Over the past 10 years, the boom in smartphones has led to a similar surge in all types of smartphone apps, particularly disease and wellness-related apps. By 2014, there were already over 40,000 of such apps available with the number probably approaching or surpassing 100,000 today. Industry estimates are that by 2018, over 50% of the more than 3 Billion smartphone and tablet users, will have downloaded mobile health and wellness apps resulting in the mobile health market expected to reach $20 billion in revenue in 2018.
With so much choice, we should ask: “Which ones are good for my health?”
Back in late 2013, the IMS Institute for Healthcare Informatics, a global authority in healthcare-related information for decision makers and policy makers , conducted an extensive and comprehensive analysis entitled Patient Apps for Improved Healthcare. They identified over 40,000 apps that qualified for their analysis, from diverse sources ranging from consumer fitness tracking to hard science-based apps for disease.
The number of apps has vastly expanded since that report, yet the key findings do not appear to have changed. These findings were:
· The vast majority of apps had less than 500 downloads. Six apps accounted for about 15% of the estimated 660,000 downloads on Google Play. One example is MyfitnessPal, a calorie tracking app since acquired by Under Armour.
· There was little correlation between app development and major health care challenges – the factors driving healthcare spending. One glaring example: the vast majority of healthcare dollars are spent by the elderly for chronic diseases, yet only 8% of those >65 years old have ever downloaded an app.
· Doctors saw multiple hurdles before prescribing apps to their patients:. Major ones were that there was too little evidence that apps had clinical benefits, and there is a lack of infrastructure for prescribing apps (“How do I do this?”). Other issues included data security and the possibility of increased liability,
· Payors, such as Medicare and medical insurance providers, saw some similar barriers, such as wanting to see evidence of improving health like reduced hospitalization, before reimbursing for mobile apps.
A 2014 editorial in the Journal of the American Medical Association referencing this study (Powell et al. In search of a few good Apps, JAMA 2014) indicated that some sort of certification or app review process/organization is needed, trying to apply the same approach that medicine traditionally used in conjunction with public and private organizations to assess the value of medical type products.
One of the suggested solutions was an organization called Happtique, which entered the app certification business. Unfortunately, this has been a challenge – the diversity and sheer number of apps make it hard to develop a set of criteria that can be applied and understood by all. In fact, Happtique instead made the criteria so complex that it discouraged most useful apps from seeking such certification.
Since apps are usually in the hands of the patient/consumer directly, how are we to assess them?
First, consumers have to become better at understanding evidence-based solutions. Often evidence shows that obtaining precise health information from wearable sensors like FitBit and the Apple Watch can be very inaccurate at times, such as tracking one’s heart rate during vigorous exercise.
Second, consumers need to consider whether the FDA has reviewed the app. The FDA has started issuing guidelines on which apps/software products would fall under their oversight as a medical device. Unfortunately, since the FDA is typically understaffed, they have not been able to police this area so far. Generally, if you are a consumer and an app tries to provide you medical information, particularly about disease, it is likely to need FDA review unless the information is primarily educational in nature (in which case they should reference the studies they use).
Third, consumers should search the internet to see if there have been legal actions by states to restrict what an app can say or do. For example, in a recent article in Wired magazine (Wellness Apps Evade the FDA, Only to Land in Court, Wired, 2017) it was noted that the New York Attorney General had come to a settlement with a number of apps, such as MIT Media Lab spin-off Cardiio, which claims to measure heartbeat from the smartphone camera alone, for cash penalties and required changes in advertising.
Smartphones aren’t going anywhere and health apps are growing exponentially. It is our burden as patients and consumers to do some of the hard work to make sure that the apps that we are downloading and trusting are truly good for our health.