Is there a good app for that?
March 16, 2017
Contributed by: Wesley D. Jackson, MD, CCFP, FCFP
The interest in mobile health has grown exponentially in recent years with an estimated 200,000 health and medical apps currently available. While fitness applications (apps) have consistently been the most popular choice, more and more consumers download and use the plethora of other health apps available on all platforms. Standards of quality in apps have been slow in development.
In the United States, the Food and Drug Administration currently applies the only regulatory standards for apps related to medical devices. At the time of writing, Canada has no such regulation. In 2015, however, the Canadian Medical Association (CMA), published “Guiding Principles for Physicians Recommending Mobile Health Applications to Patients.”1 The document outlines basic information for physicians about how to assess a mobile health application for recommendation to a patient in the management of that patient’s health, health care and health care information. The seven characteristics of an app suitable for recommendation highlighted in this document include:
1. Endorsement by a professional or recognized association, medical society or health care organization
3. Information reliability
4. Privacy and security
5. Freedom from conflict-of-interest
6. No contribution to fragmented health information
7. Demonstrated impact on patient health outcomes
On November 16, 2016, the American Medical Association released a physician adjudicated guide to health app recommendation2 that mirrors many of the CMA principles, with specific focus on integration of these tools into clinical workflows, patient-physician relationships and reimbursement models. Other major health care providers on both sides of the border are contributing to standards that will hopefully shape the future quality of health care apps available. However, the clinicians of today must make informed decisions based on their own experience and research prior to using or recommending apps to colleagues and patients.
Librarians have been using a tool named "The CRAP Test"3 (who ever said that librarians were boring?), developed by Molly Beestrum, when deciding if a website is a credible, valid source. The CRAP test examines four major areas of a website:
- Currency (regularly updated)
- Reliability (evidence based)
- Authority (author credentials)
- Purpose (pushing agenda or selling something)
While I’m unaware of a similar test to review health apps, these principles still apply and can be useful in evaluating any app considered for recommendation or use.
I have recently become aware of a new Canadian website, launched in August 2016, dedicated to the assessment of patient-focused health apps. Practical Apps,4 a collaboration between Ontario Telemedicine Network and The Women’s College Hospital Institute for Health System Solutions and Virtual Care, was created to help physicians use mobile tools to help their patients. Practicing physicians have been recruited to focus on a specific medical concern and evaluate several patient-related apps addressing that concern. The goal is to have a new medical problem addressed each month. These reviews are available at the time of writing of this article:
- Alcohol consumption
- Smoking cessation
iMedical Apps5 is an independent US-based online publication for medical professionals, patients and analysts interested in mobile medical technology and health care apps. Physician editors lead a team of physicians, allied health professionals, medical trainees, and mHealth analysts in providing reviews, research and commentary on mobile medical technology. The publication is heavily based on personal experiences in the hospital and clinic setting and can be a great resource for analyzing a specific app or finding a new one.
Primary Care Resources,6 funded by the department of Distributed Learning and Rural Initiatives at the University of Calgary, is a cross-platform tool designed to allow rapid access to many local primary care resources, clinical pathways and point-of-care tools (apps) available to physicians with a goal to improve patient care and learner education. Both the website and the associated iOS app contain valuable information about several physician tested apps.
While most practicing physicians do not have the time or the inclination to search for new medical apps, hopefully these tools, and others to be developed, will help us provide the best possible mobile experience for a changing generation.
References available upon request.