Do Your Homework on Mobile Health Apps

“Digital health” is a common Information Age phrase with an extraordinarily broad multifaceted meaning. In July 2017, the Food and Drug Administration (FDA) published a “Digital Health Innovation Action Plan” that defined the scope of digital health to include “categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine.”

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The authors of the FDA plan added that such technologies “can empower consumers to make better-informed decisions about their own health and provide new options for facilitating prevention, early diagnosis of life-threatening diseases, and management of chronic conditions outside of traditional care settings.”

However, the field of digital health is also fraught with mass confusion and hype. Health Affairs , a peer-reviewed journal on health policy thought and research, recently reported that valid studies and assessments of digital health products and services “on real patients are just beginning.” While there is great promise “to solve some of the biggest problems in our healthcare system” through digital health technologies, the article said, many consumer-based digital health products and services have not yet officially demonstrated effectiveness in clinical environments.

So, what’s an interested consumer or health care provider to do?

Part of the reason for confusion is a paradox of choice problem. There are simply too many digital health products and services being hawked to doctors, caregivers and patients.

Case in point: mobile health apps (also called medical apps). The FDA defines these as “software programs that run on smartphones and other mobile communication devices. They can also be accessories that attach to a smartphone or other mobile communication devices, or a combination of accessories and software.” Mobile health apps run the gamut, claiming to help monitor and improve sleep habits, improve cognition, manage medication, prevent falls, diagnose skin problems, check your vision, monitor blood glucose, take your blood pressure, perform an EKG, help with weight loss and exercise and more.

According to a IQVIA Institute for Human Data Sciences report, more than 318,000 health apps were available to consumers in 2017, with more than 200 health apps introduced to the Apple Store and Google Play every day.

This is where Bertalan Meskó, director of The Medical Futurist Institute based in Budapest, Hungary, can help consumers make wise choices. Meskó and his team have built a large body of informative, easy-to-understand internet resources on digital health that features product reviews and analysis, trend reports, advice pieces, how-to articles and the latest news in medical innovation.

In one of his articles, Meskó addressed how to evaluate mobile health apps. “If you are skeptical about an app,” he wrote:

• Check the company behind it: look it up in company databases, browse through its appearance in relevant news sites. Some of his recommendations include MedPage Today, Healthline, Medgadget, and WebMD.
• Find out how often an app’s updates come out.
• Read a few user reviews by checking whether MobiHealthNews or Medgadget reviewed the app.
• Be vigilant about how many things it requests your access. For example, why would an app providing information on diabetes want to connect to your camera and photos?

Also check out Meskó’s articles under the category of Health Sensors & Trackers, which typically include information from his personal use of mobile health products, including his reviews on the effectiveness of a dermatology app, apps related to tracking your fitness, a vision test app, sleep tracking apps and much more.

Another digital health guru, so to speak (among many), is Los Angeles-based Dr. Brennan Spiegel, director of the Center for Outcomes Research and Education (CS-CORE) for Cedars-Sinai Health System in California. CS-CORE is conducting important research on how mobile health apps that run on wearable devices (think Fitbits and smartwatches) can provide effective benefits in a variety of hospital patient caregiving settings.

Spiegel and his colleagues recently wrote a case report related to one among many facets of their work that use mobile health apps connected to various devices. Published in the Journal of Medical Cases, the case report outlined an instance where the possibility of a major adverse cardiac event was detected and treated effectively through two remote patient monitoring apps.

“We used an [FDA-cleared] EKG monitor [AliveCor’s Kardia] that worked through a smartphone,” Spiegel explained. “We presented in the case report a patient who detected an irregular heart rate, used the sensors, found that there was a problem, came to the hospital, got it confirmed and was treated appropriately.”

In addition to the Kardia EKG monitoring data, the patient also used a wrist-worn Fitbit Charge 2 that tracked activity and heart rate. “We had additional information on how well the patient was sleeping, walking around, and how the patient was feeling,” Spiegel added.

In another Cedars-Sinai study, the results of which were recently published in the JAMA Network Open medical journal, Fitbits were used on 100 patients who had undergone surgery, ranging from lung lobectomies and gastric bypass to hip replacements and abdominal hysterectomies.

It is critical for such patients to get out of their hospital beds and walk around after their surgeries. “We know that helps reduce infection risk and blood clots; it helps healing,” Spiegel said.

But there was nothing in place to effectively monitor patients’ post-surgery walking progress. “So, we just put Fitbits on people to see if they were walking.” The study found that “higher step counts up to 1,000 steps in postoperative day 1 was associated with significantly lower odds of prolonged length of stay, with no further decrease in odds after 1,000 steps.”

The work of Spiegel and others proved that mobile health apps used under specific guidance and medically professional-controlled monitoring can be beneficial in a hospital setting, but that’s not always the case for those who use apps at their own discretion without consulting with their doctors and caregivers.

According to American Medical Association CEO Dr. James Madera, mobile health apps are certainly on the threshold of becoming “incredibly important in medicine,” which makes it also “incredibly important that we get our act together around their quality and uniformity.”

As an example, he pointed to an Instant Blood Pressure app that made it into the top 10 Apple App Store’s Health & Fitness category in 2014, even though it provided grossly inaccurate readings (and is no longer available, as noted in an article published on the iMedicalApps website).

Additionally, Madera explained that effective and purposeful “mobile health apps must be evidence based, they have to be validated, they should be actionable, and they should be connected to allow interoperability [with your electronic health records]. Otherwise, you’ll have data dumps into a vacuum where it’s not processed, it’s not helpful. On the other hand, if you have tools that are evidenced based and validated, they’re actionable, and then they are connected to the health record and organized within it. That’s the kind of data that will be useful.”

Bottom line, as noted by Spiegel: “Make sure your doctor agrees with it.”