Web-based tool to report cancer symptoms to clinicians
As announced on June 4, 2017 at the Annual Meeting of The American Society of Clinical Oncology (ASCO) by Ethan M. Basch, patients with metastatic solid tumors who used a web-based tool to report their symptoms to clinicians showed improved quality of life and longer overall survival. In this randomized trial, 766 patients were assigned to either standard symptom monitoring or to the intervention, which consisted of weekly e-mail reminders to self-report their symptoms. Median follow-up was 7 years. Possible explanations of the observed survival benefit are earlier clinician intervention in response to new symptoms and enhanced control of chemotherapy side-effects that resulted in longer therapy duration. This study provided critical evidence in favor of the integration of proactive symptom monitoring systems into clinical practice.
eHealth regulations
On the other hand, online symptom checkers are frequently used to self-diagnose and/or self-triage, but the accuracy of such tools may be questionable and the risk-benefit profile is not well established. With increasing popularity of web- and mobile-based digital Health systems, there is a need for more stringent and specific regulations on their usefulness, safety assessments, and their processes of approval.
Work on eHealth policies are well under way – for example, the European Commission’s Unit on eHealth, Wellbeing and Ageing is responsible for the implementation of the eHealth Action Plan 2012-2020. Dr Terje Peetso, a policy officer, recently emphasized the importance of collaboration in the digital health tools development, particularly the engagement of medical doctors in this process. While the European Union prepares for the roll-out of new eHealth policy in the next few years, the UK, with the upcoming Brexit, will also have to face this challenge. It seems more likely that the UK will continue to follow EU regulations, rather than create independent guidelines. This possibility was discussed earlier this year during the Medical apps: mainstreaming innovation meeting at the Royal Society of Medicine.
NHS Digital Apps Library
The lack of clear regulations affects both patients, who try to choose the most reliable health apps, and physicians, who would like to base their recommendations on reliable evidence. To address this gap before stricter regulations come into force, the NHS recently launched a trial version of the NHS Digital Apps Library. This platform was developed to collect apps that have been assessed or are currently being tested by the NHS Digital teams. The broader aim is to make NHS.UK a trustworthy source of effective digital health tools, which may be easily accessed by the public and recommended by physicians.
Patient data protection in eHealth solutions
It’s clear that an app will not replace a doctor, but the most successful digital tools enable remote communication between patients and physicians.
Patient data protection and medical information governance are additional aspects of eHealth regulations that require more stringent policies. This topic has received considerable attention, particularly after a study published in March 2017 highlighted a number of inadequacies that occurred when NHS patient data was shared with Google’s DeepMind. However, not only does the sharing of official patient records need to be regulated, but so does the collection of detailed medical history by tools that use machine learning to provide diagnosis and triage feedback. A number of solutions are currently being developed, with preliminary testing showing potentially high accuracy. Most of these tools will offer a few possible diagnoses and if the symptoms suggest a serious disorder, the tool will direct the user to seek specialist medical care.
What’s next for eHealth?
It’s clear that an app will not replace a doctor, but the most successful digital tools enable remote communication between patients and physicians. While success stories of digital health solutions are regularly in the news, the most pressing matter is to develop comprehensive eHealth policies on effectiveness and safety assessment, market release approval, and patient data protection. Securing these aspects and addressing grey areas will help create better digital health tools that may complement clinical practice and improve patient outcomes.
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