Locking it down: Finding useful ways to secure mobile medication apps for consumers

We recently finished a project funded by the Office of the Privacy Commissioner of Canada's Contributions program. Over two years, we completed two studies. Both studies are undergoing peer review and will be published at a later date.

Locking it Down: Privacy and security of mobile medication apps

The first study was an exploration of the privacy settings and policies of medication management apps available in Canada, titled, "Locking it Down".

Overall, we found that of the 184 medications on the Canadian market, 89% ask for health information beyond the list of medications and 40% ask for personal identification. However, 65% lack basic security measures such as the option of password protection. Only 10% of all apps reviewed mentioned that they encrypt the data that is stored in the app. Our conclusions were that healthcare professionals and organizations need to put pressure on mHealth developers to build secure systems that can adequately protect consumer health data.

The poster was presented this spring at the McMaster Clinical Research and Quality Improvement Symposium and at the Ontario Pharmacy Association annual conference.

Evaluating security features for mobile health applications in younger and older adults

Over the last two years, we also explored the most usable ways to secure mHealth apps with passwords. Over a period of 6 months, we recruited 59 older participants (50+) and 23 younger participants (18-30y) to try out four different password options: 4 digit PIN, Android pattern-lock, graphical password and fingerprint.

Surprisingly, we found that the PIN and pattern-lock performed well in both age groups but the fingerprint was much slower and error-prone, especially for older users. This finding is of particular interest as biometric authentication can be particularly useful in individuals who have cognitive impairment and struggle to remember passwords and PINs.

Our findings suggest that future research on biometrics should include older adults to ensure that biometric options are accessible to this critical user group.

Below is a presentation we shared at the recent McMaster Clinical Research and Quality Improvement Symposium.

Results from both studies will also be presented at the upcoming 76th FIP World Congress of Pharmacy and Pharmaceutical Sciences in Buenos Aires, Argentina.

mHealth & Passwords - Created with Haiku Deck, presentation software that inspires

What we learned partnering students & seniors for health literacy

In this photo, one of our participants who has a high computer literacy brought his new iPad. It offered him an extra challenge so he didn't get too far ahead of the other participants.

Hi Everyone – Kate here to give you a quick wrap up of the final two sessions of our health literacy workshop last month.  As Kelly mentioned in the last post, we spent the first week going over drug information searching, and a quick overview on the ins and outs of using a browser. 

In week 2, 9 participants joined us to learn how to look up illnesses and conditions. For homework, participants were assigned a news article that came out the day before about shovelling and heart attacks. We asked them to read the article, and then find information about heart health and their personal risks. All of the feedback we got about the homework was positive–-as one of the participants said, “it was great to think about what I’m reading, instead of just reacting to what I’m reading”.

We finished the workshop in week 3 with a session on searching for symptoms and medication side effects. The final 6 participants learned about critiquing symptom checkers and they even found a few we didn't know about! 

Scaling Up

Overall the sessions were a wonderful experience – the students and seniors all had a lot of fun doing it, and there were some great lessons learned. I’m really excited to build the pilot program into a longer 5 session program together with our local public library. Building the program to teach more about  tablets and smartphones, and drawing a bit more on media health literacy out will be really valuable to the participants.  

Lessons Learned

I think some of the best learning was how well the students and seniors paired up. Kelly and I have long said, the worst person to teach seniors about their computers are their children (just ask my parents, and I do this for a living). We often hear from seniors that the most helpful computer teachers are grandchildren.  I’m really excited to see what happens – be it continuing with UW student volunteers, or reaching out into the community to draw in high school students. 

