Medical Mobile Apps

So how do you choose an app from the many options? The best way is to start by identifying your priorities: how do you want to engage with the app? Whate features are you looking for? Is there a particular standard of privacy you are seeking? Recognizing that app choice is a personal decision based on many individual factors, the goal of this database is to equip users with the information necessary to make a decision based on the app characteristics that matter most to them.

The material provided here covers: (1) why it is critical to assess an app, (2) how to evaluate an app, and (3) an opportunity to seek additional guidance on apps and/or the evaluation process. It is not intended to provide a recommendation, endorsement, or criticism of any particular app, but rather serves as a tool for you to do your own evaluation of any app you might be considering. The goal is that in using this methodology, you will be able to make your own educated decision about particular apps and their suitability for your practice.

Despite an estimated 300 000 mobile health apps on the market, there remains no consensus around helping patients and clinicians select safe and effective apps. In 2018, our team drew on existing evaluation frameworks to identify salient categories and create a new framework endorsed by the American Psychiatric Association (APA). We have since created a more expanded and operational framework Mhealth Index and Navigation Database (MIND) that aligns with the APA categories but includes objective and auditable questions (105). We sought to survey the existing space, conducting a review of all mobile health app evaluation frameworks published since 2018, and demonstrate the comprehensiveness of this new model by comparing it to existing and emerging frameworks.

Commercial mobile apps for health behavior change are flourishing in the marketplace, but little evidence exists to support their use. This paper summarizes methods for evaluating the content, usability, and efficacy of commercially available health apps. Content analyses can be used to compare app features with clinical guidelines, evidence-based protocols, and behavior change techniques. Usability testing can establish how well an app functions and serves its intended purpose for a target population. Observational studies can explore the association between use and clinical and behavioral outcomes. Finally, efficacy testing can establish whether a commercial app impacts an outcome of interest via a variety of study designs, including randomized trials, multiphase optimization studies, and N-of-1 studies. Evidence in all these forms would increase adoption of commercial apps in clinical practice, inform the development of the next generation of apps, and ultimately increase the impact of commercial apps.

Mobile health apps are health and wellness programs available on mobile devices such as smartphones or tablets. In three systematic assessments published in BMC Medicine, Huckvale and colleagues demonstrate that widely available health apps meant to help patients calculate their appropriate insulin dosage, educate themselves about asthma, or perform other important functions are methodologically weak. Insulin dose calculators lacked user input validation and made inappropriate dose recommendations, with a lack of documentation throughout. Since 2011, asthma apps have become more interactive, but have not improved in quality; peak flow calculators have the same issues as the insulin calculators. A review of the accredited National Health Service Health Apps Library found poor and inconsistent implementation of privacy and security, with 28 % of apps lacking a privacy policy and one even transmitting personally identifying data the policy claimed would be anonymous. Ensuring patient safety might require a new approach, whether that be a consumer education program at one extreme or government regulation at the other. App store owners could ensure transparency of algorithms (whiteboxing), data sharing, and data quality. While a proper balance must be struck between innovation and caution, patient safety must be paramount.