This week, we look at some of the best apps for heart health. After using the COVID-19 App Formulary, Dr Tom Micklewright gives another personal, practical view on three apps which can help patients better manage heart health at home.

ORCHA has reviewed a total of 221 apps for heart and stroke. This is a category of low-scoring apps, with almost 80% scoring below our quality threshold. This is worrying, considering that these apps have been downloaded 1,077,586,960 times on Google Play, and includes apps from well-known brands.

It illustrates why our independent app reviews should be consulted to check which apps are safe to use, before downloading or recommending to a patient.

In the video below, hear Dr Tom Micklewright introduce his independent reviews of heart health apps that can help during the COVID-19 crisis, and how professionals can recommend these solutions to patients via the ORCHA App Library.

Click below to watch the video:

Kardia demonstration: 

Dr Micklewright looks at the way in which the Kardia app and device provides medical-grade single lead ECG tracing, meaning it can be used to detect atrial fibrillation (AF). Patients can take their own readings, which are recorded and can be tracked in the app:

Click here to access ORCHA’s review of Kardia on our COVID-19 App Library.

FibriCheck app demonstration: 

Dr Micklewright demonstrates the FibriCheck app, exploring how it can be used to detect AF, how it compares to a patch-based ECG trace, and what the clinician dashboard feature looks like:

Click here to view ORCHA’s review of FibriCheck on our dedicated COVID-19 App Library.

Fitbit demonstration: 

For his insight into another top-scoring app that can help with managing heart health at home, Dr Micklewright demonstrates how Fitbit goes beyond simply tracking steps and sleep, to also track heart rate. The Fitbit watch and app mean that tracking heart rate can become a routine part of the patient’s day:

Click here to read ORCHA’s review of Fitbit on the COVID-19 App Library.

ORCHA COVID-19 App Formulary: 

Dr Micklewright summarises which apps can have a role in identifying heart arrhythmias, and which help with more general lifestyle changes. All apps mentioned can be accessed on ORCHA’s COVID-19 App Library.

On 5th May, Northern Ireland’s Minister of Health announced as part of NI’s Coronavirus News Conference that a new health App Library has been launched to help people manage their health and wellbeing, as part of the NI Government’s COVID-19 response. We are delighted to have worked with Health and Social Care in Northern Ireland (HSCNI), in collaboration with the Department of Health in NI, to facilitate this App Library.

Our aim is to continue helping health and care organisations to embed safe digital health into care pathways, and allow patients to access assured apps to help with self-management during the COVID-19 crisis.

Health Minister, Robin Swann, explained:

“Since taking up post as Health Minister I have made mental health and wellbeing a priority. In these unprecedented times it is hugely important to consider the impact that this deadly virus can have on our lives, including the impact on mental health and wellbeing.

“We must support people to look after their mental health and this new Apps library will provide a one stop shop where the public can access safe and secure apps to help them during the pandemic.”

Click below to watch the NI Health Minister announce the App Library launch:

As the NHS, social care organisations, and local authorities, continue responding to the COVID-19 crisis, ORCHA is seeing a growing number introducing bespoke App Libraries to help their patients, professionals and service users find the best health and care apps at this time.

Who has recently launched an ORCHA App Library to help their patients and service users?

Over the past month alone, the following organisations have worked with ORCHA to launch a bespoke App Library to help their patients and service users. These sites largely function as part of the COVID-19 response in the first instance, but also to support mHealth recommendation to patients and service users.

• The Chartered Society of Physiotherapy to support its members, physiotherapists, across the country, providing them with the ability to recommend mHealth to their patients and service users
• Lancashire & South Cumbria NHS Foundation Trust (LSCFT)’s App Library serves as part of the Trust’s COVID response in the first instance, allowing its healthcare professionals to recommend apps for self-management to their patients
• Dorset CCG launched an App Library to support Dorset STP, catering to health and social care, including social prescribers and health coaches
• Cheshire & Merseyside HCP’s App Library is part of its COVID-19 response in the first instance, and comes free with SilverCloud on Alma Health, where the ORCHA App Library is integrated as an iFrame
• East Berkshire CCG has also launched an ORCHA App Library as part of its COVID response, which has been implemented as an iFrame on the Frimley Health and Care website and Berkshire West ICP website
• Staffordshire County Council’s App Library has been launched in an iFrame with a COVID-19 focus in the first instance, and has been put in place to support vulnerable communities
• Health and Social Care in Northern Ireland (HSCNI) has launched another App Library in partnership with ORCHA. In addition to its Apps4Dementia App Library, HSCNI has now launched a mental health focused App Library, in collaboration with the Department of Health in NI, as part of its COVID-19 response.

Additional organisations who are expected to launch an App Library to integrate with their services soon include: The Society of Occupational Medicine (SOM), Herefordshire and Worcestershire STP, Shropshire, Telford & Wrekin STP, Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH), Lancashire County Council, Home Instead, and Saints Community Development Foundation, the charitable arm of St. Helens rugby club.

This comes at a time when ORCHA is also providing a COVID-19 App Formulary so that all professionals, patients and consumers can access safe, digital resources to help with the self-management of their health and wellbeing. We hope these App Libraries will help to support populations, health and care workers, and vulnerable people throughout the COVID-19 crisis and beyond, facilitating continual access to safe digital health solutions that have been assessed by ORCHA.

Commenting on this growth in demand for App Libraries, ORCHA’s Founding CEO, Liz Ashall-Payne, explained, “Digital Health has a clear role to play to help tackle the COVID-19 pandemic. In both health and care settings, there are good quality apps that can help make a real difference to someone’s physical or mental health. We are driven to help people find them.”

What are the benefits of having a bespoke ORCHA App Library?

