Do health apps really improve patient outcomes?
Barry Nguyen, APAM, discusses the merits and disadvantages of mobile and tablet apps as a treatment tool.
Health professionals, providers, and patients around the world are hopefully looking towards digital health. In the context of this article, digital health incorporates anything related to technology-enabled solutions. This includes wearables, apps, telehealth, data analytics, AI, and patient engagement tools. There is much expectancy around the potential of emerging solutions capable of improving value, convenience, access and affordability of healthcare—and ultimately, improving patient outcomes.
The tangible value of such technological applications have already been demonstrated in physiotherapy through telehealth video conferencing tools such as Coviu and exercise prescription tools such as Physitrack.
Not only for the young
A 2019 report demonstrated mobile technology adoption is not just among millennials but also older generations.
The advent of smartphone and tablet technology with 5G internet capabilities, high-quality cameras, and mobile apps has allowed for innovators to potentially solve one of the most challenging problems associated with healthcare—having a positive influence on age groups and populations. Although millennials lead smartphone and tablet technology usage, baby boomers and Generation X are not far behind. It’s worth noting that downloads of smartphone apps are declining in general, but health app usage has increased— particularly among millennials.
The application of mobile technologies in healthcare is broadening in terms of scope, impact and value. Even so, the challenges of bringing such innovations to the market and wider community are substantial due to the regulatory complexities associated with healthcare—particularly with claims on safety and effectiveness.
Unresolved challenges to do with health apps
They are various unresolved challenges associated with health apps, such as the question of whether or not health apps really do improve patient outcomes. There is very little useful guidance for health professionals on how to use health apps to add value to patient care. What health professionals perceive as high-quality health apps may not reflect patients’ views.
Most mobile health app guidelines do not involve patients in the development. Data privacy and security have been primary user concerns of health apps as most health apps do not undergo rigorous scientific and clinical evaluation. This is not often due to developer negligence or bad intentions, but more likely to do with the fact that evaluation is difficult due to the rapid rate of development and changes in technology.
There is an urgent need for healthcare professions and regulatory agencies to proactively address the challenges associated with bringing clinically validated health apps to the market to maximise the value, quality and safety.
The wheels have recently started to turn with many industry stakeholders starting to contribute to addressing these challenges—in particular, the Australian Digital Health Agency funded by the federal government, Consumer Health Forum of Australia, various research projects from universities, health professional peak bodies, and various private and non-for-profit organisations.
Recent health app developments and news
A recent study published in npj Digital Medicine on 13 January 2020 titled ‘What is the clinical value of mHealth apps for patients?’ demonstrated significant challenges for health professionals in both evaluating and using mHealth apps to improve the health of their patients. The study demonstrated that apps can generally be categorised into diagnostics/clinical decision-making support, behavioural change, digital therapeutics, and disease- related education. It concluded that there is potential for health apps to add value to patient care when used as part of clinical workflows; however, the level of evidence is currently only sufficient to support a small number of apps for a limited number of defined clinical scenarios.
Another recent Bond University study published in npj Digital Medicine identified ‘prescribable mHeath apps’ and found six systematic reviews. The study found that the overall quality of evidence of effectiveness greatly limits the prescribability of mHealth apps.
A survey published by the Consumer Health Forum of Australia in early October 2018 discovered that consumers would most likely trust recommendations from their GPs or pharmacists on health and wellbeing apps. It also indicated that consumers trusted recommendations from their peers but to a lesser degree. Big tech companies such as Google and Apple were less likely to be trusted sources of health app advice.
There has also been recent controversy in the media with data privacy issues associated with health apps. In particular, health apps have been known to change their terms of service without users’ knowledge. They often fail to appropriately and successfully inform their users of their changes in terms of service. This suggests that an app company could collect months of user data and then all of the sudden change their privacy conditions without or hardly informing the user.
In the United States, health professionals are governed by HIPAA laws, which state that health providers must keep health information private. But for consumer products like apps, the companies are not bound by the same laws. There are experts in the United States attempting to lobby Congress to change this. Law experts are also arguing that health apps collecting sensitive data need more transparent terms of service.
The future
Apps will likely be integrated into existing clinical management workflows to improve accessibility, convenience and affordability to healthcare services. They will also likely play an increasing role in remote healthcare or the practice of telehealth.
The aggregated data collected from these apps have the potential to add new insights and substantial value to clinical decision- making, personalising care, reducing healthcare costs and ultimately improve health outcomes at both an individual and population level.
The governments around the world will likely have a clearer role in regulating the quality, safety and value of health apps. There will also be clearer and stricter data and privacy laws around sensitive health information.
There will be an abundant source of online resources on user reviews (from both health practitioners and patients) of health apps. Despite there being over 250,000 health apps accessible by the public, high-quality research studies and aggregated data on what health apps work is lacking.
Email inmotion@australian.physio with any comments or queries regarding this article.
Disclaimer: This material is intended for general information purposes only and does not constitute legal advice or meet the specific needs of your clinical context.
Useful online resources
HealthDirect health and wellbeing apps
VicHealth healthy living apps guide
NHS apps library
Digital health guide
HealthAide
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