Choosing the right apps
The volume of mHealth apps on the market poses a serious obstacle to any physician who wishes to recommend them, notes Jogi.
According to IMS Health, in 2015 there were 165,000 mHealth apps available in app stores. Over 50% of these apps have a narrow functionality that limits their use in healthcare, and two-thirds of the apps merely provide information about medical conditions. That still leaves tens of thousands of apps for doctors to comb through.
Moreover, physicians have little to guide them in their search. There aren’t any good services for rating mHealth apps, says Paul Krebs, Ph.D., an mHealth app researcher, an assistant professor in the division of general internal medicine at NYU School of Medicine and a clinical psychologist at the VA New York Harbor.
Clancy says IMS Health’s reviews are more accurate than those in the app stores or those of other app rating services such as SocialWellth and HealthTap. IMS’ reviews are based on the “actual app rating and recommendation behaviors of thousands of physicians that use our product, as well as the app download and retention behaviors of the patients that have been recommended apps by our users,” he said.
One reason for the lack of mHealth app studies is that developers aren’t required to show that their apps are safe and effective unless they’re applying to the FDA for approval. The FDA requires clearance only for apps that act as a medical device or work with a medical device. Most mHealth apps don’t do either, and the FDA has approved only 219 apps to date, according to a department spokesman.
Krebs, who has studied consumer use of these programs. estimates that fewer than 5% of mHealth apps provide medical advice to consumers, Adam Powell, Ph.D., president of the Payer+Provider Syndicate in Boston and an expert on the adoption of new technology, warns that physicians should be cautious about recommending educational apps, which might be providing information that isn’t evidence-based.
If doctors do recommend an app, it should be one they have used themselves, Krebs says. That’s what both Jogi and Livingston have done; in fact, Livingston uses the fitness app he recommends to patients to manage his own weight.
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David Lee Scher, MD, a cardiologist and a digital health consultant in Harrisburg, Pennsylvania, says that most doctors who prescribe apps know about just a few apps and recommend them over and over again. He advises clinicians to pay attention to social media to keep up with newer apps.
Some institutions—including Ochsner Healthcare, Cleveland Clinic and Mount Sinai Health System—vet apps and include them in an app store for patients and/or a library for clinicians. If a hospital or health system does that, Powell says, it gives physicians more confidence that those apps are worth recommending.