Here are some tips if you are thinking of doing something similar in your own area:

• Don’t forget why people like Dr. Oz--the participants continually told us that Dr. Oz's videos and accessible language were invaluable. If you are going to steer people away from his content, you should be able to suggest something just as accessible and easy to understand.
• The internet is… well, that song from Avenue Q is right.  It took about 5 minutes for one of our student/senior teams to find Reddit as a potential resource – and about 0.3 seconds for that student to turn bright red and click away from a thread of nude photos. There was lots of great info on Reddit--just be prepared.
• There is such thing as too much information – when you’re searching for drug information online, sometimes a laugh at some of the wilder sites is a welcome break from what can be a mountain of information.
• Don’t take for granted the resources you use daily on the internet – Wikipedia, Reddit, Twitter can all be great – as long as you’re critical enough and know where to fact check them.
• Don’t underestimate anyone – a lot of the students were shocked at how comfortable the seniors were using the internet, and ended up learning just as much about new resources as the seniors did. 

Partnering Seniors & Students for Health Literacy

Students and seniors search for drug information online.

Earlier this week, we did a little pilot where we partnered university students and seniors to help seniors learn to search for high quality medication information online.

The idea came to me when I was giving a presentation on digital health literacy at a seniors' computer club called "Bits and Bytes".  My PhD student Kate Mercer has a background as a librarian. She and I often present on the digital health literacy. When we talk with seniors, we tend to get a lot of unexpected questions--everything from "What is an operating system?" to "How do I figure out if my drugs are covered by my plan?".

After the Bits and Bytes presentation I met a man named Lew Ford. Mr. Ford is a retired teacher. A few years back he'd run a pilot program that partnered high school students with seniors. I asked if he thought we could do something similar with university students and the idea was born.

Over the next few weeks, we managed to get a small group together that included Mr. Ford, Kate, a pharmacy student, a health sciences student and a biology student. The students crafted the curriculum while Mr. Ford and Kate recruited participants for a pilot. 

Our first session this week was wonderfully eye opening. We had 5 participants, and started by covering the basics of online searching, including browsers and cookies. We then headed to the pharmacy practice lab where each senior was partnered with a student and assigned a computer. We gave each pair the following tasks:

1. Think of a drug you want to know a bit more about
2. Find a government website on that drug
3. Find a HON certified website on that drug
4. Find a blog on that drug
5. Find your drug on Health Canada's website
6. What did you trust? What did you learn? What was easiest to find? Do you feel better or worse about the drug?

The seniors searched, the students offered technical support and my research team offered feedback on search strategies and websites. We concluded the session with a group discussion of what we learned and sent each senior home with homework for next week's session.

Overall, we had a great time and hope to offer a regular program. If you are thinking of doing something similar at your own site, here are a few of the early lessons that I collected from the students and participants:

1. Technology can be stressful for new users. The support offered by the students allowed the seniors to focus on the tasks rather than the technology.
2. Active learning by doing is a heck of a lot more fun than passive learning by lecturing.

3. Don't underestimate how much seniors know about technology and computers. They are equally eager to learn and pick things up very quickly.

4. Little tips like using Control+F (PC) or Command+F (Mac) to find a word on the page were a big hit (e.g., "cancer").

Security, Privacy and Digital Health Innovation

On Monday, July 21 2014 we are hosting a meeting as part of our Perspectives series to explore the views of the community on the topic of security and privacy needs in digital health innovations. 

The goal of our Perspectives series is to gather experts and non-experts together to explore complex issues in digital healthcare innovation.

Our first Perspectives event was held last July to discuss of mobile health tools for older adults. Through a series of presentations and discussions with healthcare providers, developers, patient advocates and researchers, one of the big issues that emerged was the need for mobile health tools that are both secure and accessible for patients with complex health issues. In other words, we may expect tools to have strong passwords but not so long or complex that patients living with low vision, memory impairment or low literacy cannot access the tools.

In the spring we secured funding from the Office of the Privacy Commissioner of Canada to explore ways to secure mobile patient health data while also ensuring patients can easily access their own data when they need it.

If you would like to join us, please contact Kate Mercer at kathryn.mercer@uwaterloo.ca or at 519-888-4567 ext 21357.