APA’s App Evaluation Model and WeFeel

minus the scoring (which would be a little too self-serving)

Earlier this year the APA released its official mental health care app evaluation model. This has provided much needed guidance in a world full of apps making claims to help with mental health. WeFeel has been following along as the APA has worked through the creation of these guidelines since our inception in early 2015, and because of that we’ve been able to build our service based on their guidelines.

In order to make it easier to evaluate using WeFeel in your practice we’ve compiled this list of responses to the APA’s questions, because frankly there are a whole lot of them, and your time is limited. While each section in the original guideline allows for you to add a number of points to come up with an overall score, we thought it a tad inappropriate to give ourselves a perfect(ish) score. Check out the link above to their site to see how the points thing works. Below you’ll find our responses to each of the questions you should consider.

Gather Background Information:

  • What is the business model? If the app is free, then how does it support its own development? WeFeel follows a subscription based business model, with both monthly and annual subscriptions available. Typically subscriptions are purchased directly by clients via an in-app purchase, though some institutions choose to purchase subscription activation codes directly from WeFeel on behalf of their clients.
  • Who is the developer? WeFeel is the developer, to find out more about us as people check out Why We Do This
  • Does it claim to be medical? Unlike apps that are “For entertainment purposes only”, WeFeel provides a framework of tools designed to be used in conjunction with a mental health care professional. These tools (such as emotion journals, goal settings and coping strategies) are well established outside of the mobile app space as being effective, and are simply replicated as a single mobile tool set. In addition to this, WeFeel then provides visualizations of the data collected for the mental health care professional to interpret along with their clients. While WeFeel alone does not provide diagnoses or treatment, when used properly with a professional, WeFeel is another (more convenient) medical tool to help with various mental health disorders. WeFeel is currently being used by therapists to treat Anxiety, Depression, Bipolar Disorder, Addiction, Autism Spectrum Disorder, and in couples therapy.
  • What is the cost? Does it require in-app purchases to unlock certain features? Is it free? The app is free to download and use with some limits to functionality, though we designed it to still be helpful as a free service. One month subscriptions and one year subscriptions are available to unlock the full feature set. Currently (April 2017) pricing is $1.99/month and $19.99/year. In addition to this WeFeel has a Pay-It-Forward program where each license purchased buys a license for someone in need. Right now WeFeel has provided free licenses to a school that helps young adults with Autism, and for a pilot to use WeFeel to help with suicide prevention among at risk middle school students.
  • Does it integrate advertising into its usability? Absolutely not. At WeFeel, we don’t believe that advertising is an appropriate way to monetize mental health care.
  • On which platforms does it work (e.g., iOS, Android)? WeFeel runs on Android, iOS, and Windows 10 (phone, tablet, and desktop).
  • When was it last updated? How many updates have there been? What were the reasons for the updates (i.e., security updates; software glitches or bugs; improved functionality or added services)? We try to release new versions every 6-8 weeks. New releases typically add 1-2 new features, and have bug fixes to address any issues that have been reported to our support team. The majority of bug fixes address graphic issues that are found as new devices are released.

Risk/Privacy & Security

  • Is there a privacy policy? Yes there is, you can find it within our app or on our website here: http://wefeel.us/privacy-policy/ The short version is that we take privacy very seriously, we never sell any private information, although we do allow individuals to opt-in via the app to have anonymous emotion data made available to approved researchers.
  • What data are collected? Because WeFeel is a cloud based service that allows you to synchronize your entries between devices, any data you enter into WeFeel is stored for the purpose of syncing devices and allowing you to share that data with people of your choosing. Anonymous usage data may be collected by the app stores, which in some cases is presented to WeFeel. This data consists of things like how many devices currently have WeFeel installed, and how many times the app has been used in a given day. The collection of this data is governed by the individual app store policies, and is applicable to any application downloaded via an app store. WeFeel does not extract and store this data separately.
  • Are personal data de-identified? WeFeel intentionally does not store personally identifiable data such as user names, email addresses, physical addresses, credit card numbers, etc.
  • Can you opt-out of data collection? For WeFeel, the default is to opt-out. One has to manually opt-in for data collection for research purposes. Other data is not collected by WeFeel.
  • Can you delete data? Uninstalling WeFeel from your device will delete all local copies of data. In order to allow that data to be retrieved by the individual at a later date, the data which has been synced to the WeFeel service does retain a copy. Up to this point, we haven’t had any requests to allow a user to be able to remove their data from the system, but are open to add this as a feature should there be a demand.
  • Are cookies placed on your device? WeFeel runs as a native application on each platform and uses the local device’s mechanism to store application state data such as user preferences. This isn’t a “cookie”, but works similar to one.
  • Who are data shared with/What data are shared? WeFeel allows a user to share their data with anyone else who uses WeFeel. This is determined and controlled entirely by the individual, who has the ability to revoke the share at any point. People also may opt-in to share their emotion data with researchers. This will allow researchers who have been approved by WeFeel to view anonymous data from only those who have chosen to opt-in.
  • Are data maintained on the device or the web (i.e., “the cloud”)? Both? Both. One of the nice features about WeFeel is that your data is synchronized across all devices, while still allowing for offline viewing.
  • What security measures are in place? Are data encrypted on the device and server? The data which is stored locally is stored using the devices native system for storing user specific application data. These days, the majority of devices encrypt this data by default, and if not your device typically will have an option to encrypt user data. In addition to this, WeFeel does not store any of the data that one typically has concern for such as email addresses, social security numbers, credit card numbers or addresses. Data used to link a user’s device to their data is encrypted using 256 bit encryption, both locally and in the cloud.
  • Does it purport HIPAA compliance? / Does it need to be HIPAA-compliant? WeFeel follows all the guidelines of HIPAA. Access to data is limited to necessary individuals and all data transmissions are via secure connections. All data is stored in the Microsoft Azure Cloud, which meets ISO 27001 guidelines. As for do we need to be? In reality, we do not store any personal data that falls under HIPAA guidelines and so no we don’t. But privacy and security are critical to us and so we follow the guidelines anyway. Users do control access to their own data and may choose to give access to health care providers, which they also may revoke at any time.

