It is well-known that there are some situations in which physicians continue to resist the use of mobile health solutions, and a recent study published in JMIR at the beginning of May sought to identify some of the factors that play a key role in the adoption of a free oncology decision support app. 

Oncology is a growing space in digital health. CE-approved ONCOassist, launched in 2012, gives access to a suite of specialised functionalities and features, such as a drug interaction checker, adjuvant tools and common toxicity criteria, in one platform, and currently has around 11,000 active users. It aims to help free up time for oncologists and oncology nurses and improve the quality of care provided. 

KEY FINDINGS

The authors - from the Anglia Ruskin University in England and the University of Applied Sciences Northwestern Switzerland -  carried out 17 interviews with eight oncologists and three nurses using the app from the UK, Ireland, France, Spain, Italy and Portugal, as well as two members of the ONCOassist team. 

Their findings indicate that the “stability, operation, usefulness and cost” of mobile health tools are some of the key factors impacting levels of adoption, as well as clinicians’ attitudes towards using technology in their work and the endorsement of a solution by organisations they trust. 

Looking at ONCOassist, participants said they found the toxicity criteria, calculators and adjuvant tools to be the most “useful” features of the app, helping them with “time saving and efficiency”. However, the lack of EHR integration was seen as one of its main “limitations”, and the ONCOassist team said that it was seeking to address the issue through their involvement in the Horizon 2020 DEIS project. 

“A big part of our future development is in personalisation,” Kevin Bambury, chief operating officer and cofounder of ONCOassist, told MobiHealthNews. “Oncologists tend to specialise based on specific interests, e.g. lung cancer, breast cancer (…). We are trying to give users a more personalised experience so that they will be presented with the tools and information specific to their specialist interest when they use ONCOassist. As we develop and integrate with EHRs we see an opportunity to go a step further with this and present tools and information that is specific to a patient’s needs based on the patient the doctor is seeing at that time.”

NEW FEATURES, THE NEED FOR FURTHER TRAINING AND THE IMPORTANCE OF CLINICAL INPUT IN THE DEVELOPMENT PROCESS

Asked what additions they would like to see made, participants pointed to a patient monitoring and management feature, which ONCOassist said was being piloted at the time the study was being carried out (at the beginning of this year). The authors note that the results also emphasise a further need for training, with oncology professionals not "always aware" of the functionalities that the app was offering.

Furthermore, although they acknowledge the “relatively small” sample size for the study, their discussions indicate an expectation that clinicians will play a more “central” role in the development of mobile health solutions in the future.

“Often times tools are developed without clinical input which results in poor usability and thus poor user retention. Getting direct feedback from early adopters or beta testers has helped us a lot in the development of ONCOassist,” Bambury said.

Their approach, he explained, includes working with oncology professionals to add new features to the app, as well as meeting users at trade conferences and engaging them to ensure the team understands "the complexities" of clinical practice. “We find the majority of users are very open to giving feedback,” Bambury said.

Meanwhile, one member of the team quoted in the research noted that monetisation was a challenge faced by the company, as with others in this space, saying: “I feel like we’ve figured out the user interaction, and getting that feedback, and building based on that feedback. Now, for us, the big challenge is figuring out how to kind of have a scalable model with companies that results in us generating good revenues and kind of having on-going relationships in helping and showing improved outcomes.”

The authors say that further research will be needed to update their findings, given the speed of technology development and the evolving digital health space. The case study is also limited to a single health app and its use in a specific region, and professionals contacted by the researchers that stopped using the app did not want to participate. Bambury said no financial support was given to the authors for the research or publication of the article.