NEWSLETTER, April 2019

EmERGE is a project funded by the European Union’s Horizon 2020 Research and Innovation Programme under Grant agreement no: 643736.

EmERGE has developed a mHealth platform to enable self-management of HIV in patients with stable disease. The platform – a mobile application - builds upon and integrates the existing mHealth solutions operated by pioneering healthcare providers in the UK and Spain, and adapts a rigorous co-design approach to ensure patient and clinician input to the solution.

Jenny Whetham (Project Coordinator, Brighton and Sussex University Hospitals NHS Trust, UK) provides an EmERGE project update, its current status and on study recruitment.

Jenny Whetham

It’s four years into our five-year project. We have come a long way since 2008 when in Brighton, patients with stable HIV infection started using an email service where their interim results could be checked and sent to them electronically. What was originally three visits to the clinic a year, at that stage, was reduced to once a year. This meant many people who didn’t want to come to the clinic so often could be getting on with their day-to-day lives. At the time there was also a dramatic increase in the numbers of people attending the clinic, emailing results meant we could manage capacity and streamline care. We recognise one solution does not fit all, but for some patients this pathway proved a good thing. The email service, which we called ‘Connect’ (still running) grew in terms of user numbers. We got to the stage where about 25% of people coming to the clinic were using the service. Then we applied for a fellowship for a pilot, and on the back of that came the application for the Horizon 2020 Grant. The EmERGE project itself started in May 2015.

During the first year we carried out a situational analysis into the background of each of the five clinical sites (Antwerp, Barcelona, Brighton, Lisbon, Zagreb). We looked into the set-up of clinical care at each of them, information and governance, ethical and legal aspects, and how the technology might integrate into the clinical databases at each site. Once the background work was done it was a question of developing the app itself and its integration at all of the sites. The technology in itself isn’t complicated, but it’s the relationships and trust that needs building within the clinical sites and with the community that enables this to happen.

Then we were able to start the wider study. There’s quite a large questionnaire pack that we use and we are assessing various things at baseline and annually. I believe there will be some really valuable data that comes out of it at the end of the project. We’re not just looking at the app itself, but also at the change in the pathway of care. This is about much more than offering care in a different way for people living with very stable HIV. We are trying to look at whether it minimalizes costs, or whether this is just shifting costs around the system. I think that the story will be very different at all of the sites. It might work very well, it might be well liked, but it’s how you make the case thereafter so that it can be implemented wider.

Today, there are over 2,200 people using the app in the study across five sites. The experience of the app has been different at each of them, but the variation has brought with it a lot of learning and thinking about why this is. We shall be able to report quite richly on this in due course.

Paloma Chausa (Universidad Politécnica de Madrid, Spain) explains what’s new about EmERGE 2.0.

Paloma Chausa

The previous version of the EmERGE mobile application had three main critical issues:

1) The app was not translated in Portuguese. It was considered as a major problem for the whole consortium. The translation was extremely important in order for the app to be better accepted and used by Portuguese patients.

2) The app signed out some users automatically (iOS environment). It was also a major problem. Patients had to contact their clinicians in order to reinstall the application every time they wanted to use it. Some users even withdraw from the study because of this issue.

3) Some patients did not receive their laboratory results correctly, or sometimes were not able to view the historical graphs of their results.

These issues have now been resolved in the form of EmERGE 2.0. Firstly, the new version includes a Portuguese translation. It also uses a more stable version of Ionic, the platform used to develop the EmERGE application. This seems to have resolved the automatic log out problem. The new version also fixes the laboratory data bug. Now, all patients can see their results and the associated graphs. Graphs have been also updated in order to improve the performance of the app. EmERGE 2.0 also incorporates two new features which improve the log on procedure. These include recovery of the passcode through security questions, fingerprint and other biometric authentication.

We have further analysed other desired features such as appointment and medication reminders, integration with the Liverpool HIV drug interaction database ( and automatic notifications. This analysis has allowed estimating the technical effort required and hence, their feasibility. A comprehensive document has been put together describing all desired features and the clinical and technical implications. This document will be very useful for making decisions related to the next technical steps and future versions of the EmERGE application. Some of the functions could be available soon if the EmERGE consortium decides to include them in the next release. Currently, the security implications of the proposed new functionalities are being investigated in order to guarantee the security and confidentiality of the EmERGE application.

Benjamin Marent (University of Brighton, UK) discusses Co-Design and Community Perspective.