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Barbara Ficarra

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Too Much Hype in the Mobile Health App World?

Posted: 07/23/2012 12:00 pm

The Wild West of mobile health (mHealth) is taking the health care industry by storm, but "there are no rules to the game," said Joseph C. Kvedar, M.D., founder and director at the Center for Connected Health in a recent interview. Mobile health is a "game changer," he added, but there is a lot of hype because there are a lot of people developing health apps just to "get rich quick."

According to the U.S. Department of Health and Human Services, mHealth is "the use of mobile and wireless devices to improve health outcomes, healthcare services, and health research." mHealth includes gamification, text messaging, telemedicine/telehealth (remote patient monitoring), electronic health records, and health apps, to name a few.

There's a lot of enthusiasm surrounding mHealth -- from mainstream media tapping into the mHealth rage to social networking sites exploding with discussions about mobility in health care. Take a look at the conversations happening on Twitter and you'll observe how popular mHealth really is. Follow the hashtags #mHealth, #HealthIT, #HIT100, #apps, #healthapps, #digitalhealth, #hitsm, and #hcsm; and observe the 140 characters of tweets that soar at an accelerated rate through cyberspace offer fiery information. Paul Sonnier's Linkedin group Digital Health has over 11,000 members to date.

Not only is mHealth soaring through the social networking sites, U.S. revenue in the mHealth market earned $230 million is 2010 and it's estimated to reach $392 million in 2015, according to a news release by Frost and Sullivan. Globally, Reseach2Guidance reports that the mHealth market will reach $ 1.3 billion this year. Despite mHealth being in its infancy, the revenue projections are significant.

According to a 2011 press release statement from Juniper Research, the number of mobile healthcare and medical app downloads will reach 44 million this year and will reach 142 million globally by 2016.

Consumers are downloading apps to help them stay fit, track their pregnancies, monitor their moods, eat healthier, and sleep better. They are also downloading apps for chronic disease management. They can manage their prescriptions, have medication reminders, and monitor blood pressure and sugar levels. Consumers can be empowered to take charge of their health, but right now navigating the array of health apps can be confusing. Consumers lack guidance on choosing a safe, secure, medically sound health app. Trying to navigate the health app craze without direction can be painstakingly difficult.

Cleveland Clinic, Nike Fuel Band, American Red Cross, and Walgreens are known in the space, and consumers may find it easy to trust them and download apps associated with them. However, consumers may find it confusing to navigate the mHealth app world from companies that are off the radar. How do consumers know if the apps are safe and reliable?

Consumer Safety Is a Priority

The FDA is prudent on drafting guidelines for developers, but will it stifle innovation? "It may slow innovation, but I don't know that it stifles it. Regulations do create barriers to entry as they set a high bar. But in so doing, they also create significant economic opportunities for those who follow the appropriate processes and win regulatory approval," said Bill Crounse, M.D., Senior Director of Worldwide Health at Microsoft Corporation, in an email. "I do think thoughtful regulation is required in the health industry to protect consumers. This is certainly true related to pharmaceuticals and medical devices to protect consumers from harm."

"The primary role of the FDA is to insure consumer safety," notes Kvedar. "Mobile health has the potential to get out of hand if not regulated. For example, there is an app that based on self input of one's carbohydrate count; it will generate insulin dosing suggestions. Clearly this could be dangerous," he added. "While I don't think the FDA process will ever eventuate in a 'consumer report-like' or 'D Powers-like' rating, it will be a filter. If apps get through the filter, we should at least be comfortable that they are safe."

Aside from safety concerns, there are "two problems with health apps," said Kvedar. First, after downloading the app, it may be used once or twice and then it's forgotten, he said. "There's no engagement." Secondly, health apps can be prone to error because the data that is self-entered by consumers may not be true. It's a "social diversity bias problem," he said, because the data entered isn't honest and there is no meaningful engagement to help change consumers behavior. After downloading health apps with enthusiasm, the "shiny new toy isn't so shiny anymore," because there's "lack of interest and lack of engagement," said Kvedar.

Health apps need to be engaging and motivating and offer a coaching component.

"There's a short shelf life, don't expect it to change your life," he said.

Happtique, a mobile health application store and total app management solution released a draft of the standards that it will be using to certify medical, health, and fitness apps under Happtique's App Certification Program. The purpose of the program is to help users identify apps that meet high operability, privacy, and security standards and are based on reliable content.

