social prescribers as being particularly well-placed to deliver these services, and connected ORCHA’s team behind the implementation of the Library with teams such as Citizens Advice Clinic. 

Results

Social prescribers at the Citizens Advice Clinic found the inclusion of assessed digital health technologies within their work to be an incredibly valuable additional tool. 

Elaine Elsdon at the Citizens Advice Clinic was introduced to the Humber ORCHA Library in May 2020, and began using it right away. She has found that the assurance of being able to signpost people to the health technologies available, in combination with the robust review process behind their inclusion in the Library, is very reassuring to the people she supports.

The wide variety of health and care technologies (including apps) that are identified in the Library for each condition area means that she can identify support for the wide range of people supported by the Clinic. If a client presents an issue which she hasn’t previously found a solution for, she can simply search to see which assessed solutions are available, and recommend them securely to her clients.

Mainly focusing on mental health and exercise and weight management apps, Elaine has adopted the recommendation of apps to her clients, with resounding success. Many of the clients being supported by the Clinic haven’t considered using apps for their health, but may be looking for support either in addition to or as an alternative to medication and traditional therapies. As accessing services became difficult during lockdown, Citizens Advice clients have found great use for apps to support the management of their own health.

Furthermore, as many felt during the pandemic that they might be using up limited resources which would be better spent elsewhere, or that the complexities of trying to access these services was causing them stress, the instant accessibility of support provided by health apps was and remains very much preferable. As traditional services have begun to be reinstated, Elaine has found that health apps have continued to provide support to her clients, some of whom don’t wish to access helplines or face-to-face or group therapy sessions.

The ORCHA Pro functionality has also been incredibly helpful to Elaine, allowing her to keep track of which apps she has recommended to whom, and based on this, to find solutions for clients with similar health concerns. As well as being able to track previously successful apps, Elaine can find new apps, and apps for health concerns she hasn’t previously been presented with. Furthermore, through ORCHA’s Digital Health Academy, Elaine can continue to develop her understanding and use of digital health.

Elaine Elsdon, Link Worker at Citizens Advice Clinic said

“Without ORCHA, I just would not have ever considered recommending any app at all. So for me, it’s opened up a completely new world. And therefore, it’s influenced me. It’s made me a better practitioner because I have more tools available to me, and it’s opened up a wider conversation with my clients about different kinds of support that are available out there.  I think that can only be good, for me as a practitioner but also for my clients because it gives them a much broader opportunity to look into options that might be a better fit for their needs. Not everybody wants to go to a face-to-face group in the community, and something like an app might just prove to be a perfect solution for someone.”

The health apps themselves have been incredibly beneficial for many clients. Mental health apps in particular had very positive effects for those who had perhaps been guided through various coping strategies, but, due to the nature of mental health illnesses, found it difficult to remember what they were supposed to do when they were struggling. By accessing mental health support on their phones, however, they found that they could practice these strategies as many times as they needed to, without feeling judged in any way, or as if they were taking up time or resources.

One mental health app in particular, an AI chatbot app called Woebot, has been very successful in supporting Citizens Advice clients, as it allows them to work through and reframe thought patterns they are struggling with, as many times as they need to. One user described it as “a friend in my back pocket 24 hours a day, seven days a week.”

Chloe, a client at Citizens Advice Clinic said

“[The app] is very good.  It helped me to change my mindset.  I can have self-destructive and negative thought patterns and it helped me to challenge those thoughts.  It’s such a shame I didn’t have this app in Lockdown.  It’s so helpful because I can just offload to the app any time of the day or night and clear my head.  I think of this as my little buddy, and I look forward to the next goal we can work on together.”

To date, the Humber Library (now relaunched as Humber and North Yorkshire, in line with changes to the ICS) has had almost 10,000 page views. There are over 100 ORCHA Pros registered to the Humber site, with the most popular apps being recommended residing within the mental health and healthy living categories, and having a particular focus on anxiety and depression, relaxation techniques, and cognitive behavioural therapy. Mental health is by far the most searched term within the Library, but searches for diabetes, fitness and weight management apps are also common.

As the weather gets nicer, we all like to spend more time outside. And we often hear about how good being outdoors is for our health – usually as we’re being hustled out of the door while the hoovering is finished. But it’s all well and good being told to “go outside”, “experience the joys of nature” and “touch grass”. Ok, you’re outside. Experiencing nature. Touching grass. Now what?

This is where the famous mindfulness comes into play. Mindfulness is talked about a lot these days. To be honest, it can seem intimidating – the idea that you have to be completely present, in a state of total calm, et cetera. But mindfulness is a skill, like anything else. You start small, and slowly but steadily improve. 

Guided mindfulness meditations are a good way to start practising, as these can help to keep your mind on track when it (inevitably) wanders. For guided meditations and help learning mindfulness techniques, there are some great health apps in your Digital Healthy Schools Library which can support you with practical techniques and reminders to practise them. Search “mindfulness” to get started – and remember that you can use the filters at the top of the page to find the best app for you.

And just to note – mindfulness isn’t for everyone. Many people find it helps them manage their day-to-day stress, but for some it just doesn’t work. You may want to try this article from Mind, for more information on whether mindfulness is right for you.

So, what is mindfulness?

Mindfulness is the act of noticing what’s happening in the present moment without judgement. This could be what’s happening in your mind, your body, or around you.

Whenever you catch your mind drifting into other thoughts, just gently bring it back, without any judgement towards your mind for doing what it does naturally: drift. Notice how thoughts come and go, and create space between them. This may help you to learn that your thoughts don’t have to define you, which might help you react more calmly to situations, and teach you to reflect before you respond.

Just paying more attention to yourself and your surroundings – noticing how you feel in this moment, looking more closely at whatever you can see, focusing on what you can smell, feel and hear – are all mindfulness exercises. You don’t have to be outdoors – but this article is titled “Getting Outside”, so we’ll stay on theme.

This leads nicely onto a great mindfulness exercise you may have already heard of: the Five Senses exercise. The goal of this exercise is to calm your mind by using your five senses to focus on your environment instead of your thoughts. This can help you to be present in the moment, keeping your mind just busy enough not to begin worrying, planning or daydreaming.

• First notice five things you can see. Try to look for things that you wouldn’t usually notice.
• Second, notice four things you can feel. Your clothing, the ground under your feet, the breeze, any four things.
• Next, notice three things that you can hear. Bring your attention to sounds in the background that you don’t usually pick up on, like nearby traffic, or birds singing.
• Next, notice two things that you can smell – whether they’re nice or not-so-nice.
• Last, notice one thing you can taste – whether it’s the last thing you ate, a sip of a drink, or your morning breath. Without judgement.

Nature has a scientifically proven positive effect on our mental health. Green and blue spaces (parks or woodlands and beaches or canals) are great – but trees planted along a street, plants in pots and even watching nature documentaries are all shown to be good for our mental health. In the section below, there are some great apps to help you get started with mindfulness and getting outdoors – you can search them in your Digital Healthy Schools Library to see exactly what support they provide and view some screenshots from within the apps to check that they feel right for you. If these apps aren’t quite what you need, try searching “mindfulness” to find the best app for you.

So get outside. Stare at the sky. Touch grass. Just pay attention while you’re doing it.