Apps (112)

Based in Los Angeles, iExhale, is an online mental health company. It’s, raised US$1.86 m in funds led by Dorilton Capital. iExhale developed an iOS app for people to exchange messages with licensed therapists. The company plans to use the funds to scale its initaitive and take the platform nationally. People can use the app to share personal information anonymously or offer support to others in iExhale’s social network.

An article in the MobiHealthNews says iExhale’s currently available in California, offering its services to people aged 14 and above. The app aims to improve access to affordable, convenient mental health services. It’s similar to other mobile mental health services like Talkspace.

The comapany has two key foundational factors to their mission. One is a considerable lack of practicing psychiatrists, psychologists and social workers throughout the country. The other’s an increasing willingness of patients to embrace telemedicine. It also belives that many people with no prior exposure to therapy may feel more comfortable when starting their treatment with a virtual visit rather than in person.

iExhale’s benefit is that it’s a safe, non-judgemental environment where users feel supported and understood while life-affirming change is being encouraged. It provides profiles of all online therapists, which allows searches based on experience, area of expertise and special certifications too.

When  people download the app, there’s a 48 hour window, known as Meet A Therapist,. Here, they can browse and meet therapists before booking sessions. This service’s also available to minors without parental consent because their questions are general, with large packages of therapy involved. When an underage client books a session, they must provide proof of legal consent, so parents or legal guardians are involved.

After the 48-hour trial period, sessions cost US $64.99 for 45 minutes, nearly US$1.45 a minute. No subscription’s needed. If users don’t want to book sessions, they can log in to browse iExhale’s anonymous social support network, either selecting the “How Are You Feeling?” feature to express how they feel through writing, pre-loaded pictures or specific emotions. They can also offer support to others in a safe environment. Since there is no free-form commenting or direct user-to-user messaging, and the images and emoticons are pre-loaded, the company believes there is a less of a chance of bullying or teasing.

This app is currently only availbale on iOS, although an Android version is in development. Depression is the leading cause of disability throughout the world and is especially prevalent among low-income African countries, where 75% of the people who suffer from mental illness do not have easy access to the mental health care they need. On average, developing countries only allocate 0.5% of their health expenditures to mental health, compared to more than 5% for high-income countries, says an article in Rand Corporation.

WHO has said armed conflicts, genocide, violence, famine and displacement in Africa cause significant challenges to mental health. Rates of mental disorders often double after emergencies. While the iExhale app does offer greater access to people in these regions, the cost, the reliance on Internet connection and accessibility to smart phones are all obstacles.

Dipsticks aren’t just for checking oil levels in engine. They’re an important part of simple tests that provide good measures of health and illness. Healthy.io pursues the art of colour-based diagnostics. Its app Dip.io uses smartphone cameras to analyse pictures of dipsticks used for urine tests matched against a background of a colour spectrum. Dip.io can analyse the digital photos to see if the results reveal the need to see a doctor or seek a prescription, especially a repeat.

It’s available now for pregnancy, diabetes and protein levels. Healthy.io hasn’t stopped there. These set a foundation for more sophisticated tests, such as urinary infections and as pre-eclampsia in pregnant women to see if their blood pressures are too high.

Vimeo has a video showing how to use Dip.io. A major benefit’s avoiding the need to go to clinics or hospitals for urine tests. For Africa, these efficiency gains can be considerable for patients and communities where they need long and costly journeys. Using dipsticks at home and having results promptly may help avoid some of these.

HIV/AIDS remains one of the leading causes of death worldwide. Avert has estimated that   more than 7 million people in South Africa live with HIV. About 70% of the total global prevalence lives in sub-Saharan Africa, with South Africa carrying the highest burden of the epidemic in the world in 2015. HIV/AIDS is a major health concern in South Africa, with 380,000 HIV incidences and 180,000 HIV/AIDS fatalities in 2015 as reported by Avert. KwaZulu-Natal tops the chart of the country’s nine provinces with nearly 20% of HIV/AIDS patients. 

