Earlier this year, I joined a session at the popular ScienceOnline2013 conference held at NCU in North Carolina. The session, called 24/7 Health: The role of mobile technology in healthcare was moderated by Judy Stone and Pascale Lane and touched on a number of different aspects surrounding mobile health. With the program now finalized for ScienceOnline: Together coming up fast in January 2014, the annual gathering of science communicators will likely be tackling the topic of digital health in the Ethics, Genomes & Public Involvement in Science session. With that in mind, it is worth looking back at last year in the hope of contributing to future discussions.
The main takeaway I found was that people are concerned about three things:
- privacy of the information stored in apps,
- efficacy of apps and who is checking them, and
- reproducibility of results from app diagnoses.
Once we are past the excitement of the shiny new app, hopefully useful behaviours will form. Take my iPhone for example. It took me a while to settle on a type of email notification that I actually pay attention to, and now it is an almost unnoticed part of my day. I check it the way I check the time.
If I assess my email notifications function using the criteria above, it gets a passing grade. I trust the notifications are private to my phone mainly by using an email provider with a good track record. I also try not to leave it laying around. The notifications are effective, and I can see which ones I have missed easily without opening the app. It’s also been consistent which has fostered a sense of trust towards the app.
Deciding whether to trust the email notifications on my phone is an easy judgment call. But what if a smart phone is set-up for something I’m less qualified to understand, something important about my health?
The flood of mhealth apps on the market has the air of a gold rush. How should patients decide who to trust? Look for apps developed with hospitals or universities? Rely on app-resources provided at the pharmacy with their medication? The gold rush is on and trusted standards for apps are starting to take shape. It’s possible one of these institutions will act as a sieve for golden apps in the future.
Apple’s Apps for Healthcare Professionals Collection
The collection itself is a heartening step toward creating a trustworthy body. Apple has certainly acknowledged not only the popularity of mhealth apps, but also their potential.
The pitfall still comes from finding gold – useful apps – among the other sparkly apps available. As noted by Tom Lewis on iMedical Apps, “while there were some apps that have received FDA approval, this was not mentioned at any point”. Tom also notes some apps that probably shouldn’t belong. One glance at the collection reveals many unproven pseudoscientific-based apps, and a glance is not sufficient to detect medical apps that simply don’t work, like the highly publicized melanoma app that was discredited earlier this year.
Still, HIPAA-compliant apps are appearing in the app store; the demand for standards is increasingly likely to shape the market in the future. But more high-profile failures are not the ideal way to create a demand for improved vetting in the future.
FDA and government bodies
The immediate problem with relying on local government bodies to regulate apps and mobile health solutions lies in infrastructure. So many mobile health apps are coming so quickly that looking for worthwhile, functional, evidence-based apps will take a large investment of resources to keep up with the current flow from both developers and the government-led institutions.
A post by Robert McMillan at Wired notes a few apps that have been going through the process of getting FDA-approval, and that the FDA themselves have issued guidelines in order to encourage a sort-of best-practice standard.
Health on the Net Foundation
Health on the Net (HON) is a not-for-profit based in Geneva, Switzerland. Their site focuses on the HONcode, a code of conduct they promote, and they already perform certification for websites – including all of the French government’s health sites. They’ve also tried to combat faulty claims using their HONcode in the past.
Perhaps apps are the next step? Looking around the English version of the site it doesn’t look like there has been a lot of activity the last couple of years and apps may be beyond their mandate.
Happtique generated a lot of buzz in late February when they announced the release of their Health App Certification Program Standards. Certification is done with the help of the Association of American Medical Colleges, CGFNS International (a not-for-profit accreditation body for nursing graduates from countries outside the US) and Intertek, a product-testing company with experience in medical device testing , pharmaceutical analysis and consumer healthcare trials.
Happtique is currently the one to watch judging from their goals. They’re well known in mhealth discussions online and that has the potential to break through to mass market appeal. Their site is user-friendly and their blog mHEALTHzone shows they’re paying attention to current issues affecting the mhealth market.
The Future of Certification
How will each of these bodies certify the three concerns I heard at ScienceOnline; privacy, efficacy and reproducibility of results? That challenge still lies ahead. Perhaps a 3-point checklist next to an app’s description is needed.
It’s possible one or two of these bodies will establish a new standard for trusted care using mobile health. At the moment, the casual self-diagnosing patient will probably continue to base decisions on app recommendations and Google searches if they feel it’s important to verify an app beyond its presence in the app store.
Allowing 3rd party certification in the App Store could work, even if it only appears in the text description. Educating patients and app users about what these certifications mean is another challenge altogether.
Discussing certification is a healthy conversation to have regarding mhealth. A conversation like this is not about increasing red tape: it’s about delivering effective healthcare for people. The current gold rush on mhealth apps will slow down, leaving institutions and agencies with both the mobile expertise and medical understanding to deliver truly helpful innovation. And let’s face it: innovative and helpful apps are the ones that will stay on your phone.
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