Apps present a fantastic opportunity to provide us with valuable health information which can help us not only improve the quality of our healthcare, but also help us to live healthier lives. The market is awash with apps, though, and we have no ability to see whether what is being downloaded will actually improve our health or if our personal data will be stored safely.
For that reason, we at Healthier Lancashire, through the Lancashire Digital Health Programme, have partnered up with ORCHA (the Organisation for the Review of Care and Health Applications) to provide this site for residents across Lancashire and South Cumbria to solve just those problems.
ORCHA carry out independent and impartial reviews of health and care related apps, and you’ll see that the resultant information is clearly presented for us throughout this website. We can be reassured that any apps shown on this site have undergone a rigorous review process, and can feel confident as we choose the best app for us.
By bringing this information to our fingertips, it’s now possible to identify and compare the best apps for our needs – and to ensure that we, and our friends and families, can get access to quality assured apps that meet a standard that clinicians across Lancashire and South Cumbria are comfortable with.
The ORCHA Review process is the most advanced review mechanism for health and care Apps available anywhere. It is the only truly comprehensive assessment of the Apps that are available on the two primary App stores ‘health, wellbeing/fitness and medical’ categories.
Our review looks at a range of elements of an Apps offer rather than just focussing on one aspect or area and it is entirely objective and based on a robust examination of quantifiable evidence and data. Some aspects of the review are automated which provides an initial filter and information gathering function. The rest of the review is undertaken by our highly trained review team. The expert input comes from our review development team, who collectively have designed and continue to refine the structure and content of the review to reflect best practice, guidance and emerging regulation.
Our review process starts with a weekly analysis of all the Apps available on the App Store or Google Play in the ‘health, wellbeing/fitness and medical’ sections. We then filter out Apps that are not designed for use in an English language and Apps that have not been updated for 18 months or more. Of the remaining Apps we organise these into over 350 health and care condition categories and queue them within their category by most downloaded.
Where there are Android and iOS versions of the same App we link these and they queue together. We review the next highest downloaded App in the queue, category by category, on a cyclical basis to ensure that we cover the full breadth or solutions available. We do offer an expedited review process for Apps that are unlikely to reach the top of the queue in their category area for some time - this is particularly the case in popular areas such as mental health Apps, Diabetes, Asthma, COPD, Sleep etc - and this enables newer Apps to gain an ORCHA score and presence on our platforms without having to wait for increased user downloads or the review team to move through the queue sufficiently to pick them up.
The Orcha Levels are as follows:
|Level 1 - Wellbeing||These are generally ‘keep healthy’ apps available to everyone who might wish to use them.|
|Level 2 - Self Managed||These apps tend to be aimed at people with an existing or potential health condition to help support them manage or monitor the condition and support independence.|
|Level 3 - Professionally Led||The patient and professionally-led apps in this level include those that are essentially prescribed by a health care professional. These apps tend to encourage a collaborative approach (between patient and healthcare professional) to managing or treating a particular condition, and may also need to fulfil other regulatory or industry related test standards. *See note below.|
|Level 4 - *Practitioner / Professional Use||These apps tend to be more heavily restricted, controlled and regulated by legal and regulatory standards as they might be liable to dangerous misuse. The clinically led apps in this level are normally developed by health professionals for use by health professionals, to aid immediate clinical decision making with the capacity for significant impact on patient outcomes. *See note.|
* Note on CE marking and the MHRAIf an App provides individualised recommendations to a user (eg. instructs the person how much insulin to take based on blood glucose values entered), it may need to be CE marked. This usually will apply to apps in level 3 or 4, but could also apply to some level 2 apps. An app does not need to be CE marked if it simply provides generalised advice (eg. advises the user what is the normal range for their blood glucose and suggest they should seek medical advice if outside of this).
ORCHA does not provide an assessment of whether an app should be CE marked, as only MHRA Notified Bodies are accredited to do this. However, we will advise if we think the app may need to be CE marked.
Create a record of your health to help you and those who care for you to monitor your progress
This App provides general information and guidance about the health issue, challenge or condition in question to help end users understanding and knowledge.
This App is able to automatically track key health indicators such as activity, sleep, heart rate or more specific condition related data either through the App itself or via a connected device such as a watch, or health band.
This App provides access to a wider social support network (virtual or real), relevant to the health area or condition it is aimed at.
This App uses information and data that it collects (via Health Tracking capability or through Information Recording features), to recommend particular actions or to provide specific health data that is derived from the basic data inputs it has received.
This apps offers guidance to professionals only relating to the diagnosis or treatment of conditions. These apps are most likely to be level 4 apps, requiring extensive testing and CE marking, having been developed by clinicians for clinicians.
To help users find the right App for their or their patients/clients needs, we try and identify as many Functions and Features that an App has to offer. These are displayed in summary form on our search result 'ribbons' and in more detail in the relevant App Cards. Users are able to filter searches according to the Functions and Features they wish to see. Some of the Functions and Features also inform what areas we will investigate in the subsequent detailed Review Areas, for example Data Collection and Sharing.
We look at an Apps compliance with standards, guidance and best practice in three distinct areas. These are Data and Security, Clinical Effectiveness and User Experience. Each of these Review Areas has been designed by relevant experts and consists of a series of objective (Yes/No) questions which should be capable of being answered by our Reviewers from information in the App, on the relevant App Store or on a supporting website. If our Reviewers cannot find evidence to support an answer from these sources they will assume that the App is not compliant with or capable of satisfying the relevant requirement.
There are often cases where an App is in fact capable of satisfying particular requirements but that this is not made clear in any obvious publicly available place. In these circumstances Users are left with uncertainty as to the real position and our view is that in this circumstance they should proceed with caution.
What do we look for? - This Review Domain looks at what information an App collects from you, what it does with that information and how secure is its handling of that data. For some Apps this is only a minor issue as they don’t gather much information. Other Apps can gather lots of very personal and sensitive information and for these it is important to know how they go about handling this.
This review area looks at what evidence there is that there is a suitably qualified professional or organisation behind the App or that it has been endorsed, accredited or underwritten by such an individual or organisation. It also assesses what evidence there is around user testing and the effectiveness of the App in terms of claimed health benefits. The higher the Level of the App and the more sophisticated its functions, the more crucial this becomes.
This Review Area looks at how an App has been designed to support the overall user experience. This includes its availability on both primary platforms, how customisable the App is, how well it caters for end users with different capabilities and needs – such as visual or other impairments – how content is managed, how well supported the App is and what it costs. This area also looks at overall User Review scores from both platforms.
The results of this analysis results in an overall ORCHA score which is built up from the answers to each of the questions in the three Review Domains. Some questions earn positive points and some earn negative points. The ORCHA Score aims to deliver a meritocratic evaluation with all Apps being treated equally and fairly irrespective of their current popularity or the financial position of their Developers.
The final stage of the process is Developer notification and publication stage. When the review is complete, we send a notification to the relevant developer/publisher giving them an opportunity to preview the Review ahead of its publication. This gives them an opportunity to highlight any obvious errors or issues before we release the Review onto all our platforms. Once the notification period has expired, we publish the Review on all our platforms.
All our reviews will remain valid until a new version of the App is produced. If a new version is not produced within 18 months of the current version, we mark the relating to the App as 'Out of Date' and the ORCHA App Score will start to degrade at the rate of 5% per month.
If the Developer implements a new version of this App we will automatically detect this via the relevant App Stores and we will mark the current review as being related to an old version of the App on all our platforms. The new version of your App will go back into the queue for a Re-Review and we will in time undertake this.