| Thuisarts.nl |
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Team of physicians and editors developed the content End-users involved in a later phase Process of co-creation could be improved
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Intended use of Thuisarts.nl:
by the general public/patients; to obtain information about their symptoms or before a consultation GP; to explain medical information GP; refer a patient to the website GP; to check if their advice is up to date
As patients have a better understanding of their complaints, the consultation could be more tailored. |
Information is simply phrased, and supported by pictures and videos The popularity of the website has grown exponentially Several million unique page views each month Also used by an older population [29]
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After launch, a decreasing trend in consultation rates, mainly caused by a decrease in short- and telephone consultations [29] No evidence available on usability or impact on patient outcomes
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No known adverse or unintended effects among the patient population Further improvement could be made by adding an ethical expert to the team, and by promoting co-creation with vulnerable and low-literacy patient groups
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Website that informs patients and GP’s about basic medical conditions. Simple application, without a major negative impact on daily routines. However, Thuisarts.nl has not yet systematically adapted to the wishes and requirements of the end-users, which we believe is a precondition for the development of a professional and high-quality eHealth application |
| Liva Healthcare |
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Development by:
entrepreneurs behind NetDoctor.com multidisciplinary teams of healthcare professionals, software developers, scientists and patients
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The healthcare professional refers a patient to Liva Healthcare No direct consequences for the routines of the referring healthcare professional An important driver of long-term weight loss was a strong relationship with a personal coach
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More accessible than conventional treatment and ‘easy to use’ [30] Participants felt that having an initial one-off, face-to-face meeting with the dietician or lifestyle coach was important for their future web-based interaction
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Effective in improving the lifestyle of patients with diabetes, e.g. more exercise and weight loss [32,33] Open to peer-reviewed scientific evaluation; programme will be improved after analysis by scientists [30]
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No adverse or unintended effects among the patient population Further improvement could be made by adding an ethical expert to the team, and by promoting co-creation with vulnerable and low-literacy patient groups
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Liva Healthcare is an easy-to-use application to improve lifestyle, with evidence-based results on clinical outcomes, high user-satisfaction and limited resistance from doctors [38].
This eHealth tool can support behavioural changes through monitoring and providing relevant feedback. Support from family and peers also matters, and long-term success depends on ability to establish positive day-to-day support [30] |
| SHUTi |
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Development by multidisciplinary team of:
psychologists psychiatrist engineers software developers commercial experts
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GP’s can prescribe the SHUTi program for treatment of insomnia in adults The acceptance of this online cognitive behavioural therapy is adequate, as GP’s generally recognise the value for the treatment of insomnia. No frequent referral because of consultation time constraints and limited knowledge [39] No specific education of healthcare professionals is needed, and elaborate implementation strategies are not necessary as healthcare professionals can simply prescribe the online programme [40]
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Acceptance by patients was high, with a relatively high usage and adherence [34] The design of SHUTi aims to simulate the schedule and framework of an in-person treatment. It uses approachable and supportive language to help the user feel encouraged and motivated [41]
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The efficacy of SHUTi has been demonstrated in multiple randomised controlled trials, which reported a significant and persistent reduction in symptoms of insomnia [34,42] and depression [42] A recent systematic review and meta-analysis confirms the general efficacy of similar online programs [43] A subsequent version of SHUTi (i.e. Somryst) recently obtained authorisation from the FDA in the USA to be used as a ‘prescription digital therapeutic’ for the treatment of insomnia in adult patients
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No adverse or unintended effects among the patient population Further improvement could be made by adding an ethical expert to the team, and by promoting co-creation with vulnerable and low-literacy patient groups
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Effective and practical online solution for the treatment of insomnia in general practice. Insomnia is currently not adequately treated in the primary care setting [44] due to limited knowledge of sleep treatments [39] . Hence, contrary to international clinical guidelines that recommend CBT-I as the first line treatment for insomnia, hypnotic medication remains the primary treatment modality in the majority of the patients [45]. SHUTi is considered a viable option in the treatment of insomnia [43] |
| Babylon |
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Development by:
Babylon is regulated by the Care Quality Commission in England |
Using Babylon means a different way of working for GP’s, with a more coaching, supportive role Patients do not need to learn a lot; in practice, a lot of young and healthy patients use this service
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The advantages are:
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No analysis by an external academic partner Impossible to determine how well it would perform with a broader set of cases Babylon's own study does not offer convincing evidence that its system can outperform GPs in any realistic situation, and there is a possibility that it might perform significantly worse when diagnosing disease [46]
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To convince citizens to use Babylon Health, the developers use highly developed marketing techniques Data are stored to promote development of algorithms, without transparency in the algorithm method. Further clinical evaluation is necessary to ensure confidence in patient safety, privacy and accuracy of the algorithms [46] Possible risk that it improves the health status of the so-called ‘worried well’, but not that of vulnerable, high-risk groups
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AI-based platform that claims to help patients to make a diagnosis. The usability is good, but there is no peer-reviewed analysis of data and a significant risk of underperforming diagnostics |
| SkinVision |
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Development by a multidisciplinary team:
dermatologists scientists engineers
According to existing law SkinVision is a healthcare provider and must meet established qualitative and safety requirements. Initially, it did not comply with legal requirements and, among others, had to draw up a policy plan by October 2020 [47] |
False-negative outcomes might delay the detection and treatment of skin cancer False-positive outcomes may cause unnecessary stress among users or unnecessary visits to GP’s The user may ignore the advice given in the smartphone app due to a lack of trust or unawareness GP’s need to understand the basics of AI to deal with such algorithms in the diagnostic process
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The app seems easy to use. Users need to be able to take a photo with their mobile phones There are no (scientific) publications available on usability
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The accuracy of algorithm-based smartphone apps for the assessment of skin cancer is debateable [35] The algorithm has a sensitivity of 95% and a specificity of 78.3% in recognising signs of skin cancer [36] SkinVision outperforms other skin cancer detection apps in terms of accuracy [35] The current accuracy of the algorithm may warrant its use by lay users or GP’s
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The medical consequences of the use of SkinVision are still unclear Although studies have demonstrated that SkinVision can have beneficial effects when diagnosing skin cancer, adverse effects have also been reported [35] Patient safety is not fully guaranteed in this phase
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Skin cancer detection app for patients and doctors, based on an algorithm with high sensitivity and moderate specificity to detect skin cancer; there is room for improvement in terms of specificity and in terms of qualitative and safety requirements |
