By Emily May, Research Analyst, Deloitte Centre for Health Solutions

Did you know that in 2020 more than 90,000 new digital health applications (apps) were added to app stores, more than 250 new apps on average, every day?¹ Neither did I until conducting some research for a conference panel a couple of weeks ago. Digital health apps range from providing a platform for services such as virtual GP appointments and chronic disease management to consumer health apps that help people manage their own health through tracking daily steps and accessing exercise and nutrition programmes. This blog explores the current use of digital health apps, how the COVID-19 pandemic has accelerated their adoption, the ethical and regulatory considerations, and the potential of these apps to drive a preventative, digital-first healthcare future.

The proliferation of digital health apps

Globally, over 350,000 health apps are available to download from the various app stores. However, downloads and the corresponding use of apps are heavily skewed, with just 110 health-related apps downloaded more than 10 million times, accounting for almost 50 per cent of all downloads.² Apps that fail to follow guidelines, don’t function as intended, are out-of-date, or economically unviable due to the ongoing costs of continually updating to new operating systems, are removed from the app stores.³

What impact has COVID-19 had on the adoption of health apps?

During the pandemic there has been a proliferation of symptom checker apps, apps to manage lateral flow test results and apps acting as vaccine passports. Many new and existing digital health tools have also helped citizens mitigate some of the health impacts of COVID-19. These apps have enabled citizens to engage with clinicians through virtual visits, track their general health metrics and monitor and manage their health condition or symptoms remotely. Virtual consultation (telehealth) technologies have been scaled dramatically to help clinicians diagnose, monitor and care for patients remotely, contributing towards a digital-first healthcare system.

In England, the NHS app, which uses independent digital platforms, has helped users access their GP record, conduct health assessments, arrange, and conduct video appointments and order repeat prescriptions. The NHS app also provides a library of trusted health symptom and diagnosis information and also provides proof of vaccination (acting as a COVID-19 vaccine passport for travel). As the most downloaded free app in England, growing from 200,000 users in January 2020 to over 16 million in September 2021, NHS app users have ordered almost 3.2 million repeat prescriptions and booked over 268,000 GP appointments from June to September 2021.⁴

This increase in use mirrors the increase in use of health and fitness apps. In 2020, app downloads grew by 30 per cent and time spent on apps by 25 per cent, compared to 2019.⁵ This significant uptake is expected to continue post-pandemic as demonstrated by the increase in investment funding with a record $24 billion of investments in digital health in 2020, globally, and average deal sizes increasing significantly to $45.9 million.⁶

Health apps are increasingly focused on health condition management rather than wellness management (the proportion of such apps has grown from 28 per cent in 2015 to 47 per cent in 2020). Mental health (MH), diabetes and cardiovascular disease-related apps accounting for almost half of disease-specific apps.⁷ Indeed, regulated, evidence-based, MH health apps not only improve access to advice and support, but can clinically reduce symptoms of anxiety and depression.⁸ Whilst these apps can be used in conjunction with traditional, face-to-face talking therapy, they also can be used as the platform to provide synchronous or a-synchronous support from a mental health therapist. A growing body of evidence shows that these types of platforms have increased accessibility by removing social stigma and the challenge of travelling to an in-person appointment. They are also facilitating access for those who have previously shied away from face-to-face therapy.⁹

How is the UK tackling the ethical and regulatory considerations?

Some 88 per cent of health apps have the ability to collect, and potentially share, user data. This makes the management and protection of data an important ethical consideration and one that requires compliance with regulatory standards.¹⁰

More specifically, the capacity and versatility of health apps, to collect a vast array of personal data, has the potential to create an increasingly powerful and personalised source of useful health data. This could be invaluable in facilitating earlier detection and diagnosis of disease and supporting technology-assisted clinical decision making. However, to realise their full potential there is a need to improve siloed data systems and methods of data analysis while maintaining user confidentiality. The Digital Technology Assessment Criteria (DTAC), officially launched in February 2021, provides national, tangible, baseline criteria for digital health technologies to give staff, patients, and the wider populations the confidence that the apps they use are safe and well-built.¹¹

In June 2020, the Medicines and Healthcare Regulatory Agency (MHRA) updated their MHRA App Guidance requiring developers to reassess their compliance and the classification of their products under medical devices regulations.¹²Apps such as symptom checkers, ones that aid diagnosis, track skincare imaging and reproduction health apps, all potentially fall under the new medical devices regulations, increasing the regulatory requirements and data collection rules for such apps.

In 2021, 28 per cent of apps have no privacy policies, increasing the risks of consumers using mobile health apps.¹³ The NHS App Library seeks to address this by assessing apps against stringent criteria to help patients and the public find trusted health and wellbeing apps.¹⁴

Moreover, in August 2021, NHSX launched the ‘What Good Looks Like’ framework providing guidelines to support NHS trusts.¹⁵ This framework describes the common foundation which should be in place across the NHS, to ensure that digital systems meet the needs of their staff and patients within a secure digital infrastructure, to support the digitisation of NHS services and build on the progress made in adopting digital tools during the pandemic.

What does the future hold for health apps?

Digital health apps are helping clinicians to work smarter and empowering patients with easier access to advice and support, whilst improving their understanding and management of their condition. As nuanced in our sixth prediction of 'Predicting the future of healthcare and life sciences in 2025: The future unmasked', in the future clinicians and patients will be empowered by digital diagnostic and treatment paradigms. We also predict MedTech and related health applications will be crucial drivers of value-based care. Together these developments will contribute to the delivery of 4P medicine (medicine that is predictive, preventative, personalised and participatory).¹⁶

We believe that health apps will play an important role in empowering patients to manage their health through digitally-enabled care pathways, broaden access to healthcare services, and increase participation and awareness of the wider populations’ health and wellbeing. Evidence-based health apps will likely be integrated into established clinical treatment pathways, with the aim of both improving outcomes of current treatments and increasing access to specialised, and, where relevant, personalised, therapies.

Health apps also have the potential to improve sustainability of healthcare, due to reducing the amount of patient and clinician travel, remote monitoring, treatment, and surgery; and remote medication management, including improved adherence. However, to achieve this ambition, citizens need to trust that the health apps are collecting and analysing data safely and effectively and in accordance with robust data standards and regulatory scrutiny; and, importantly, that clinicians are acting on the results.

Emily May - Research Analyst, Centre for Health Solutions

Emily is a Research Analyst for the Centre for Health Solutions where she applies her background in both scientific research and pharmaceutical analytics to produce supported insights for the Life Sciences and Healthcare practice. Within the Centre, she performs thorough analysis and research to help find solutions for the challenges impacting the industry and generating predictions for the future. Prior to joining the centre, Emily worked as an Analytical Scientist conducting physical chemistry analysis on early stage drug compounds and previously lived in Antwerp, Belgium where she researched and developed water-based adhesive films.

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^{1 IQVIA | Digital Health Trends 2021
2 ibid
3 ibid
4 NHSX | 16 million NHS app users
5 https://www.appannie.com/en/go/state-of-mobile-2021/
6 IQVIA | Digital Health Trends 2021
7 ibid
8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897664/
9 https://committees.parliament.uk/writtenevidence/19183/pdf/
10 https://www.bmj.com/content/373/bmj.n1248
11 NHSX | Digital Technology Assessment Criteria
12 GOV.uk | Medical Devices Software Applications
13 https://www.bmj.com/content/373/bmj.n1248
14 NHS | Apps Library
15 NHSX | What Good Looks Like
16 Deloitte | Medtech and the IoMT are crucial drivers of value based care}