An ageing population and chronic disease are putting pressure on the Irish health system. The field of eHealth is rapidly evolving and has the potential to become an important component of healthcare, but there appears to be a gap currently between research in this field and the integration of eHealth technology into clinical practice. During the eHealth Ireland Ecosystem Conference held in April 2018, a workshop was conducted to explore the barriers and facilitators to the adoption of eHealth technology, particularly remote monitoring systems in community and home cardiac care. Participants included clinicians, academic researchers, technologists, patient advocates, policy makers, and representatives from the health service. The conversations in the workshop pivoted around why technology systems in cardiac care rarely moved beyond the research project stage and what can be done to address this issue. The discussions in the workshop focused around the lack of funding available, the need for reimbursement models, the lack of awareness about remote monitoring, the angst about who is responsible for the data generated, the design of systems, regulatory standards, and the increasing demand on services, education, and patient empowerment.

Background Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient’s medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored. Objective The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. Methods A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. Results Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps. Conclusions The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.

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BACKGROUND Managing the care of older patients with heart failure (HF) largely centres on medication management. Due to their frequent medication or dosing changes, an app supporting them to keep an up-to-date list of medication could be advantageous. During COVID-19 times, HF outpatients’ consultations are taking place virtually or by phone. An app with the capability to share the medication list with healthcare professionals before consultation could support the clinic efficiency, for example, reducing consultation time. However, the influence of apps on maintaining an up to date medication history for older adults with HF in Ireland remains largely unexplored. OBJECTIVE The objectives of this review are twofold: to review apps with a medication list functionality and to evaluate the quality of the apps included in the review using the Mobile Application Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. METHODS A systematic search of apps was conducted in June 2019 using the Google Play StoreTM and iTunes App StoreTM. The MARS was used independently by four researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. RESULTS Google play and iOS app stores searches identified 483 potential apps (292 from Android stores and 191 from Apple stores). Six apps met the inclusion criteria. Medisafe app had the highest overall MARS score (4/5) and the medication list & medical records app had the lowest overall score (2.5/5). Five out of the six apps achieved an acceptable quality MARS score (>3.0). Two apps scored the maximum number of features (n=11) according to the IMS Institute for Healthcare Informatics functionality score and two scored the lowest (n=5). The apps had on average 8 functions based on the IMS functionality criteria (range 5 to 11). CONCLUSIONS The quality of current apps with a medication list functionality varies regarding their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality. However, the subjective quality or satisfaction with the apps was poor. Only three apps are based on scientific evidence and have been previously tested. Two apps featured all the IMS Institute for Healthcare Informatics functionalities and half do not provide clear instructions on how to enter medication data, do not display vital parameters data in an easy to understand format and do not guide users on how or when to take their medication. CLINICALTRIAL N/A

As the number of older adults in our society increases, a greater demand is put on our healthcare systems. This increasing demand on healthcare and especially on the front-line care-givers and professionals has led to a greater need for individual patients to actively engage in personal behaviour change to manage their conditions and improve their quality of life. The Human Computer Interaction Community has a growing body of research pertaining to the many and varied ways that Behavioural Change Techniques have been integrated into digital applications and intervention systems. However, it has been noted that the limitations as to how these interventions have been evaluated has led to the existing research having little impact. This study will explore the design strategies and theories that currently exist regarding implementing digital BCTs and will concentrate on why do these types of interventions work, if they work at all?