Compliance of Blood Donation Apps with Mobile OS Usability Guidelines

A method and validation for auditing e-Health applications based on reusable software security requirements specifications

OBJECTIVE

This article deals with the complex process of obtaining security requirements for e-Health applications. It introduces a tailored audit and validation methodology particularly designed for e-Health applications. Additionally, it presents a comprehensive security catalog derived from primary sources such as law, guides, standards, best practices, and a systematic literature review. This catalog is characterized by its continuous improvement, clarity, completeness, consistency, verifiability, modifiability, and traceability.

METHODS

The authors reviewed electronic health security literature and gathered primary sources of law, guides, standards, and best practices. They organized the catalog according to the ISO/IEC/IEEE 29148:2018 standard and proposed a methodology to ensure its reusability. Moreover, the authors proposed SEC-AM as an audit method. The applicability of the catalog was validated through the audit method, which was conducted on a prominent medical application, OpenEMR.

RESULTS

The proposed method and validation for auditing e-Health Applications through the catalog provided a comprehensive framework for developing or evaluating new applications. Through the audit of OpenEMR, several security vulnerabilities were identified, such as DDOs, XSS, JSONi, and CMDi, resulting in a "Secure" classification of OpenEMR with a compliance rate of 66.97%.

CONCLUSION

The study demonstrates the proposed catalog's feasibility and effectiveness in enhancing health software security. The authors suggest continuous improvement by incorporating new regulations, knowledge from additional sources, and addressing emerging zero-day vulnerabilities. This approach is crucial for providing practical, safe, and quality medical care amidst increasing cyber threats in the healthcare industry.

Telemedicine solutions for patients with mental disorders: a Delphi study and review of mobile applications in virtual stores

Mental disorders are a critical public health challenge since they profoundly affected people lifestyle. Mental healthcare treatments aim to promote a higher quality of life of the patients. These procedures include interventions for prolonged mental illness which can be supported by telemedicine technologies. This paper presents a comprehensive analysis of mobile applications selected to address the most critical needs of people with mental problems. Needs include areas of the patient's life, such as basic activities, behavioral changes, and daily life tasks. This work has two main objectives; (1) identify critical needs for patients with mental disorders and (2) identify and analyze apps that can meet the identified critical needs. A Delphi methodology survey was carried with a group of thirteen volunteers, including nurses, assistants, and psychiatrists who are working in Zamora and Valladolid, Spain. This survey has recommended different needs for patients with mental disorders and address objective 1. Google Play and Apple Store have been assessed to select the most relevant mobile applications that were recommended in the Delphi study to address the essential needs of these patients according to objective 2. The results of the Delphi survey show 24 different needs for patients with mental disorders. This study has analyzed 62 mobile applications which address the essential needs recommended in the Delphi study. The selected mobile applications represent 31 applications with feedback (50%); 15 informative applications (24%), and 16 independent applications (26%). On the one hand, applications with feedback request can address 13 recommended needs (54%). On the other hand, informative applications can address 7 needs (29%). Finally, the independent applications are only able to respond to 4 of the 24 recommend needs (17%). Mobile health applications present effective technologies to support the needs of patients with mental disorders. However, this study suggests a critical limitation of mobile applications for mental health since the majority of the applications require user activity. Therefore, future research initiatives on the design and development of mobile apps for people who have mental disorders should focus on independent applications.

Mobile health applications for postnatal care: Review and analysis of functionalities and technical features

BACKGROUND

Providing a continuum of care from antenatal, childbirth and postnatal period results in reduced maternal and neonatal morbidity and mortality. Timely, high quality postnatal care is crucial for maximizing maternal and newborn health. In this vein, the use of postnatal mobile applications constitutes a promising strategy.

METHODS

A Systematic Literature Review (SLR) protocol was adopted to perform the selection, data extraction and functional evaluation of the available postnatal apps on iOS and Android platforms. The analysis of the functionalities and technical features of the apps selected was performed according to a 37-items assessment questionnaire developed on the basis of the scientific literature of postnatal care and a preliminary analysis of available postnatal apps RESULTS: A total of 48 postnatal apps were retrieved from the app repositories of the iOS and Android platforms. The results of the functional content analysis show that the postnatal apps selected relatively achieved low scores owing to the complexity and the ramification of the postnatal care.

CONCLUSIONS

The present study helps in identifying areas related to the postnatal care that require further endeavors to be properly addressed. It also provides directions for developers to leverage the advancement and innovation on mobile technology to build complete and well-suited postnatal apps.

Mobile health app usability and quality rating scales: a systematic review

PURPOSE

To review the rating scales used to evaluate usability and quality of mobile health applications, and to compare their purpose, content, and intended target users (i.e., patients, caregivers, or researchers).

MATERIAL AND METHODS

We conducted a systematic review of the literature in accordance with the PRISMA statement on Medline, CINAHL, PsycINFO, IEEE Explore databases, as well as a review of the grey literature to identify rating scales used to evaluate usability and quality of mobile health applications (m-health apps), between January 1, 2000 and July 31, 2018. Two researchers screened the titles and abstracts of articles that met inclusion criteria, and retrieved usability and quality rating scales from the articles.