David Lee Scher, M.D., a former cardiac electrophysiologist who is presently director at DLS Healthcare Consultants and senior medical advisor to Happtique, said in an email interview:

Happtique App Certification Program represents a major step in setting standards for safe and reliable health, fitness, and medical apps. Certification will assure users that the app meets security, usability, privacy, and content standards. Happtique has curated and categorized over 12,000 apps to date in over 300 categories.

Mobile technology has allowed consumers to receive information at lightning speed and gives consumers health and wellness apps that can help improve their health care. Mobile technology may help to transform the lives of patients and provide a stronger partnership with health care providers.

Bottom Line

Consumers need safe, reliable, trustworthy apps to help guide their health and wellness and help them manage their chronic diseases.

The health app world needs guidance. The vast assortment of apps to choose from makes it difficult for consumers to navigate. Which apps are reliable, trustworthy, and medically sound?

Joseph Kvedar, M.D., Justin Major and Carol Colman are actively involved in writing a series of books for consumers titled Wellocracy; it's the first in a series of books to help consumers navigate the ever-growing and dizzying array of health apps.

So, how do consumers navigate the crowded world of health apps? "Common sense rules," he said. If consumers think it's a "magic app," it probably isn't.

In this exciting world of health care where technology rules, one thing is for sure, technology will never replace the doctor/patient relationship (or health provider/patient relationship). Face-to-face communication with health care providers will always be paramount.

It doesn't seem as if there is too much hype -- just little guidance. The push to move the mHealth app world forward may be in the power of consumers to clamor for health and wellness apps that are safe, reliable and trustworthy, developed by companies who are not just those looking to "get rich quick," as Kvedar said.

Your Turn

We would love for you to share your thoughts in the comment section below. Do you download health apps? Do you feel guidance is needed to help navigate the enormous amount of health apps? What health apps do you use? As always, thank you for sharing your thoughts and for your valuable time.

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07:54 AM on 08/28/2012
The idea that a mobile health app can lose its luster after being downloaded is indeed a real problem. However, if the patient is directed by a caregiver during an appointment on which apps are most beneficial for them and educated on how the app can help, the stakes have suddenly been increased, making the app a more vital tool.

I can say that throughout my years of doctor visits, I have never been informed by a caregiver on the benefits of mobile apps or other available digital communication. I have always brought these ideas to their attention and asked questions based on my own research.

For the most part, patients are expected to “go it alone.” They begin by visiting a physician who may take a few moments to review the patient’s current state of health. Afterwards, the physician may assign a prescription, offer some advice about adopting a healthier lifestyle, and finally, advise the patient to "check back in a month." The patient then goes to the pharmacy to fill the prescription and that’s where the physician’s support typically ends — at the very point treatment begins.

We at TeleVox recently completed a study that revealed beyond-the-clinic digital care, such as emails, apps, texts, or voicemail is exactly the type of experience U.S. consumers want and expect from their doctors.

I would enjoy hearing your thoughts on our study.

Thanks
Scott Zimmerman, President, www.TeleVox.com
Download the study here: http://bit.ly/tvoxreport
07:21 PM on 07/27/2012
Great article, Barbara. You also chose to interview a great leader in this space, Dr. Kvedar. One of the biggest issues I see is we're currently attempting to create two universes - and they're not parallel! One is the plethora of mobile health apps with no real clinical data (usually), and the second is the health information exchange space (HIE; which is struggling). People will quickly give up an app if there is no access to real data, and it relies heavily on their own input. At the same time, the HIEs are for the most part struggling with business plans, and a small minority are only starting to think about engaging patients/consumers/families. Might we create some real opportunities for new value creation by linking these two universes? ONC is pushing this concept via the Consumer Innovation Challenges - what we need is for the HIE world to grasp the opportunity to transform from the inside out, using mHealth, social media and gaming functionality, and consumer-mediated exchange all rolled into one. Thank you again for great coverage.
03:02 PM on 07/27/2012
Thanks for your article, Barbara. We agree that mHealth apps should be engaging, motivating - designed with the user experience in mind. In healthcare, apps can really change our behavior and affect the way we get and stay healthy. Learn more about how mhealth is revolutionizing healthcare in a recent whitepaper: http://www.mobiquityinc.com/our-ideas/white-papers/five-ways-mhealth-revolutionizing-healthcare

- Dr. Stephen Ferzoco, Chief Medical Officer, Mobiquity
photo
Paul Sonnier
Digital Health Catalyst
02:36 AM on 07/27/2012
Barbara,

My sincere thanks for mentioning the Digital Health group on LinkedIn.

