Projet ApiAppS
Aide à la prescription individualisée d'applications et objets mobiles de santé - Decision Support System for Individualized Prescription of mHealth Devices and Apps
L’objectif du projet ApiAppS est d’identifier, explorer et lever les verrous scientifiques existant pour que le médecin puisse utiliser un outil d’aide à la prescription de dispositif(s) mHealth adapté(s) au profil du patient, qui soit interopérable avec les sources d’information utilisées (dossier médical informatisé du patient et banque de connaissances médicales), et qui prenne en compte le contexte psychosocial de cette prescription (impact sur la relation médecin-patient ; perceptions, attentes et appropriation des technologies mobiles pour la santé par les deux parties).
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The objective of the ApiAppS project is to identify, explore and remove existing scientific obstacles so that general practitioners (GPs) can use a system to be of help in the prescription of mHealth apps/devices adapted to the patient's profile. This system will be interoperable with the information sources used (EMR and medical knowledge databases). Moreover, ApiAppS implementation will take into account the psychosocial context of this prescription (impact on doctor-patient relationship; perceptions, expectations and appropriation of mHealth technologies for both GPs and patients).
Période du projet :
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Membre(s) SESSTIM du projet :
Commanditaires :
ANR - Appel à projets générique 2017 (référence du projet ANR-17-CE19-0027)
Partenaires :
SESSTIM : Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, UMR 1252 Inserm/IRD/Aix-Marseille Université
D2IM : Département d’Informatique et d’Information Médicales du CHU Hôpitaux de Rouen (www.chu-rouen.fr/cismef/d2im/)
GRePS : EA 4163 - Groupe de Recherche en Psychologie Sociale - Institut de Psychologie – Université Lyon 2 (greps.univ-lyon2.fr)
DERMG Nice : Département d'Enseignement et de Recherche en Médecine Générale de Nice (dermg-nice.org)
dmd Santé (www.dmd-sante.com)
SILK Informatique (www.silk-info.com)
Site Web dédié au projet :
https://www.projet-apiapps.org/
Thèmes :
Problématique:
La santé mobile (mHealth) a le potentiel pour jouer un rôle positif dans différents domaines influençant l’état de santé d’un individu (bien-être, prévention, prise en charge, suivi ou surveillance de pathologies avérées) tout en étant économiquement bénéfique au système de santé. L'utilisation des dispositifs mHealth peut réduire le nombre de visites médicales, ce qui maximise la commodité pour le patient tout en minimisant le coût pour le system de santé. Toutefois, plusieurs éléments freinent ce potentiel.
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Mobile Health (mHealth) is a developing field that can play an important positive role in various domains affecting the individual's health condition (well-being, prevention, management, monitoring or follow-up of known or suspected pathologies) while being economically beneficial to the healthcare system. The use of mHealth (apps or devices) can reduce the number of medical visits, maximizing convenience for the patient while minimizing the cost to the healthcare system. However, various factors prevent to reach this promising potential.
Méthode :
L’hypothèse que nous faisons dans le projet ApiAppS est que les médecins peuvent jouer un rôle central pour guider au mieux les choix qui s’opèrent. Nous pensons qu’il est nécessaire de se diriger vers un mécanisme d’intégration technique (dans les logiciels métiers) et humaine (dans la relation médecin-patient) des dispositifs mHealth comparable à celui d’une prescription médicale usuelle. L’outil d’aide à la prescription couvrira plusieurs domaines de santé. Un focus sur une pathologie chronique sera toutefois réalisé, en fin de projet, afin d’étudier à la fois la prescription, l’utilisation effective et l’apport (efficacité) de certains dispositifs mHealth sur un panel d’utilisateurs (médecins et patients).
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The assumption we make in the ApiAppS project, is that physicians can play a central role in guiding the choice processes when mHealth use is a possibility/option for better patient health. We believe that it is necessary to move towards a mechanism of technical integration (in practice and patient management softwares) and human integration (in the physician-patient relationship) of mHealth comparable to the mechanism of a usual medical prescription. The Decision Support System for the Prescription of mHealth technologies will cover various health areas and pathology categories. However, at the end of the project, an experiment on a specific chronic disease will be carried out in order to study prescription, effective use and contribution (effectiveness) of certain mHealth apps. This experimentation will be carried out with two panels of users (GPs and patients).
Perspectives :
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Api AppS will tackle the following technology and information challenges:
1) Which information should be available in the electronic medical record, in the knowledge databases, and in mHealth app web stores to allow a basic coupling between these systems? Which ones will allow an optimal coupling?
2) What are the coding format(s) and the terminology(ies) adapted to this information?
3) Are the existing interoperability frameworks adaptable to the problem of communication with a store dedicated to mHealth apps/devices?
4) How to secure data transmission in such a system and be in conformity with the ethic and legislation?
ApiAppS will lead to the definition and implementation of: 1) an interoperability framework to be in compliance with, if one wants to connect EMR softwares / knowledge databases with mHealth app web stores containing classified and labelled mHealth apps/devices; 2) a web-service for decision support and help in selecting/prescribing mHealth apps/devices adapted to a patient. Selection/prescription will be consistent with the information available on the 3 different systems (mHeath store, EMR, Medical knowledge databases) and if needed, further information about the medical context will be asked to the GP.
ApiAppS implementation will closely integrate the psychosocial aspects related to the mHealth apps/devices usage and to their prescription. These aspects will be identified and analysed in a dual approach (anthropological and psychosocial) in order to better document:
- Representations, beliefs and practices of GPs and patients, related to mHealth apps and devices. More specifically, we will study if mHealth apps/devices are perceived as tools to enhance personal responsibility (patient empowerment) according to the different interpretations of this concept (reinforcement of an expertise knowledge, control feeling and skills, individual engagement in the management of the risks related to his/her disease, autonomy of decision, self-regulation, emancipation process) or if mHealth is more perceived as a control and a standardization by health stakeholders and authorities. It will be examined whether these devices are perceived by physicians and patients as complementary to health professionals in certain tasks (therapeutic education, prevention and medical follow-up) or even if they are substitutable to these professionals, allowing then a delegation of tasks. We will study the doubts and fears that can fuel skepticism (reliability, data security, confidentiality, ethical and / or legal issues raised, impact of devices on daily lives of users). We will seek the determinants (for example the dimension of innovation, the attraction for information technologies) of mHealth adherence. We will also seek the constraints linked to the use of mHealth according to the different person profiles. We will analyse (anthropological approach) how mHealth can modify the relation to the norm (biomedical and societal) of the users and their relation to the body, and thus reconfigure territories of the intimate.
- The expectations and needs of physicians and users regarding mHealth depending on the types of apps or devices, and on the kind of diseases and on patient profile.
-The place of mHealth apps in the doctor-patient relationship: Are they a third-party in the therapeutic relationship? If so, are they perceived as intrusive, disruptive to the relationship, or conversely, as an element that can reinforce it (or even take on a symbolic dimension of prolonging this relationship like medical drugs)? Do mHealth generate a change in the doctor-patient relationship towards greater involvement of patients in medical decision-making? It will also be questioned whether the prescription itself (and certain uses of mHealth apps) induces new ethical problems and fears in terms of data security?
These social sciences and humanities researches on technology issues will provide new findings in this domain.