RESULTS

We identified 24 usability scales and 25 quality rating scales in 87 peer-reviewed articles. We identified only one quality rating scale designed for non-expert users (i.e., patients or caregivers). None of the studies used a theoretical framework for app evaluation to support the scales. The validity of existing quality rating scales is yet to be investigated.

CONCLUSION

Existing usability and quality rating scales are targeted at professionals, not end users who are patients or caregivers. Rating scales that are usable by all end-users would make mobile health apps accessible and meaningful to consumers.Implications for rehabilitationThe number of mobile health applications on app stores that can be used for rehabilitation is increasing.Most healthcare providers lack the training to identify m-health apps with high quality to be used in rehabilitation.This study has reviewed the current rating scales that can help clinicians and care providers rate the quality of m-health apps and identify the ones that are most appropriate for their practice.

E-health internationalization requirements for audit purposes

BACKGROUND AND OBJECTIVE

In the 21st century, e-health is proving to be one of the strongest drivers for the global transformation of the health care industry. Health information is currently truly ubiquitous and widespread, but in order to guarantee that everyone can appropriately access and understand this information, regardless of their origin, it is essential to bridge the international gap. The diversity of health information seekers languages and cultures signifies that e-health applications must be adapted to satisfy their needs.

METHODS

In order to achieve this objective, current and future e-health programs should take into account the internationalization aspects. This paper presents an internationalization requirements specification in the form of a reusable requirements catalog, obtained from the principal related standards, and describes the key methodological elements needed to perform an e-health software audit by using the internationalization knowledge previously gathered.

RESULTS

S Health, a relevant, well-known Android application that has more than 150 million users in over 130 countries, was selected as a target for the e-health internationalization audit method and requirements specification presented above. This application example helped us to put into practice the proposal and show that the procedure is realistic and effective.

CONCLUSIONS

The approach presented in this study is subject to continuous improvement through the incorporation of new knowledge originating from additional information sources, such as other standards or stakeholders. The application example is useful for early evaluation and serves to assess the applicability of the internationalization catalog and audit methodology, and to improve them. It would be advisable to develop of an automated tool with which to carry out the audit method.

A systematic review of gamification in e-Health

Gamification is a relatively new trend that focuses on applying game mechanics to non-game contexts in order to engage audiences and to inject a little fun into mundane activities besides generating motivational and cognitive benefits. While many fields such as Business, Marketing and e-Learning have taken advantage of the potential of gamification, the digital healthcare domain has also started to exploit this emerging trend. This paper aims to summarize the current knowledge regarding gamified e-Health applications. A systematic literature review was therefore conducted to explore the various gamification strategies employed in e-Health and to address the benefits and the pitfalls of this emerging discipline. A total of 46 studies from multiple sources were then considered and thoroughly investigated. The results show that the majority of the papers selected reported gamification and serious gaming in health and wellness contexts related specifically to chronic disease rehabilitation, physical activity and mental health. Although gamification in e-Health has attracted a great deal of attention during the last few years, there is still a dearth of valid empirical evidence in this field. Moreover, most of the e-Health applications and serious games investigated have been proven to yield solely short-term engagement through extrinsic rewards. For gamification to reach its full potential, it is therefore necessary to build e-Health solutions on well-founded theories that exploit the core experience and psychological effects of game mechanics.

mHealth App for iOS to Help in Diagnostic Decision in Ophthalmology to Primary Care Physicians

Decision support systems (DSS) are increasingly demanded due that diagnosis is one of the main activities that physicians accomplish every day. This fact seems critical when primary care physicians deal with uncommon problems belonging to specialized areas. The main objective of this paper is the development and user evaluation of a mobile DSS for iOS named OphthalDSS. This app has as purpose helping in anterior segment ocular diseases' diagnosis, besides offering educative content about ophthalmic diseases to users. For the deployment of this work, firstly it has been used the Apple IDE, Xcode, to develop the OphthalDSS mobile application using Objective-C as programming language. The core of the decision support system implemented by OphthalDSS is a decision tree developed by expert ophthalmologists. In order to evaluate the Quality of Experience (QoE) of primary care physicians after having tried the OphthalDSS app, a written inquiry based on the Likert scale was used. A total of 50 physicians answered to it, after trying the app during 1 month in their medical consultation. OphthalDSS is capable of helping to make diagnoses of diseases related to the anterior segment of the eye. Other features of OphthalDSS are a guide of each disease and an educational section. A 70% of the physicians answered in the survey that OphthalDSS performs in the way that they expected, and a 95% assures their trust in the reliability of the clinical information. Moreover, a 75% of them think that the decision system has a proper performance. Most of the primary care physicians agree with that OphthalDSS does the function that they expected, it is a user-friendly and the contents and structure are adequate. We can conclude that OphthalDSS is a practical tool but physicians require extra content that makes it a really useful one.