In 2015, eThekweni District in KwaZulu-Natal’ started using mHealth to help improve services for people living with HIV. Access to HIV/AIDS treatments services remains a challenge, with only 48% of adults receiving Antiretroval Treatment (ART) in the country. South Africa, like many other African countries, face many health challenges, patient and community barriers against the smooth delivery of HIV/AIDs treatment and services.

Health system barriers include a growing shortage of staff due to high turnover, highly congested and poorly coordinated healthcare facilities and a knowledge gap between healthcare providers and their patients. Patient barriers are long distances, transport costs and longer waiting times before receiving primary healthcare or treatment. Lastly, HIV/AIDS related stigma and discrimination remains prevalent in communities.

Health-e News has a report saying the project includes an app so healthcare providers can track individual performances of caregivers in every ward, while indicating where health services are inefficient. The app enables healthcare providers to login with their own personal username to report on their activities and interventions. Managers can use the app to monitor activities in each ward. The project focuses on HIV patients and has received a twelve-month grant of £96,944 roughly R1 547 086 in 2015.

Integrating apps like these in healthcare can increase efficiency in the delivery of HIV treatment and services and can build trust between healthcare providers and their patients. It should help improve co-ordination, address staff shortages, allow healthcare providers to monitor and track their patients’ status, and enable managers to improve the functioning of facilities. It could help other districts too.

Emergency Rooms (ER) are busy. mHealth that eases workload and makes ER doctors’ working lives better are worth it. In Med Page Today, Dr Iltifat Husain has identified four that help.

GoodRx for Doctors, described by Dr Husain as “fantastic … for helping your patients be compliant with their prescriptions,” it included a bookmark to find medications prescribed frequently but may be unaffordable for patients. An equivalent for Africa’s health systems would be well received by communities.

OrthoFlow was developed by UK orthopaedic surgeons and doctors working in Accident and Emergency. Dr Husain says it’s “A great fracture management app that essentially puts an orthopedic surgeon in your pocket.” It helps with fracture management and understanding essential features of fractures, such as how much displacement needs changed management.

STD Tx Guide, developed by the US Center for Disease Control and Prevention (CDC) provides alternative antibiotic regimes for patients allergic to penicillin (PCN). The app was updated recently to include new guidelines.

Gout Diagnosis avoids tapping red or painful joints. Dr Joshua Steinberg took a validated study on gout diagnosis and created an app. He’s a bit of an appthusisast. They’re all available from iTunes.

Africa’s mHealth plans could include investment programmes in ER services. These would have to be in parallel with investment in mHealth for citizens and communities.

Being nosey’s a generic human trait. There’s an app that helps. Following a successful launch in Kenya in April this year, the South African Red Cross Society (SARCS) has announced the official launch of its app, created and developed in partnership with Connectik, says an article in ITWEB Africa.

App users can see where local projects are. When they’ve found out what’s going on near them, they can volunteer, sign up to receive emergency alerts during national and local crises, make donations, register for training courses and events, and see blood donor locations. The launch of the app is the first nation-wide initiative for SARCS' new senior leadership. It’s the organisation's major stepping-stone as it seeks to digitise and improve services.

SARCS hopes the app will provide help to mobilise its resources by increasing membership, volunteer base and programme delivery. It should also improve community engagement.

As mHealth expands, choices and decisions about which apps to use and which to avoid become increasingly challenging. The American Medical Association (AMA) has adopted a set of principles in Safe, Effective mHealth Applications that can help. They may help Africa’s healthcare professionals and health systems too.

The AMA’s position’s that doctors are optimistic about eHealth and its potential medical benefits. It’s also clear that some mHealth apps and devices aren’t safe and can pose threats to patients’ health and safety. Resolving this needs more evidence to show mHealth’s accuracy, effectiveness, safety and security.

