Mental Health is a significant challenge for health services in the Netherlands. Depression has the highest burden of disease of all health conditions (8.2%), including cardiovascular diseases and cancer (1). To address this growing demand, professionals have identified that digital health can be useful in treatment, enhancing, and extending services. But they haven’t used it extensively, as there has been uncertainty around which products are good. Professionals wanted digital health to be assessed before recommending it to patients.
Yet at the same time, people experiencing mental health conditions have been increasingly using apps. This has typically been approached informally by trial and error or by asking peers. But this approach takes time, requires persistence, and isn’t informed by evidence.
So in 2019, the Ministry of Mental Health Services put in place the funding to establish a program to evaluate health apps, putting in place the tools to enable digital health to be safely part of mental health recovery services. With this funding at the end of 2019 ‘MIND’ – in co-creation with ‘de Nederlandse ggz’ – started the development of www.ggzappwijzer.nl, which was eventually launched at the beginning of 2021.
To be guided by evidence MIND reviewed scientific papers to understand if apps really do help. Once it was confirmed that there are good apps that do provide a positive impact, they researched how people find and choose apps.
As there is very little research into how people choose health apps, the team conducted experiments themselves. They discovered that searches result in hundreds of app suggestions, with no trusted information to indicate which are good.
Focus groups revealed the information people want when choosing an app. They don’t just want a score, they want the facts behind this. Basically, they want to know three things:
Also, people are interested in the opinion of others about an app. Do peers and/or professionals give some kind of appreciation or depreciation of an app?
Whilst researching the sector, the team learned about the Organisation for the Review of Care and Health Apps (ORCHA), and the hundreds of assessments it had already conducted on mental health apps. The team felt that the ORCHA assessment was objective and thorough; they liked how the assessment publishes not only a score but also the additional information sought. Further research revealed that for every question the MIND team had developed to assess an app, ORCHA had already asked it. In fact, ORCHA asked more questions the team couldn’t possibly answer within a reasonable balance between costs and benefits.
ORCHA’s comprehensive base of reviews, together with its work with the NHS, led MIND to work with ORCHA. This collaboration was more appropriate for the program than trying to reinvent the wheel.
The program decided to utilize ORCHA’s objective reviews and layer on top of its own qualitative assessment information. For this additional layer, MIND arranged for 4 to 8 people to test an app for two weeks, after which each participant answers a structured questionnaire containing 20 (quantitative and qualitative) questions. Questions ranged from ‘How easy was this app for you to keep using?’, ‘To what extent would you recommend this app to other people?’ to ‘What improvements do you suggest to improve the app?’. Participants included both professionals and people with mental health conditions. The feedback has been consistent from both groups, each bringing a different but each other reinforcing perspective. The individual testing reports were transformed by the MIND team into one consolidated summary, which functions as a preview of what someone can expect from this app.
As part of this program, almost 100 digital health products have been through the ORCHA evaluation and 20 of these have been through the additional MIND structured questionnaire layer. It is hoped this second figure will reach 50 by the end of this year. The evaluated products are hosted on a website that can be easily searched by everybody interested in mental health apps. The website is also useful for healthcare professionals to advise about using a mental health app.
Since its launch in January 2021, the site has been visited 35,000 times and feedback has been extremely positive. People welcome the trusted information on the apps that are in the library. This has been especially important during lockdown when an increasing number of apps from unreputable sources have been launched.
To reach more people, the library of reviews is now also integrated into QULI, one of the major personal health records in use in the Netherlands, as part of the Medmij program.
The combined ORCHA assessment and MIND reviews have also enabled the team to have informed discussions with developers of digital health. They have provided developers with clear and actionable advice on how their products can be improved.
Commenting on the program, Rimmert Brandsma, Project Leader, eHealth, MIND, said:
“The relationship between MIND, de Nederlandse ggz, and ORCHA has also been very successful. There is huge synergy and I feel the end product is better having all partners working actively together.
“We look forward to the next steps, of making multilingual versions of the website and increasing the number of apps assessed, possibly including AI, VR and wearables into the assessment structure. This will help us to support even more people to find the best digital health.”
Digital health underpins the NHS future of a more patient-centered and sustainable healthcare service. National targets have been set out in the NHS Long Term Plan, and they have been recently supported by national standards in the NHS Digital Technology Assessment Criteria (DTAC). Commissioners and providers are taking this direction to ensure a consistent experience of using digital health products, leveling up the playing field, and connecting systems.
However, to build a sustainable digital transformation plan, it is important to gain a view of what is happening now.
To give an accurate picture, ORCHA commissioned independent research to ask people in the UK what they think of digital health, how they are using it, and if they want the NHS to provide it. ORCHA commissioned OnePoll to conduct an independent online poll of 2,000 UK residents, to better understand the nation’s true opinions and actions.
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Citizens and ex-pats based in Dubai will have access to the Middle East’s first digital health library, thanks to a ground-breaking partnership between the Osteopathic Health Centre, Dubai, and ORCHA (the Organisation for the Review of Care and Health Apps), the world’s largest app review and distribution company.
The Centre, founded in 2000, takes a holistic approach to medicine, specializing in non-invasive and manual therapies.
This one-year contract, which has the option to renew for a further two years, will complement the Centre’s existing offer, allowing a projected 40,000 customers in the country to access a library of top-rated health apps, to support with everything from smoking cessation to mental health support, to allergies to obesity.
An additional key focus for the app library will be family medicine, an area that provides family members with support on sexual health, ante- and post-natal care, and family planning plus a broad range of physical conditions.
As part of the partnership, ORCHA will provide all the Centre’s practitioners with CPD-accredited training in how to use digital health plus an online Digital Health Formulary, which will enable apps to be selected and prescribed in the same way as traditional medicines are prescribed.
A full library of apps will be hosted on the Centre’s web pages, each of which has been tested against more than 350 digital health standards and meet crucial ISO 82304-2 benchmarks. Patients will also be able to browse and learn about what’s available, helping them to self-manage conditions from their homes.
Nargis Raza, Proprietor and Director of the Centre said:
“Digital health is an idea whose time has come, for our country and our region. Evidence is mounting year by year that apps improve outcomes. For example, only 2% of those with COPD today use an app, yet clinical studies confirm that the right apps can improve outcomes and reduce the need for medical appointments.
“Many of our patients experience chronic back pain and we’ll be using our app library to recommend the best apps to help them self-manage this debilitating condition at home, as part of our care programme.”
Her Majesty’s Trade Commissioner for the Middle East, Simon Penney, said:
“Digital technologies have been at the heart of the public health response to Covid-19 worldwide and we’ve all learned that with digital on hand, we can do far more with less. It’s heartening to see Dubai’s Osteopathic Health Centre leading the way in the Middle East with this forward-thinking contract with ORCHA. The centre’s patients will benefit in so many ways and I hope this is the start of a leap forward in digital health for the country and the entire region.”
ORCHA business development director, George Kowalski, who will be based in Dubai to oversee the project, said:
“When it comes to digital health, the UAE is at a turning point. The population is very mobile, as we have so many ex-pats in the country, and a by-product of this over the last year has been an increased COVID-19 infection rate. Medical practitioners haven’t been able to see enough patients, due to strict safety protocols. Being able to give patients access to high-quality, safe apps will be transformational.
“We are here to support the Centre with its innovative project and part of that will mean engaging with patients and professionals to help them understand the benefits of health apps.
“In the future we’d like to see digital health technologies adopted across the entire UAE, along with a standardised approach, in the same way that Europe’s Nordic states are working together to create a unified platform across five independent countries. The result will be improved healthcare access for millions of people.”
