The Global Mobile Apps Download

Published Date: 02 Nov 2017

In a recent report released, mobile devices are now exceeding traditional computers in unit sale as well as revenue, with an expected total global mobile subscription to exceed 7 billion in early 2013 (Sharma, 2012). The growth is the most prominent in Asia countries such as China and India, hitting the record of 1 billion and 950 million subscription respectively. Consequently, it is not surprise to see the development and sales of mobile applications (mobile apps) to surge exponentially. It is forecasted that the mobile apps download clicks across all devices will reach 50 billion by 2012, which is a tremendous increase from 7 million in 2009 (Na, 2011) (see Figure 1.1).

Figure 1: Global Mobile Apps Download.

Source: Chetan Sharma Consulting, 2010.

A mobile app is a software application designed to run on smartphones, tablet computers and other mobile computing devices. Smartphones and other handheld devices allow users to install and use the application on their own base on their own need and interests. The applications are classified into a full wide range of category from gaming, education, entertainment, lifestyle, utility tools, and book to finance, weather, sports and travel, as well as medical apps, and the list goes on (see Figure 1.2). The average health care app costs about US$15, which is above the average costs of general app, and the apps are being developed for health education, health management, data management, and other health workflow processes etc. These health care apps make up about 1%-2% of the entire market for apps, and is expected to grow 25% annually over the next 5 years (Anderson, 2012).

Figure 1: Active Application Count by Category 2013.

Source: App Store Metrics, 148apps.biz.

Being one of the application categories, medical apps have made up about 2% of the total apps, consisting of about 16 thousands apps, and the number is increasing steadily by days. Type of medical apps which are designated specifically for health care professionals include: Disease Diagnosis Applications (e.g. 5-Minute Clinical Consult, Johns Hopkins Antibiotic Guide), Drug Reference Applications (e.g. Skyscape’s Rx Drugs, Medscape, Epocrates), Medical Calculator Applications (e.g Body mass index, body surface area, MedMath), Literature Search Applications (e.g. PUBMED, Mdot), Clinical Communication Applications (e.g. Amcom Mobile Connect, mVisum),HIS Client Applications (e.g Meditech EMR), General Health Care Applications (e.g. H1N1 Swine Flu Update, WISER, Boborleta) and Medical Training Applications (e.g. iCPR, iResus, CME) (Mosa et al., 2012).

Just as the internet sparked the rise of e-health, so as the smartphone’s popularity is revolutionizing health care industry. According to Savit et al. (2012), the five ways in which mobile apps will transform health care include: improved access to care, improved patient engagement, new provider business models, reduced Medicare fraud and improved patient safety. In this context, health care delivery is moving rapidly from a world of patient influx to a world of data influx, transforming the way patients are engaged by the healthcare system. One should not underestimate the impact of these new capabilities as to how consumers use and act on health information through the apps. For most health care organizations nowadays, the question is no longer they should involve but rather how quick they can become part of the market. Example of organization innovations in taking the lead in using medical apps and to improve health care include: eVisits for patients, PineApp for patients, medication or patient care app for nurses, and mobile drug referencing tools for physicians and pharmacists (Jeni, 2012). Mobile technology holds a potential for more efficient, more competent and cost effective process in healthcare, pharmacy included.

Year 2011 has seen a huge leap forward in healthcare mobile computing industry when the US Food and Drug Administration (FDA) announced and issued a draft guidance document (FDA, 2011) in an attempt to regulate mobile medical application (the ‘apps’). The move did not surprise everyone because it has well been advocated that the use of mobile medical apps on smartphones and other mobile computing devices is revolutionizing delivery of health care from the point of care giver to another end of care receiver.

