How to make mHealth apps more useful to patients

Mobile health apps possess the potential to transform how people manage their health especially for those who have chronic or complex conditions. Achieving this potential will not be easy for a number of reasons.

In a recent study, researchers examined a number of popular health apps and assessed their usefulness helping people take care of various medical issues (Medical Xpress):

"It's based on a comprehensive review of 137 of the most highly rated or often recommended mHealth apps aimed at people with chronic conditions. They selected only the cream of the crop from the Apple and Google app stores that are aimed at people with high health needs. Such people have high health costs and may have care needs that are complicated by lower income or level of health knowledge."

The 137 apps evaluated by the researchers targeted a wide range of health and medical conditions including asthma, arthritis, cancer, diabetes, high blood pressure, depression, lung disease, liver disease, kidney disease, heart failure, addiction to drugs, alcohol or tobacco, memory loss and dementia, obesity, pain, and stroke, However, not all of these areas were well represented with quality apps.

Overall, the authors of the study felt that the apps fell short in a number of respects that are outlined below:

1. Many conditions (e.g. arthritis or pain) are not well-represented in the app store: "People with some conditions - such as diabetes and depression - can find a wide range of highly rated apps that offer to help them. But people with other conditions - such as arthritis or pain - find few options when they search for high-quality apps."

2. App store ratings are of poor quality: "App store ratings, supplied by other users, aren't always a reliable guide even with highly rated apps. [...] "We found that the consumer-generated rating on the app store is a very poor marker of how usable an app is, and whether a physician would recommend it."

3. Apps do not notify users of possible danger indicated by entered values: "Nearly all the apps (121) let people enter information into their phone about their health that day, such as a daily blood sugar or blood pressure level or whether they were feeling suicidal. But only 28 of these apps reacted appropriately when the reviewers entered a dangerous value - a blood pressure that was sky-high, a super-low blood sugar level, or a suicidal mood, for instance."

4. Apps do not offer sufficient recommendations or engagement: "Many apps offered tracking functions, education, reminders and alerts that could be useful to a high need, high cost population. But few provided tailored guidance based on what the user actually entered into the tracking interface, or offered ongoing engagement that rewarded "good" results."

5. Insufficient sharing of information with medical records: " And only one (app) allowed users to share data directly into the electronic health record that their medical team uses."

6. Insecure sharing of information: "Most of the apps allow users to share their health information with others, but the researchers found that often this was through insecure methods. Half the apps allowed sharing by email, and 17 percent allowed text-message sharing. The apps were tested in 2015, after the launch of Apple and Google options for secure sharing of health information, but only a minority allowed this kind of sharing."

7. Poorly explained privacy policy: "Only two-thirds of the apps had a written privacy policy" spelling out how they protect or use the information supplied by users. This is better than previous studies of all mHealth apps have found, but still troubling to the researchers because the apps in this study were supposed to be the most top-notch."

8. Apps geared more to healthy users than those with serious medical conditions:  "But the question is, to what extent are apps serving the needs of patients with chronic diseases, and their caregivers, as opposed to generally healthy people seeking help with wellness."

How can the apps be improved? By addressing the above deficiencies, one can compile a list of possible enhancements:

1. High quality apps targeted to people with chronic conditions rather than healthy people.
2. Apps that provide more direct recommendations. As Dr. Singh states in the article. "Do we really want our mHealth apps to be passive observers, or should we expect that they do more than that, and model themselves after crisis hotlines with specific action plans?"
3. Better communication of data to medical personnel and records. "Clinicians still think of apps the way they think of pen and paper - a patient enters information that they need to track, and then communicate it to their health providers on the phone or when they have an appointment," he says. "But if the information logged in an app is important, it should get dealt with right away. We need to think about care models that allow information to be acted on in real time - so that a blood pressure of 250 uploaded at 3 a.m. gets prompt attention."
4. Better engagement. In this area I think the wearable products such as Fitbit and Apple Watch have done a good job.
5. Improve the app functionality so that a physician would recommend it. A corollary is get buy in from the medical community so that they take better advantage of real-time information.

All of the above upgrades represent difficult but worthy challenges. Mobile apps will revolutionize healthcare and the time is now. As their impact deepens, more and more apps will be regulated by the FDA (because they confer significant medical benefits) rather than be by the Federal Trade Commission which protects consumers from false claims by products, which are mainly non-medical. Smartphone mHealth apps will become a more integral constituent of the healthcare fabric.

Figure 1. Mobile Apps have the potential to collect valuable health information from those with serious medical conditions as well as the healthy.