The AMA’s principles aim to encourage integration of eHealth innovations, such as mHealth apps and associated digital devices, trackers and sensors, into clinical practice. It does this by promoting coverage and payment policies based on whether mHealth apps and related devices are evidence-based, validated, interoperable and actionable. The principles are:

  1. Support establishment or continuation of valid patient-doctor relationships
  2. Have clinical evidence to support mHealth’s use to ensure safety and effectiveness
  3. Follow available evidence-based practice guidelines to ensure patient safety, healthcare quality and positive health outcomes
  4. Support healthcare delivery that’s patient-centred, promotes care coordination and facilitates team communications
  5. Support data portability and interoperability to promote care coordination of medical home and accountable care models
  6. Abide by licensure laws and medical practice laws and requirements in the state in which the patient receives services facilitated by mHealth
  7. Require doctors and other healthcare practitioners using mHealth to deliver services to be licensed where patients receive services, or as authorised by the state’s medical board
  8. Ensure delivery of services using mHealth is consistent with practice laws
  9. Ensure patient privacy and data security in compliance with laws and regulations and promote patient awareness of varying levels data privacy and security afforded by mHealth.

Given the lack of regulation of mHealth apps, regardless of whether the apps related device is encrypted, the AMA advises physicians to alert patients of the potential privacy and security risks for any mHealth apps that they prescribe or recommend, and document the patient’s understanding of such risks.

A next step is an AMA assessment of the potential liability risks to doctors is using, recommending or prescribing mHealth. Fierce Healthcare has a report highlighting an important difference between prescribing drugs and mHealth. An approved medication basically remains unchanged, but mHealth keeps changing with numerous updates, and not updating's potentially worse.

These principles offer a valuable start for Africa’s doctors and health systems to introduce effective mHealth regulation. As Africa’s mHealth expands, the need for, and value of, regulation will increase too. A lead by Africa’s medical profession will help.

Ten winners of the AppsAfrica.com Innovation Awards 2016 were announced at a pan-African mobile and tech awards party in Cape Town, South Africa. This year, the awards attracted over 200 entries from 25 countries. Winners hailed from Kenya, Nigeria, South Africa, Tanzania, Uganda and Zambia.

Ask Without Shame from Uganda won the Social Impact Award. The app allows youths to access medical advices at any time about whatever emergency they’re facing, or questions they may have about sexuality. Medical experts are on hand to offer free and anonymous advice.

Young people can use the app to access accurate information on their phones about sex, HIV, STDS, body changes, contraception and pregnancy. An easy to use interface makes it possible to access information quickly. If users don’t find the information they need existing categories, they have an option to ask a direct question with guaranteed privacy. Users can also access medical experts by dialing, texting or WhatsApping +256706666001. Users can download the app from Google store by clicking here

Ask Without Shame was launched during the 1st Uganda Innovation Day on 12 December 2015. It reached 3,000 users in its first three months, and was invited as an emerging African Startup to exhibit and pitch at the biggest worldwide IT expo Ce Bit in Hanover, Germany.

The service continues to grow. The team plans to expand its range to reach over a million young people in East Africa.

Clinical depression leaves sufferers feeling isolated, overwhelming all aspects of their daily lives. Its impact’s worst in the Middle East and North Africa. These were the findings of study by a research team at Australia's University of Queensland and published in PLOS Medicine.

The 2013 report says eight African countries were in the highest group of over 7% prevalence for Years Lived with Disability (YLD). They’re Algeria, Botswana, Equatorial Guinea, Gabon, Libya, Rwanda, Sudan and Tunisia. Eight countries are in the next highest group, 6% to 7%; Burundi, Congo, Morocco, Somalia, Swaziland, Tanzania, Uganda and Zambia. Taken together, it’s about 30% of Africa’s countries. Five countries, fewer than 10% are in the lowest group of lower than 4%:  Burkina Faso, Guinea Bissau, Ethiopia, Nigeria and Togo.