The extraordinary spread and penetration of mobile technologies, as well as encroachment in their innovative applications to address health priorities has evolved into a new field of eHealth which is known as Mobile Health (or mHealth). Mobile health (mHealth) is fundamentally the practice of medicine and public health which are supported by mobile devices, or more specifically by the apps-sophisticated programs. The use of mobile apps offers a highly accessible and cost-effective means of implementing motivational and self-management programs, and hence delivering high quality healthcare that is going to benefits the patients in the end of the day (Handel, 2011). It is believed that healthcare providers, as well as pharmaceutical industry, will supplant mobile phone industry as the primary distributors for mHealth apps (Larkin, 2011). It is widely agreed that the effective application of information technology (IT) in mHealth can enable the industry to address its three most pressing concerns: an increase in medical errors, rising costs, and the fragmentation of care delivery (DePhillips III, 2007).

Information systems have developed substantially over years to support the infrastructure of medicine such as education, decision making, communication and many other aspects of health care professional activities (Greenes et al., 1990), which is now known as Health Information Technology (HIT). On the other hand, medical informatics or health informatics is now emerging as a distinctive academic entity. It can be regarded as an umbrella for medical informatics, bioinformatics, and pharmacoinformatics, reflecting that informatics plays a significant role in all parts of healthcare (Ã…strand, 2007). In parallel with the rise of information technology over the years, the role of pharmacists has changed considerably. Despite the fact that pharmacists are no longer compounders of medicines, pharmacists are still responsible to ensure delivery of quality, effective and safe pharmaceutical care to patients. Pharmacy informatics focuses on the use and integration of data, information, knowledge, and technology involved with medication use processes to improve outcomes (Siska, 2007). Table below depicts some examples of emerging pharmacist activities with medication use health information technologies, (Fox et al., 2011):

Domain

Health Information Technology (HIT)

Activities

Clinical Medication Management

Electronic health record (EHR)

Clinical decision support (CDS)

Computerized prescriber order

entry (CPOE)

Smart infusion pumps

Pharmacy information management systems (PIMS)

Participate in the development of the EHR to include the appropriate medication analysis and clinical decision support tools.

Develop requirements to be built into various medication use technologies to impact prescribing, prescription review, dispensing, and administration.

Participate in designing electronic work queue systems that can provide real-time lists of potential interventions based on the patient’s medications, lab values, renal function, drug interaction, etc.

Collaborate with informatics divisions and other clinicians to develop and build CDS, electronic order sets, and other components of CPOE.

Provide clinical data and medication safety principles to develop and optimize smart infusion pump drugs libraries based on prescribing patterns and literature.

Incorporate more clinical management principles into these systems to improve drug selection, preparation, and dispensing.

Preparation and Dispensing Management

Automated workflow systems

Pharmacy information Management systems (PIMS)

Medication tracking systems

Analytics and metrics

To prepare for increased direct patient care roles, pharmacists will design automation workflows and quality processes for compounding and dispensing activities to be overseen by technicians.

Develop process and procedures around consistent remote order review and approval of doses using CPOE and automated workflow systems while on patient care rounds.

Develop/implement auto-identification systems to track medications from receipt, through preparation, distribution, and administration.

Consult on the distribution process data needed to audit and steer analytic processes to improve operational efficiencies.

Table 1-1: Emerging pharmacist activities with medication use health information technologies.

Despite the fact that innovations in information system have greatly improved the quality and productivity in various industries, it is reported that slight progress has occurred in healthcare industry in adopting clinical IT, such as Electronic Medical Records Systems (EMR-S) (See Figure 1-3) and Clinical Decision Support tools, which would be the most vital systems for in delivering high quality patient care and provision of more-integrated healthcare (Fonkych et al., 2005). Many healthcare organizations nowadays have realised that implementation of health information technology (HIT) is not merely a matter of buying and installing its respective software or hardware. Successfully implementation of HIT relies momentously on the acceptance and adoption by its end users (Ketikidis et al., 2012). Thus, it is important to identify the characteristics and factors that influence adoption or rejection of HIT amongst health providers, and to evaluate the effect of potential policies, and to suggest what the targets of such policies should be. The same is applied to the adoption of medical applications on mobile devices as a new HIT amongst health care professionals, especially amongst pharmacists within pharmaceutical industry. As quoted by Buntin et al. (2011) "The ‘human element’ is critical to health IT implementation."

