Trudy Simpson

Healthcare apps: helpful or harmful?

Trudy is Junior Researcher in the CMF Public Policy team.
The views expressed do not necessarily reflect those of CMF.

social_mediaFrom finding a carpark to counting our calories, apps now cover virtually every area of our lives, including in healthcare.

A 2011 General Medical Council survey showed 30% of doctors use a smartphone for medical apps. This will have increased significantly in the last five years. In addition, health apps, ranging from health and fitness trackers to virtual GPs and genetic screeners, account for more than 1.5% of a total app market.

A 2015 Digital Health market report for the Office of Life Sciences also estimates that the mobile Health apps market is predicted to grow at 35% in the UK and 49% globally from 2014 to 2018.

Apps are so prevalent that in 2014, The Medicines & Healthcare products Regulatory Agency published guidelines on health apps and the National Health Service (NHS) is now currently upgrading its Health Apps Library. In addition, The European Commission has been looking at issues around the rising use of this and other wearable technology.

Some of the most popular health apps allow healthcare professionals to join networks, share best practice and store and access data.

In fact, the General Medical Council launched its own app in 2015 to help doctors update and share their knowledge.

Medical or health apps may also assist patients and others to improve their health and allow medical professionals to

  1. increase their knowledge of patients’ conditions
  2. improve their relationships with their patients and
  3. encourage patients to take more responsibility for their health

For example, the Kings Fund reports that ‘Smartphones are highly effective data collection devices and they can record a lot of detail about people’s lives. As well as tracking their own health status, people can also help researchers gather large amounts of data on health problems and their determinants using their smartphone.’

It adds, ‘Many digital therapy platforms include a way for people to connect with peers and share their experience, or to connect with health professionals remotely… Digital therapeutics are often cited as a solution to help manage long-term conditions that call for behaviour changes or to prevent diseases in the long run.’

But there are also dangers that include:

  • Patient safety concerns
    In the Online Journal of Public Health Informatics, researchers raised concerns that apps, many of which are developed without medical consultation, may ‘lack accuracy and reliability in the content… used in diagnosis and patient management.’In fact, a European Commission report quoted a 2012 study by the New England Centre for Investigative Reporting that showed that of 1,500 health apps evaluated, 20% claimed to treat or cure medical problems, yet only a small percentage of them had been clinically tested or approved.A 2014 report from a joint Academy of Medical Sciences and the Royal Academy of Engineering meeting also raised questions about ‘the adequacy of current monitoring and vigilance systems’ of health apps.In addition, Chair of the RCGP Professor Maureen Baker has warned that: ‘…errors in technology can happen too…’ She adds, ‘… It is essential for patient care that apps provide correct, evidence-based information and that appropriate safeguards are put in place – there is definitely a need for some form of regulation.’

    Referring to apps offering virtual GP consultations via smartphones, she wrote, ‘Patients will be having consultations with GPs who are unfamiliar with – and won’t necessarily have access to – their medical history, or information about drugs that they have been prescribed. Medical histories provided by patients themselves will rarely be as comprehensive as those held by their family doctor. There are also many signs and symptoms that GPs look out for when making a diagnosis, that the patient might not think to raise. And a virtual GP cannot conduct a physical examination’.

    Researchers also recently raised concerns that people at risk of suicide, abuse or rape may rely on apps that do not get them adequate help. In an article in April, Nature also reported concerns about low regulation and low understanding of potential risks around mental health apps.

    If you type in ‘depression’, its hard to know if the apps that you get back are high quality, if they work, if they’re even safe to use,’ John Torous, a Harvard Medical School psychiatrist who chairs the American Psychiatric Association’s Smartphone App Evaluation Task Force, told Nature.

    In the same article, Jen Martin, the programme manager at MindTech, a national centre funded by the UK National Institute for Health Research, added, ‘At the low end, people might waste their money or waste their time and at the higher end, especially with mental health, they might be actively harmful or giving dangerous advice or preventing people from going and getting proper treatment.’

  • Possible data confidentiality breaches
    In April 2016, the Irish Medical Organisation (IMO) called for greater data protection across Europe because of possible data mining of people’s health information through app related privacy breaches. The IMO said sensitive medical information could be revealed to third parties without patient consent and could later be exploited for commercial purposes.A 2015 study published in BioMed Central (BMC) Medical Journal also questioned ‘the ability of accreditation processes relying substantially on developer self-certification to ensure adherence to data protection principles’.It said, ‘Regulators should consider establishing standards for accreditation processes, and be ready to intervene if accreditation programs cannot manage risks effectively.’A recent study in the Journal of the American Medical Association also said some healthcare apps currently have inadequate security and the ‘privacy policies for health programs — or “apps” — designed for smartphones that share highly sensitive medical information between patients and doctors are lacking, and often are completely missing’.
  • Possible stigmatisation, discrimination and isolation of vulnerable groups
    The Online Journal of Public Health Informatics said health apps may isolate less technologically knowledgeable people. ‘An app that is perfectly usable by a younger person might be very difficult to manipulate by an older or disabled person with different and unique usability needs related to ageing and/or physical and cognitive impairment.’In addition, an article in New Scientist raised questions about possible negative consequences of such digital health trends, particularly in a work related context. ‘Some health experts argue that the benefits aren’t so clear cut – and that the wellness trend, if left unchecked, has uneasy implications for what workplaces of the future will know about your health.’ The article adds, ‘It could also be a slippery slope into workplace discrimination’.

While this blogpost only scratches the surface of issues around this burgeoning technology, there are lessons that can be learned. Among them is that while God has blessed us with technology, he wants us to use it responsibly.

We have to be wise and be guided by God in deciding how and when to use such technology in our professional as well as personal lives. Philippa Taylor and John Wyatt believe ‘the wise use of technology is to be supported and encouraged by Christians.’

They also write, ‘Christians believe that we have an ethical requirement to reach out and heal the sick and to embrace technology as aids to prevent or correct illness and restore health and fitness…

But they warn, ‘whilst as Christians we can enjoy many benefits from new technologies, this must be within the context of understanding that our worth and value, our human dignity, stems from our creation in the image of God.’ They add, ‘The challenge before us is constantly to query the impact technological progress might have on the inherent nature, value and equality of all human life.’

 

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