With the rate of app downloads slowing some are starting the question whether there is a viable future for health apps
With the rate of app downloads slowing globally, and an almost non-existent regulatory framework for medical apps, some are starting the question whether there is a viable future for health apps.
Since that fateful day in July 2008 when Apple launched their App store, the app boom has been in our face. More than four million apps are available on either Android or Apple platforms today, and within those two ecosystems there are more than 165,000 specific consumer healthcare apps.
With those sorts of numbers you might expect apps to be making a significant impact in the world of healthcare already, even on the clinician side. But the reality is, health apps are hardly used, are being constantly criticised for being potentially dangerous, even deadly, and the rate of overall use globally is slowing dramatically anyway.
Last year, an IMS study of 27,000 mobile health apps (mHealthApps) found that just 36 accounted for nearly half of all downloads generated by these apps. The next 3204 took the figure up to 90% of all downloads and the remaining 23,760 apps only generated 10%. Put another way, most health apps aren’t used at all or at least in numbers that would mean they have any significant meaning to the delivery of healthcare.
These statistics aren’t likely to improve much. Rounded down, the average smartphone user in the US downloads zero apps per year. And last month, the top 15 app publishers in the US saw downloads drop an average of 20%.
The figures would be much worse for overall app use and growth, if not for a couple of “super apps” that are propping up the stats. The big two are Snapchat and Uber. Last month 27 million people downloaded Snapchat, which was a 100% increase on May 2015.
But an overall slowing in our app(etite) isn’t the biggest issue for health apps. Even if we were downloading and using them, the regulators and health experts are increasingly alarmed at the fact that virtually none of the health apps on offer today have had rigorous evidence-based testing or medical peer review to ensure patient safety.
Nearly a quarter of all health apps are directed at the management and treatment of disease, with most of rest targeting fitness and wellness. Of those targeting disease management, most aren’t developed using medical professionals, their content is not checked and there is no regulator prepared to take on the additional, and massive, burden that monitoring of this sector would represent.
The Food and Drug Administration (FDA) in the US put out a guidance document in 2013 for Mobile Medical Applications, but the document only contained non-binding recommendations and the organisation has publically stated that it will not be taking on what they describe as a “monumental task”. At least the FDA document is 44 pages long. The local equivalent from the Therapeutic Goods Administration runs to barely a page on its website.
The stakes are starting to rise in Australia however, after several researchers last month published research into mental-health and suicide apps that found that most lacked comprehensive evidence-based support, and some were even potentially harmful.
Talking to the Sydney Morning Herald, one of the researchers, Ms Jennifer Nicholas, who works with the Black Dog Institute, said that nearly all the mental health apps out there were of low scientific quality.
“That’s generally because the market is unregulated and incentives to develop apps with evidence-based content are pretty much lacking,” she said.
In the US, the American Psychiatric Association is struggling with the dilemma. In a commentary published recently in the Journal of Clinical Psychiatry two options were identified for psychiatrists to consider when dealing with consumer apps for mental health care. They can simply counsel their patients against using them, because of the limited evidence around their efficacy and content. Or, they can accept that whether they counsel the dangers or not, it is likely that because of the number and nature of these apps, patients will still likely engage in their use. Therefore, they should engage their patient in establishing meaningful rules around how they use them.
The framework recommends a framework for psychiatrists, called ASPECTS, which crudely breaks downs to apps needing to be actionable (clinical useful data capture), secure, professional (standards based), evidence based and transparent (on data reporting and storage).