Evidence:

  • What does it claim to do vs. what does it actually do? WeFeel claims to provide a toolset for mental health care professionals to work with their clients. Some of the tools are: customizable forms to enter emotions, feelings, moods, or pretty much anything else one can think of tracking, and the ability to create journals, coping strategies and goals. WeFeel allows an individual to share this data with mental health care provides, and/or loved ones. WeFeel provides various means to visualize that data such as charts, graphs, word clouds and data summaries to help one see patterns and find root causes of issues. As to what it actually does…well of course we hope it does all of the above and more.
  • Is there peer-reviewed, published evidence about tool or science behind it? We are working with a local university to create a WeFeel specific peer reviewed study, but in the meantime every major tool within WeFeel is backed by peer reviewed research as to their efficacy. For example, many studies have been done on the value of journaling one’s feelings, or of taking a moment out of each day to step back and evaluate one’s emotional state.
  • Is there any feedback from users to support claims (App store, website, review sites, etc.)? We have lots of success stories at this people from individual users, of which you can find some in our posts on our website and Facebook page. You can also check out this video from Dr. Scott Seaman, one of our early adopters who has helped us refine WeFeel in a clinical setting over the past 9 months: https://www.facebook.com/wefeelus/videos/767747563363719/
  • Does the content appear of at least reasonable value? We certainly hope so! If not, we are always open to feedback and new feature requests. Please feel free to contact us so we can do better.

Ease of Use

  • Is it easy to access for the patient at hand (i.e., based on patient diagnosis or other factors)? WeFeel was designed to be very graphical, and easy to use to collect data. We tested it with ages varying from 8 – 70 years old. By moving traditional mental health care tools to a mobile format we’ve made it easier than ever for patients to be compliant with their providers “homework” requests.
  • Would it be easy to use on a long-term basis? We currently have patients who have been using WeFeel for over a year. WeFeel has customizable reminders to use the app, which helps promote long term usage. Plus, the longer one uses WeFeel, the easier it is to find patterns and track behavior.
  • Is the app or are features of the app customizable? Nearly everything WeFeel does is customizable. WeFeel has the ability to add up to 8 unique items to track, nearly everything on the emotion entry page can be enabled or disabled to match the needs of the patient, coping strategies are a framework that are filled out with the therapist so that they are appropriate to the situation, and the dashboard and talking points pages have a large set of filters so that you can drill down to find only the entries relevant to that particular patient.
  • Does it need an active connection to the Internet to work? Only for the initial setup, and if you want to sync entries with others. WeFeel automatically flips between online and offline mode depending on your Internet connection, and will automatically synchronize data when a connection becomes available while the app is running.
  • What platforms does it work on? WeFeel runs on iOS devices (iPhones and iPads), Android Phones and Tablets, and Windows Phones, Tablets and Desktops/Laptops.
  • Is it accessible for those with impaired vision or other disabilities? In its current release WeFeel is accessible in that it is designed to have much larger icons when running on a tablet so that those with minor visual impairments can still enter data. Windows 10 users can use Cortana to create emotions entries by saying “Hey Cortana, I feel…..” In the future we’d like to update the app to follow proper accessibility guidelines.
  • Is it culturally relevant? WeFeel has attempted to be as culturally neutral as possible.

Interoperability

  • Who “owns” the data (i.e., patient, provider, developer)? WeFeel’s policy is that the individual owns their data. They control who it is shared with and have the right to revoke access at any time.
  • Can it share data with the EHR? At this point WeFeel is not designed to integrate with EHR systems.
  • Can you print out your data? WeFeel is not designed to print out any data, as most people don’t use mobile devices to print things. Also once an app allows data to be store outside of its control the organization using that data must follow along the HIPAA guidlines. For now, since that is beyond our control, we’ve not allowed for care-providers to print out user data.
  • Can you export/download your data? This is a feature we are considering, and have been given valid arguments for and against implementing this functionality. At the moment, Journals can be emailed to other people (specifically by the user that owns the data) and in the future we may add the ability to email a complete report of a user’s data.
  • Can it share data with other user data tools (eg, Apple HealthKit, FitBit)? WeFeel has the ability to gather data from the Microsoft Band such as heartrate. Future releases will support things like FitBit and HealthKit.

Let us know if you have any questions about our answers. We think it is critically important to be transparent with our customers about how WeFeel works and what we are doing to ensure it continues to meet the highest quality standards. Thank you for looking into WeFeel, we hope you’ll find that it can make a real difference in helping you help others to achieve better mental health.


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