Figure 1-3: Percentage of Physicians Using Electronic Medical Records (EMR) in 2005, in US (Blumenthal et al., 2007)

1.2.3 Problem statement

Over the years, the adoption of health information technologies in health care industry has been the focus of many studies (Holden et al., 2010). However most studies have focused mainly on adoption of HIT by physicians only and other important health providers within the industry were given less priority as compared. One ought to not disregard the importance and functions of pharmacists in providing quality pharmaceutical care to patients as highlighted by World Health Organization (WHO) (WHO, 1994). Hence it is crucial to figure how pharmacists will adopt to HIT.

The problem stated in this research is that penetration of mobile devices incorporated with the widespread use of medical applications has render pharmacists to use this new HIT inevitably. It is important to learn about the behaviour and factors that will affect pharmacist’s adoption of medical applications in their practice before implementing the costly HIT and its related policies within any healthcare entity.

1.2.4 Research Questions

1.2.5 Aim and objectives of study

1.2.6 Significance of study

Information on how technology adoption can be influenced and improved provides a useful tool for health administrators and mangers to assess the likelihood of success for new and existing technology. This will also allow government agencies to proactively design and target interventions to increase the success of new innovation for future new policy development and implementation.

Measures designed to extend and enhance the capacity of pharmacists to utilize the potential of existing and developing technologies is in the interest of the profession. Pharmacists will increasingly find themselves needing to utilize technology in providing pharmaceutical care, prescribing medicines electronically, and preventing medication errors (Dasgupta et al., 2009). Hence, it is essential to ensure user acceptance issues do not hamper the continual growth and encroachment of the profession of pharmacist.

1.3 Research Design

1.3.1 Study 1: Qualitative approach

1.3.2 Study 2: Quantitative approach

1.4 Definition of terms

1.5 Structure of the thesis

1.6 Summary

CHAPTER 2

LITERATURE REVIEW

Overview

Information technology in pharmacy

2.2.1 Health information technology (HIT)

2.2.2 Role of pharmacists in m-health

Mobile platforms and applications (Apps)

2.3.1 A brief history

2.3.2 Scenario in 21st century

Medical apps

2.4.1 An introduction

2.4.2 Implication in health care

Technology acceptance model (TAM)

2.5.1 Research model & theory

2.5.2 Indication in health care

Theory of resistance model

2.6.1 Research model & theory

2.6.2 Indication in health care

Adoption of HIT among health care professionals

2.7.1 Acceptance factors

2.7.2 Resistance factors

Summary

CHAPTER 3

RESEARCH METHODOLOGY

Overview

A mix method design paradigm

The variables

3.3.1 Identification of variables

3.3.2 Definition of variables

Research framework

Hypotheses

Data collection

Data analysis

Validity and reliability issues

Ethical issues

Summary

CHAPTER 4

STUDY 1: THE FOCUS GROUP

Overview

Method

4.2.1 Participants and recruitment procedures

4.2.2 Data collection

4.2.3 Data analysis

4.2.4 Ensuring the integrity of research

Findings

4.3.1 Participants profile

4.3.2 Acceptance factors

4.3.3 Resistance factors

Discussion

4.4.1 Acceptance factors

4.4.2 Resistance factors

4.4.3 Limitation of Study 1

Summary

CHAPTER 5

STUDY 2: THE QUESTIONNAIRE

Overview

Method

5.2.1 Development of questionnaire

5.2.2 Validation of questionnaire

5.2.3 Sample of respondents

5.2.4 Data collection

5.2.5 Data analysis

Results

5.3.1 Partial least square analysis

5.3.2 Correlation between variables

Discussion

5.4.1 Relationships between variables

5.4.2 Limitation of Study 2

Summary

CHAPTER 6

DISCUSSION OF THESIS FINDINGS

Overview

Medical apps adoption by pharmacists

6.2.1 The acceptance factors

6.2.2 The resistance factors

Summary

CHAPTER 7

CONCLUSION AND RECOMMENDATION

Overview

Summary of chapters

Limitation of this research

Implication for pharmacy practice

Future avenues for research

Conclusion Remarks