I wholeheartedly agree with you that “It doesn’t seem as if there is too much hype – just little guidance. The push to move the mHealth app world forward may be in the power of consumers to clamor for health and wellness apps that are safe, reliable and trustworthy.” This creates a powerful positive feedback loop between consumers and healthcare systems (which are also undergoing a digital transformation) thereby accelerating the digital health revolution.

By way of illustration, a recent story in the Wall Street Journal, “The Customer as a God,” focused on the growing power of customers using electronic devices for daily communication, shopping and other activities. As my colleague Dr. Caroline Popper pointed out, she sees a number of parallels between the view of customer-empowerment in today’s and tomorrow’s consumer electronics world and the healthcare industry: “In the consumer electronics world, internet/wireless service providers determine how the consumer will use devices and control the internet that connects them. Meanwhile, in healthcare, physicians and hospitals “provide” the care that patients are told to accept. Fast forward about 10 years, and the providers are no longer in charge—the consumers are.”
http://popperandco.com/2012/07/consumers-to-battle-the-healthcare-gods/

Best regards,
Paul Sonnier

Head of Digital Health Strategy, Popper & Company
Founder, 11,000+ member Digital Health group on LinkedIn
Mentor, Blueprint Health
Twitter: @Paul_Sonnier
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Wayne Caswell
Consumer Advocate & Founder of Modern Health Talk
12:20 PM on 07/25/2012
Thanks for your article, Barbara. There seems to be a void of information that sits between online consumer support groups on one hand and tech companies and associations on the other. That's why I started Modern Healh Talk (http://mHealthTalk.com). It's mostly a blog and resource center that includes several of Dr. Scher's articles, as well as other notable byline articles. But so far I've struggled with my vision of building an online community where people share their stories of how technology has addressed real health problems. Happtique is an important step in such a vision, and I like how medical specialists do the vetting of apps.
12:58 AM on 07/25/2012
Hi Barbara, great post thank you. Information such as privacy, reliability of content, operability etc should be standard and found in the app's terms and conditions. But I think the key here is 'partnerships'. Health providers and the medical profession are not game designers or social community builders or user-experience experts, nor are many of them behaviour change experts. Understanding the psychology behind behaviour change is critical for a medication adherence app or fitness app etc.
There's an opportunity for entrepreneurs in the emerging game, mobile app and social space to work collaboratively - 'partner' with - health providers to design and build engaging, compelling apps that won't lose the user's interest after 2 or 3 visits. It's tough to get right, and it requires constant iteration and release of new features and A/B testing etc. It's also expensive to get right. I know, because that's the area we are in www.goalpost.it, and while we are enjoying positive early signs of success, we are learning truckloads from our users every day, and a lot of what we're learning blows our assumptions out of the water. Which is awesome!
04:54 PM on 07/24/2012
Great, thoughtful piece. Having worked in mHealth for years, I think what's needed - and what will help eliminate the need for guidance - is integration among apps and devices to make each app's unique service offering more meaningful to patients and clinicians. An open architecture that enables software components to be shared and reused will allow innovators to develop new, better applications that are complementary - making the role of each application more important and the overall impact of connected interventions that much stronger. Without this modular infrastructure, the lack of interoperability of apps and devices will continue to stifle the scaling and impact of mHealth, perhaps resulting in just hype, after all.

Ingrid Madden
www.openmhealth.org
06:50 AM on 07/24/2012
Liked the piece. But not convinced that these will necessarily change peoples behaviour. The lowly bathroom scale, around for years, has not made any difference to increase in obesity rates.
09:50 PM on 07/23/2012
This commentary provides a terrific overview, but fails to distinguish between mobile health apps as medical devices and mobile health apps as consumer devices: the primary distinction that concerns FDA.

In our view, mobile health will eventually bifuracate into two distinct markets: a regulated industry, deployed by hospitals, doctors and ACOs, and an unregulated direct-to-consumer industry of diet and exercise apps. These two industries will feature dramatically different investment, pricing, ROI, marketing and management issues.

http://mobilehealthmarketnews.com/what-is-mhealth-ii/
01:18 PM on 07/23/2012
Health "apps" will transform healthcare and it is certainly the wild west right now. The main thing we need is apps that connect to the healthcare system. At Jiff, we did a review of several hundred healthcare apps that should comply with HIPAA privacy standards and less than 2% met the standard. Most did not even try. Many of these apps had prominent healthcare institutions associated with them. There are four areas we should be evaluating apps on: 1) clinical integrity of the app, 2) security and privacy (HIPAA), 3) regulatory (FDA), and 4) design/UX (which should lead to higher levels of engagement).