Pfizer’s released Mood ivator in the US, an mHealth service to help motivate and encourage adults with depression. Patients can use it to track and export their mood and goal progress. Its data’s in easy-to-read charts that can be shared with doctors to inform care decisions. The app’s designed to complement patients’ treatments. Tracking mood, setting goals and establishing to support daily living are all features. It

Moodivator’s free and available for iPhones from the Apple App Store. It could help millions of Africans.

mHealth and its apps might be smart at diagnosis, but doctors are smarter. A study by a team from Harvard, Boston and Washington, in the Journal of the American Medical Association compared doctors’ diagnostic accuracy with symptom checker algorithms that people can use instead of visiting their doctors.

A cohort of 234 doctors had better results than symptom checkers by a score of 84% for the initial diagnosis compared to 51% for the apps. The overall score put the doctors ahead by about two to one for 45 clinical vignettes of hypothetical patients. About 90% of the doctors were trained in internal medicine, with 52% fellows or in residency.

A report from the US National Academies Health and Medicine Division builds on two ground breaking reports from the Institute of Medicine, To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century. They found that diagnosis and diagnostic errors have been unappreciated in efforts to improve healthcare quality and safety.

The latest comparative study of doctors and apps aim to test eHealth’s potential for improvement. It doesn’t look like it. The findings are crucial for eHealth investment decisions for self-diagnosis as means of expanding healthcare access. It seems that eHealth gains for better diagnoses are elusive goals.

Why is it that lots of mobilists spend hours a day using some apps, but not much on mHealth? Could it be that mHealth isn’t good enough at its psychology? In a park recently, as in now in many other parks, lots of young people were wandering around from tree to tree, seemingly aimlessly, but playing Pokemon. Trees are good for health, but no mHealthers were in the crowd.

While technical imagination and usability are essential for app’s success, many commercial apps are relying on behaviourism, a branch of psychology from B F Skinner in the 1930s. Originating from his stimulus, response and reward using rats and boxes with mazes, levers and food, it’s taken on a new role by B J Fogg as behavioural design. Both are based on the theory that environment can shape behaviour.

An article in The Economists 1843 magazine says that designing the right box, and hey presto, behaviour’s controlled. The old, bad joke was what’s the difference between magicians and psychologists? Magicians pull rabbits out of hats, psychologists pull habits out of rats. Now, they’re putting habits into app users. Fogg found that people spent longer using computers if the computers had previously been helpful to them. The implication’s that apps can be designed using psychology so people will use them when they may not have done.

It’s Computers as Persuasive Technologies (captology), and now embedded into daily life rom Fogg’s laboratory at Stanford University’s Persuasive Technology Laboratory. This behavioural design model sets out to hack people and exploit their human instincts, quirks and frailties. The goal’s to supplement motivation and persuasion with a more effective option of making behaviour easier. When motivation’s high or behaviour’s easy, users respond to simple trigger, such as vibrating phones. Well-designed, called hot, triggers find users at exactly the time they’re ready to burst into action. They put hot triggers in the path of motivated users. 

The challenge for mHealth developers’s to design hot triggers instead of just mundane triggers to appeal to users’ emotions in their computer transactions. This isn’t new. Fogg’s theory dates back a long time before social media invaded the world. Nir Eyal’s added to it since. His book Hooked, he sees hot triggers as internal factors, not internal as Fogg does, so apps succeed when they meet people’s basic emotional needs and unthinking choices before users are consciously aware of them.  Tristan Harris, a former Google employee after Google bought his start-up and his app Apture, calls this “Whoever designs the menu controls the choices.”

Africa’s health systems can benefit by assessing their mHealth apps for effective hot triggers and technical prowess to ensure they’ll maximise benefits. For such a significant investment, it’s essential they‘re effective. They also should ensure that hot triggers are ethical, not just medically, but constitutionally. Borrowing from magic, the hot trigger Genie’s already out of the bottle. Africa’s health systems need to make sure it work well for everybody.