To drive uptake of health and care apps, ORCHA provides tailored App Library sites, featuring a range of evaluated apps to help professional health and care bodies meet the health and support challenges in their region. Our platform is safe, efficient, and enables the best apps to be identified. ORCHA also provides customisable ‘microsite’ App Libraries, which health and care organisations/bodies, local authorities, and charities, can purchase to drive uptake of health and care apps. These tailored App Library sites enable clients to optimally target the audiences they want to activate or support.

What does the Pro Account feature entail?

The ORCHA Pro Account is the key to embedding and integrating digital health into day-to-day care delivery. Pro Accounts can be purchased as part of the microsite, App Library package, so that health and care professionals can recommend apps directly to patients and service users. A Pro Account provides all the tools and support required for professionals to interact safely and effectively with ORCHA’s digital health solutions, as well as providing health and care organisations and systems with the ability to monitor, manage and govern all elements of the digital health integration lifecycle.

The Pro Account offers a variety of ways to quickly find and recommend mHealth apps that have been reviewed by ORCHA, including functions such as: Favourites, Recommendations Sent, Recommendations Received, Quick Search, and the Advanced Search features. Professionals can also choose to share links to app Reviews, rather than recommending an app directly.

Why work with ORCHA?

With over 365,000 health and care apps on the market, empowering people and professionals to know which apps are safe and trustworthy is essential. Working with ORCHA allows health and care bodies, professionals, patients and service users to access high quality digital health.

Embedding an ORCHA App Library into health and care pathways overcomes the barriers of awareness, access, trust and governance that so often inhibit the adoption of mHealth.

Our vision is to revolutionise care through the safe integration of digital health solutions into all aspects of health and care services, leading to more patient-centred, effective care.

Where else does ORCHA work in the UK?

As well as working with health and care bodies across the world, ORCHA continues to expand its service offering across the United Kingdom. The below map outlines which parts of the UK we currently work with, and those areas in which ORCHA App Libraries will be coming soon! We look forward to working with more health and care bodies to help even more patients and service users to access safe, high quality digital health resources.

Established to evaluate Digital Health products and services, the Digital Assessment Questionnaire (DAQ) has evolved over time, first setting standards too low, then too high. But after years of development and significant NHS investment, the DAQ became a global digital exemplar – one of the world’s most rigorous digital health assessment models, yet capable of processing an evaluation within a matter of days. A standard that adapted requirements and thresholds based on need in its broad-based sector.

Any standard intended to replace the DAQ must offer a leap in benefits to the NHS, patients and developers. As such, the initiative by NHSX to design a new standard offers a huge opportunity. After working with national bodies worldwide, helping to develop the NICE standards, and recently, as an approved assessor, applying the DAQ for the past 18 months, we are excited by what can be achieved.

As the consultation on the new NHS Digital Health Technology Standard closes, our call to NHSX will be to ensure that the new standard:

1. Uses lessons learned: In the development of the DAQ, there were many approaches tested and removed because they were unsuccessful. A close understanding of lessons will ensure that time and resources are not wasted. For example, it is tempting to think that the tougher the standard, the more protection it offers. But set the standard too high and no solutions designed to help patients can make it to the market. Regulation needs to measure the right things and set the bar at an appropriate level, giving consideration to the risks that it is designed to mitigate.
2. Does not collate but adapts: Simply collating all appropriate standards into a single assessment process does not work. For example, the Open Web Application Security Project (OWASP) security standard is required in the proposed new NHS Technology Standard, yet the ability to demonstrate compliance with its principles is a hugely complex task, which has, to date, proved impossible. We would encourage the approach taken by the DAQ for the DCB0129 Clinical Risk Management information standard. Here, the assessment process was refined to accommodate the standard’s requirements. This involved developing a granular interpretation of which solutions the standard was or was not applicable to, as well as a refined and more detailed breakdown to evaluate compliance. This step should also seek to remove duplication in checks made by standards.
3. Leverages international programmes: If the new NHS Technology Standard is to utilise international best practice, a good starting point would be the EU sponsored project team behind the crafting of a CEN/ISO Technical Standard for Digital Health and Wellbeing solutions. ORCHA has been supporting this work and can recommend this initiative. The CEN/ISO standard is a significant programme that consolidates an array of the most applicable standards in the Digital Health space into one overarching model. This is a great starting point for any national standard and represents a solid foundation for assessment. The new NHS standard does reference the new CEN/ISO Draft Technical Standard, but with a view to adding it to a list of requirements, rather than using it as an opportunity to consolidate the list of standards required for developers and the process to follow.
4. Is designed with process in mind: The creation of a standard is just the starting point. A process is needed to implement the standard, which can take between 9 to 12 months to develop.  Considering how a standard will be applied throughout development will ease this development stage. Development with process in mind may also help the programme to consider a closed-loop system. For instance, ORCHA works with national bodies across EMEA, providing a review process, national app library and local app libraries which correspond to the national platform. This means the whole process and offer is connected, ensuring a 360° view and management. For example, every time an app is updated in an app store, our system triggers a re-review and the app libraries notify users that the review does not include the latest update.
5. Incorporates AI and other emerging technologies:It will be important for any future standard to build suitable assessment elements around technologies such as AI. With experts in the field, ORCHA has already developed an assessment module for AI and would be happy to support the NHS team in this area. The issue of data interoperability is another essential consideration in terms of future technologies.

We call for these areas to be considered, but most importantly, we ask for clarity around the goal for the programme. There are some fantastic principles and concepts in the draft standard, but it would be good to understand the specific step change in outcomes wanted. Only once we know what the problem and target is, will ORCHA and the digital health ecosystem be able to help the NHS to shape the future of Digital Assessment and the New NHS Technology Standard.