Challenges in Assessing Mobile Health App Quality: A Systematic Review of Prevalent and Innovative Methods

CONTEXT

Mobile apps are poised to become a major source of health guidance; however, concerns about their quality and safety remain. Governments, clinicians, and health researchers are struggling to determine how to adequately evaluate the content and function of mobile health apps to guide consumers toward apps that will effectively and safely support their health. Researchers are both adapting existing research methods, such as those for systematic reviews, and exploring novel methods toward this aim. The purpose of this systematic review was to describe prevalent and emerging methods for searching, data extraction, and analysis in the context of mobile health apps and commercial app stores.

EVIDENCE ACQUISITION

A systematic search was conducted on April 6, 2016, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for published studies that evaluated health-related apps targeted at consumers in a commercial app store, and a descriptive content analysis of their methods was performed.

EVIDENCE SYNTHESIS

Although the majority of studies self-identified as "reviews" or "systematic reviews," their claims to have performed an exhaustive, replicable, and systematic search and data extraction are unsupported, given the nature of commercial app stores' search engines and personalized app content. Currently, studies of health-related app content are largely descriptive, and most use surrogate and one-dimensional outcome measures for app content quality.

CONCLUSIONS

This field is rapidly developing, and innovative methods for systematic searches, multidimensional quality assessment, and contextualizing content assessment are emerging. Areas for future methodologic development are highlighted, including expanding definitions of app "content" and assessing risk of bias.

Mobile personal health records for pregnancy monitoring functionalities: Analysis and potential

BACKGROUND AND OBJECTIVE

Personal Health Records (PHRs) are a rapidly growing area of health information technology. PHR users are able to manage their own health data and communicate with doctors in order to improve healthcare quality and efficiency. Mobile PHR (mPHR) applications for mobile devices have obtained an interesting market quota since the appearance of more powerful mobile devices. These devices allow users to gain access to applications that used to be available only for personal computers. This paper analyzes the functionalities of mobile PHRs that are specific to pregnancy monitoring.

METHODS

A well-known Systematic Literature Review (SLR) protocol was used in the analysis process. A questionnaire was developed for this task, based on the rigorous study of scientific literature concerning pregnancy and applications available on the market, with 9 data items and 35 quality assessments. The data items contain calendars, pregnancy information, health habits, counters, diaries, mobile features, security, backup, configuration and architectural design.

RESULTS

A total of 33 mPHRs for pregnancy monitoring, available for iOS and Android, were selected from Apple App store and Google Play store, respectively. The results show that none of the mPHRs selected met 100% of the functionalities analyzed in this paper. The highest score achieved was 77%, while the lowest was 17%.

CONCLUSIONS

In this paper, these features are discussed and possible paths for future development of similar applications are proposed, which may lead to a more efficient use of smartphone capabilities.

Experiences and Results of Applying Tools for Assessing the Quality of a mHealth App Named Heartkeeper

Currently, many incomplete mobile apps can be found in the commercial stores, apps with bugs or low quality that needs to be seriously improved. The aim of this paper is to use two different tools for assessing the quality of a mHealth app for the self-management of heart diseases by the own patients named Heartkeeper. The first tool measures the compliance with the Android guidelines given by Google and the second measures the users' Quality of Experience (QoE). The results obtained indicated that Heartkeeper follows in many cases the Android guidelines, especially in the structure, and offers a satisfactory QoE for its users, with special mention to aspects such as the learning curve, the availability and the appearance. As a result, Heartkeeper has proved to be a satisfactory app from the point of view of Google and the users. The conclusions obtained are that the type of tools that measure the quality of an app can be very useful for developers in order to find aspects that need improvements before releasing their apps. By doing this, the number of low-quality applications released will decrease dramatically, so these techniques are strongly recommended for all the app developers.

Evaluation Study for an ISO 13606 Archetype Based Medical Data Visualization Method

The objective of this evaluation study is to assess a method for standard based medical data visualization. The method allows flexible and customizable visualization for ISO 13606 archetype based medical data. The chosen evaluation concept is based the Guideline for Good Evaluation Practice in Health Informatics (GEP-HI). The stages of the study were identified. Each stage got a detailed description. We also identified the participants and their required qualifications and responsibilities. The evaluation location was described in details. The evaluation metrics were defined. The questionnaires for doctors, patients and experts were developed to fulfill the requirements of the evaluation study. The study was performed in Tomsk, Russia. 30 patients and 5 doctors participated in the study. The overall performance of the users reached the expert level by the end of the study. Patients as well as medical staff stated in their comments that the usability of the system was high, and they preferred it to the previously used paper-based and computer based systems. This was also shown by the high level of satisfaction measured within our study. The visualization approach, integrated into the electronic health record, was well accepted in our pilot setting with high usability scores from patients and doctors alike. The results showed the efficiency for both modeling and visualization part of the system.