Healthcare apps should be treated like over-the-counter meds
April 1, 2016
It can be daunting for clinicians, who are already overwhelmed with patient-care responsibilities, to now screen and manage an entirely new modality – the mobile ‘apps’ that run on smartphones and tablet computers.
However, the potential for improving outcomes and reducing system costs is significant through the use of mHealth apps. On the other hand, patient harm is also a real possibility, through inappropriate use or through the use of apps with false claims. With the presence of mobile devices in society increasing and the growing number of mHealth consumer apps, clinicians will inevitably be crossing paths with patients who seek advice about mHealth apps.
How then, should physicians interact with patients using or asking about apps? What approach should they take to learning about the best or most appropriate apps? We present some solutions in this article.
mHealth apps can be categorized based on the intended user, being healthcare providers and patients (who are termed as ‘consumers’ of mHealth apps). With respect to consumer mHealth apps, a survey of 2000 app developers from around the world found these applications are being used diversely to monitor fitness data (e.g., steps, speed, HR, hydration, calories, mood), patient vitals (e.g., BP, blood oxygen, glucose, temp, medicine adherence, brain waves, posture), and medical exams (e.g., respiratory rate, EEG, ECG, blood test, US, urine test.)
Fitness and wellness apps are currently the most commonly used, but developers agree that apps targeting chronic illnesses will gain a larger share of the market in coming years.
Among the most common disease-specific apps are those targeting diabetes, obesity, hypertension and coronary heart disease, and to a lesser extent asthma, depression, and cancer.
Surveys of healthcare providers and industry developers have revealed a sense of optimism about the potential of mHealth apps to change healthcare for the better. Many industry developers believe that mHealth apps show great promise and potential for improving healthcare delivery and health outcomes.
According to one survey, the major ways in which this will happen include improved prevention and education, reduced or slowing down of healthcare costs, and improved interaction between patients and doctors.
As the demand for health information and health services increases, mobile health apps will take a more prominent place in healthcare. However, this demand should be met with some sort of regulatory or certifying body in order to protect consumers, and, on the other end, to allow physicians to be aware of which apps to comfortably recommend to their patients.
Before apps are adopted in practice it is necessary to determine their safety and effectiveness. According to one industry report, over 300 clinical trials using mHealth apps were registered on ClinicalTrials.gov in 2015, representing a huge leap forward in their validation.
Regulatory bodies such as the US FDA will play an important role in testing these apps by defining whether they are “medical” or “wellness” apps (the latter will be exempt from some regulations). Similarly, Health Canada has expressed intent to have a regulatory process for “higher risk” medical apps; however what defines this remains to be seen and only a handful of mHealth apps can be found through Health Canada’s website.
The Canadian Medical Association in 2015 released a policy report to help guide physicians on recommending mobile health apps to patients. The document, however, provides only basic high-level recommendations and lacks a useable approach that can be applied to practice.
Navigating the ever-evolving space of mHealth apps can be a challenge for both the clinician and the patient alike. As patients further turn to their healthcare providers for advice and information regarding the use of such tools, it will become critical for providers to have a practical approach towards making such recommendations. This is particularly true in this transition period where there is no centralized regulation or evaluation of these applications.We propose that clinicians evaluate and treat mHealth apps with a very similar framework to the way OTC (over-the-counter) medications are treated. Conceptually, both groups of “interventions” share many similarities: they don’t need a prescription for usage; patients will still approach clinicians and other healthcare providers for advice on their use; they carry potential risks and benefits that need to be weighed to the individual patients and there is a broad selection of uses, as well as a growing market of companies selling the products that can make selection difficult.
Just as a clinician may have a preferred choice of over-the-counter medications that they may recommend, clinicians through experience, research and sharing within their networks can begin to develop a list of their “preferred apps” for specific therapeutic conditions and purposes.
There needs to be more work at multiple levels of the healthcare system to approach this topic.
Medical associations and the Ministry of Health need to continue to develop a robust and agile framework for screening and categorizing such apps, and provide material to educate both patients and healthcare providers alike.
Medical schools and residency programs need to incorporate topics around health information privacy and mobile health applications as a standard practice. Until then, frontline clinicians must take the responsibility for developing their own lists of ‘preferred apps’ and sharing them within their networks and associations, and ensuring time is allocated to discussing this important topic with patients.
Puneet Seth, MD, is a practicing physician in Ontario and is Chief Medical Officer of InputHealth, an award-winning digital health company connecting patients and providers through the Collaborative Health Record. You can follow him on twitter @psethmd. Dorian Murariu, MSc, is a Clinical Research Coordinator in Ontario and a co-investigator on clinical studies in diverse fields including head and neck surgery, cardiology, medical education, and global health.