Jordi Rovira
From her office at the UOC's eHealth Center, Carme Carrion promotes the design, assessment and scientific validation of mobile apps based on the best scientific evidence available. Holder of a doctoral degree in Chemistry and director of the doctoral programme in Bioinformatics, Carrion is responsible for a key aspect of this new academic centre, presented last June and the first specialized in eHealth in southern Europe.
Just a few months ago, the UOC eHealth Center was officially opened. What is its current status? Is it growing by the moment?
We're in the first months of life after a gestation period that lasted just over nine months. Now it has to learn to walk by contact with the outside world. That's our current status.
The goals are clear.
Yes, the goal has been clear from the very beginning: to generate scientific evidence and impacts by putting technology at the service of health from a global health viewpoint. We have defined four lines. Of these, three (health data science, education, empowerment and participation in health and, lastly, design and assessment of eHealth interventions) are moving ahead while the fourth (eHealth and equity) is still on standby.
And how is this new academic centre structured within the University?
At the top, there is the Vice President, Marta Aymerich, and below her, Manolo Armayones, the eHealth Center's Development Director. We are under the umbrella of the Office of the Vice President for Strategic Planning and Research, but, apart from that, there is an Executive Board whose members are the deans of the Faculties of Health Sciences, Computer Science, Multimedia and Telecommunications, and Psychology and Education Sciences, in addition to Pastora Martínez, Vice President for Globalization and Cooperation, and Marc Alabert, Director of Strategic Planning. So, we are an umbrella with antennas in the various faculties that may be involved in what is going on.
A few weeks ago, you were appointed coordinator of the Design and Assessment of eHealth Interventions area. What is your function?
Everything is just starting and, therefore, my role is to get things happening in our field. And what reaches us from outside, which is quite a lot, needs to be channelled to see whether it is feasible and whether it makes sense to do it from the University. And, lastly, to promote projects and innovation in this line. But, above all, to guarantee the seal of academic quality. Because that is the big problem in this field, especially in apps. Everybody has ideas and wants to do things, and you can make something technological but then it has to be used and it must generate a positive impact on the user and, if possible, on the health system too.
In a nutshell, it has to work.
It has to work and people have to use it. And there must be science behind it, not just fanciful ideas. Therefore, it must be validated with scientific evidence. Our task is to guarantee this seal of quality. First, to make things happen, and then to make sure that they have quality and can create an impact that improves how people manage their health.
According to the eHealth Center's promotional video, there are 260,000 health apps but people stop using 80% of them after two weeks...
Yes, that happens with most apps in general. Even Pokemon Go only lasted for six months, when it seemed that everyone was using it. So there is obviously a compliance challenge here. And one thing is compliance in the healthy population and another in chronically ill people, where compliance with this type of intervention is greater. However, probably not everyone is predisposed to using it or has a profile that suggests that it will work. The “one size fits all” approach doesn't work in any sphere of life, and it doesn't work in this one either. For example, an app for diabetes is expected to be equally useful for diabetics who are 60 and diabetics who are 90. But things don't work like that.
So what's the solution?
Any product launched on the market never is for everyone; it always targets a specific potential audience. And here too. It's a mistake to think that there are apps that can be used by everyone. So the question is to think how it should be done. We don't have the solution but we should probably work much more closely with the end users right from the start. This is fundamental, and a lot of people are saying this, but it isn't being done.
Putting the user at the centre.
Exactly. Because a doctor comes to us and he says: “I've had the idea that we should make this app”. It may be a good idea but has it been run past the people who will be this app's users? Does a need really exist or do we want to create it? If the latter is the case, there is a much higher risk that it won't work. However, if it addresses a real need of a sector of the population – patients, carers, healthy population, etc. – then it's a question of coming together to work on it, design it. And then we look for the best scientific evidence to support it.
Because otherwise it may well happen that it isn't used.
There are things that can be counterproductive. It is often said that an app never harms, but I remember that, at the Mobile World Congress, they gave an example that if an app for giving up smoking doesn't work for the user, it may lead him or her to ignore all the other apps that pursue the same goal.
It generates antibodies.
And there are other factors; that isn't the only one. If instead the app has been pilot tested, validated, it has scientific evidence, it has been developed with the users (people who want to give up smoking), etc., it has a better chance of success.
And how can you know what people need?
Analysing needs is not a trivial matter; it's pretty complex. And as people are starting to hear about the UOC eHealth Center and we're on the map – at least in the more eHealth segment of the medical community – we are starting to receive requests for specific apps. In these cases, we need to discuss them and perform a proper needs analysis. However, at the UOC, we do not have any contact with the end user.
But you can talk with those who do have contact.
Of course. However, at present, we can say that in Catalonia there is a lot of movement in the eHealth sector, but it has yet to take root. In the public health system, it's very hard to get something like that accepted. Is it a problem of resources? No, not just resources. It's also a question of organizational change. I always explain how, because of a personal situation, I experienced a situation in an ICU in a hospital where there were heaps of wires, data, etc., but every evening, at 7 o'clock, the assistant did a round with paper and different coloured pens to record the vital signs and the patients' evolution, just like they used to do I don't know how many years ago. And I can't understand why this is still happening in 2017, in Barcelona, especially taking into account the technological possibilities that are now available. So we're talking about a real change that must be made but hasn't quite started.
The recently signed agreement with two research centres in Canada that are world leaders in eHealth will enable you to benefit from their experience.
It will enable their experience to be applied here and we will also contribute our value to it. The UOC has already done a lot of work in this field but, until two months ago, we hadn't put the eHealth label on it. We have carried out research on the elderly, telemedicine, gender and health, etc., and starting from now, we have to articulate it. The world is very big and highly interconnected, and Canada is considered to be the top country, but it's not the only one. We will shortly sign an agreement with a centre in Norway and we also have ties with a reference hospital in Argentina in this field. So, there are different leaders, different nodes around the world, and, in this respect, we would like to become the node for Southern Europe.