AUA 2019: Top 10 Apps for Wellness, Work and Study

Chicago, IL ( Eugene K. Lee from the University of Kansas Cancer Center moderated a panel discussion on a technology in urology. He pointed out that technology transformed urological practice through electronic health records, mobile phone applications, remote monitoring, communication and social media, wearables, and telehealth. Three panelists were introduced to expand on these topics.

Stacy Loeb, MD covered social media apps in urology. Currently 3.4 billion people are using social media apps worldwide, and 3.2 billion prefer to access them on their phone. According to the AUA survey in 2017, 74% of the conference attendants prefer mobile platforms as well.  Therefore, patients can be educated through this venue, and physicians can utilize apps to connect with other colleagues and spread information about health awareness. Dr. Loeb named Doximity as a top app for work because it allows for calling patients from the personal cellphone, but it simulates office phone number. It also offers additional services such as secure fax, newsfeed with urology articles, and a link to the US News World Report. Top app for Wellness was MapMy Run, which logs running maps and logs to share and offers running routes during conferences in different cities. Twitter was named as a top app for work and/or study. Recent survey of twitter users at the EAU and AUA demonstrated that it was perceived useful for networking, disseminating information, and research (Table 1).

Table 1

Twitter allows global multidisciplinary discussions, which involve patients and providers. For example, Twitter app is used by the urologists for crowd sourcing or sharing thoughts about complicated patient management issues such as surgical techniques, new instruments, and cancer care.

However, there are known physical and psychological harms of social media apps. According to the presenter, 259 deaths from selfies were documented in 2011 – 2017. Social media abuse is linked to physical changes (tech neck), depression, and insomnia. Biased and/or misleading health information is often posted on these venues, which increases a gap between patient and a provider.

In conclusion, Dr. Loeb pointed out that social media apps have potential benefits for both parties involved. Urologists can stay up to date on research, discuss clinical care, connect with colleagues, and advertise. Patients and caregivers can receive information and support, learn about new research, and connect with other patients.

Matthew Resnick, MD presented on improving perioperative outcomes with remote monitoring. He introduced an idea of “Failure to Rescue”, which relates to the failure to prevent morbidity and mortality from a complication of medical care. Since physicians are under pressure to optimize perioperative outcomes, early identification of a health issue and early intervention are crucial in preventing harmful outcomes. Remote monitoring can potentially assist with telecommunication between healthcare provider and a patient. There is current audio-, digital, and video-based telecommunication infrastructure that delivers patient health information to the provider through wearable sensors. Recent research study conducted by Dr. Lee and colleagues in patients undergoing radical cystectomy revealed that home-based monitoring was feasible and helped to pinpoint complications. Other study looked at the liver transplant patients. Study team used video-based education to monitor patients’ health post-surgery. Data showed no readmission in patients with 100% participation rate in daily assessments or vital signs reporting.

Remote monitoring challenges include security issues, developing a business model for the insurance companies to reimburse remote healthcare practices, and limited resources for the initial and continuing monitoring.

Anobel Odisho, MD introduced an idea of digital health in urology. According to the presenter, digital doctor can detect bothersome condition by utilizing digital health artificial intelligence, extend reach, automate care pathways, dissociate care from physical visits only, and monitor patients remotely. There are 176 urology apps identified among 30,000+ apps in app stores. Dr. Odisho pointed out that digital health has to multi-channel and synchronized.

Research study of text messaging in prostate biopsy patients revealed high patient engagement (50-71%) and a significant decrease in same day cancellations (3.8% to 0.5%). Participants received instructions prior prostate biopsy, appointment reminders, and assessments. 

Dr. Odisho presented some digital health apps related to different urologic conditions: nephrolithiasis (stent tracking and device for hydration), prostate cancer (symptom management, PSA tracking, and risk stratification), and LUTS (uroflow estimation using sound of urine hitting water in toilet and remote symptom assessment).

Primary challenges of the technology include up front costs and cost of maintenance, confidentiality issues, security, lack of informatics expertise, and increased patient expectations.

Overall goals of digital health in urology are patient engagement, outcome improvement, extended reach, and increase in research opportunities for new interventions and validations studies.

Eugene Lee, MD; University of Kansas Medical Center

Matthew Resnick, MD, MPH, MMHC, Vanderbilt University Medical Center; Stacy Loeb, MD, MSc, New York University; Anobel Odisho, MD, MPH, University of California.

Written by: Hanna Stambakio, BS, Clinical Research Coordinator, Division of Urology, University of Pennsylvania @AStambakio at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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