In our report Connected Health: How digital technology is transforming health and social care we highlighted the increasing pervasiveness of health apps and an urgent need to help patients and clinicians understand the efficacy and effectiveness of individual apps. We noted that, depending on definition, there are more than 100,000 health apps available to download from the various app stores; with the sheer number and variety of apps confusing clinicians and patients alike. Research in October 2013 that focused on 43,000 wellness, diet and exercise apps found that only 23,682 had a legitimate health function and most had limited and simple functionality. Indeed around 50 per cent achieved fewer than 500 downloads. So far there are about 450 health apps that have been tried and recommended by patients’ organisations featured www.myhealthapps.net and even fewer approved by the NHS Choices Health Apps Library.i
Importantly, many health apps do not support the areas of greatest demand in healthcare – namely patients with multiple chronic diseases, typically over the age of 65. These patients are generally among the top healthcare consumers yet smartphone penetration, which is the key driver behind the explosion in health apps, is lowest among this group (albeit growing at the highest rate).
Despite clear consensus from most stakeholders that health apps have significant potential to support patient self-care and reduce the demand on healthcare systems, their use has yet to be mainstreamed. A key reason for this is a lack of user, both clinician and patient, involvement. A new report What do patients and carers need in health apps - but are not getting? identifies ten key recommendations that would support better patient self-care and provide more sustainable models for app developers. The research for the report comprised the views of 1,130 patient and carer groups worldwide, supplemented by a multi-stakeholder meeting.ii
The research found that some of the key uses that patients want from health apps include:
- Helping them understand and manage their medical condition and treatments (61 per cent)
- Providing practical support, such as care planning (55 per cent)
- Supporting their communication with their doctor or nurse (45 per cent).
However, most responses suggest that they are still not able to do so. Furthermore, while many health app developers report that they are keen to include patient and clinical input into their development process, they have found it difficult to engage meaningfully with users or understand their needs in order to translate them into better apps.
The survey revealed unmet needs across many areas, but five areas were felt to be particularly poorly supported: cancer, diabetes, disability (pain relief and management), mental health and wellness. Based on the findings of the survey and the workshop, the ten recommendations aimed at improving patient self-care and help app development are:
- Involve patients: Establish a transparent, fair and sustainable way to involve patients, patient groups and carers in app development
- Address unmet needs: Identify and address truly unmet patient and public needs, and switch the balance from information-giving and trackers to tools that help patients put this knowledge and data into action, enabling them to self-manage
- Set up a one-stop advice shop for developers: In one place, provide them with definitive, up-to-date guidance on key issues such as regulatory requirements, clinical approval methods, best practice in involving patients, and horizon-scanning on technological developments, issues and opportunities
- Share best practice: Identify, develop and communicate models of best practice, for example in involving patients and carers in identifying unmet needs
- Gain “air time” for quality apps: Identifying ways for developers of quality health apps to market and differentiate themselves from the many products available
- Find the business model: identify sustainable business models for apps, and make this funding transparent to browsing consumers
- Demonstrate clinical rigour: Confirm and clarify the clinical approval requirements which apply to health apps
- Bring apps into the mainstream: Integrate them into wider and “real-world” healthcare solutions, rather than remaining fragmentary “add-ons”
- Future-proof apps: Make them sustainable and adaptable to future changes
- Enable informed choices to be made by patients and carers about healthcare apps, for example by raising standards of digital/app/mhealth literacy, and gaining clinician input on recommending and prescribing apps.iii
Meanwhile, a hospital in the US has developed a more direct approach to helping patients and clinicians navigate the confusion of health apps and associated technology. HealtheConnect, an on-site, physical store located just off the hospital’s main lobby was launched at the end of 2014 by Morristown Medical Center, a part of the Atlantic Health System in New Jersey. The aim is to provide advice and support to patients, family members, and medical professionals by helping them learn about health apps and wearable devices through health app curation and technology evaluation. The idea was developed in response to an increase in the number of patients seeking advice on which apps clinicians would use.iv
Twenty-four physician leaders, one from each of the facility’s clinical areas, reviewed patient-facing health apps relevant to their area of expertise. i. Most were amazed at the amount and quality of information that was available and many of them subsequently started talking to their own patients and other members of their staff about the quality of the apps that they saw. Physicians now use a special mobile app prescription pad that patients take to the HealtheConnect store where a member of the health IT team walks the patient through how to install and use the app. The evidence suggests that providing this human interaction is a more effective method of engagement and supports the behaviour change that is needed to change how clinicians and patients interact.v
While an on-site physical store in every hospital is unlikely to find favour with many organisations we believe this example and the recommendations in the above research report re-enforce the findings of our own research for the Connect Health study; that patient and clinician engagement in technology development is vital to its adoption. Without it, the potential for digital health and the rise of health consumerism to be a true change agent for the practice of healthcare will be undermined.
iiWhat do patients and carers need in health apps - but are not getting?, A report by PatientView, in conjunction with Health 2.0 and TICBioMed, co-ordinator of the EU-funded GET project. June 2015. See also: https://patientview-plus.wetransfer.com/downloads/818d5eebb540e2aea63300dba803525120150623192046/04428c