“Majority of mHealth apps fail to engage patients”

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This HealthData Management article by Greg Slabodkin highlights how a fundamental misunderstanding of mobile (the newest mass media) leaves University researchers floundering.

mHealth Insights

Before going any further it’s critical we appreciate that there are apps that are found on all mobile phones that are never made available through app stores and that are used extensively for healthcare applications eg. the emergency service app that enables any GSM mobile phone to call emergency services in any country even if it doesn’t have a SIM card in it, the emergency service app that will immediately connect you via a rival mobile network if there’s a better signal on that connection (even though you aren’t a subscriber – this is why the Jitterbug suffered that massive recall in 2009), EmergencySMS access even though your mobile account may have zero balance, etc.

I think it’s important to realise even the most basic easy to use mobiles today are far smarter than smartphones from a few years ago but also that there are many apps that are embedded/preinstalled on mobiles so that they work out of the box and are never sought or downloaded from an app store. In 2016 these are being used extensively for healthcare roles but this isn’t a new thing eg. read this article I wrote in 2009 for MobiHealthNews explaining this.

In 2016 there is an enormous range of increasing capable apps because the mobile phone manufacturers have tracking tech that lets them see what customers actually download and use their phones for. It means that they have an incredibly detailed idea of the type of apps and features that customers actually use and they can then simply use these insights to update the native Health apps they already have running on hundreds of millions of their iPhones and Galaxy Smartphones.

While many healthcare professionals have harbored high expectations for mobile apps to energize patient engagement, only a minority of the applications appear to hit the mark

Maybe Gary should try and see if those Healthcare Professionals who are so clearly misled about the mHealth opportunity would like to go back to using pagers, snail mail, faxes, printed text books to look everything up, a Filofax to maintain their calendar schedules, etc?

Perhaps the raucous laughter would make him realise we’re not talking about expectations of what mobiles can do, the way society works has already been transformed radically as a result of the widespread adoption of this technology eg. if you haven’t seen a Patient in a waiting room doing ‘work’ on their mobile you haven’t actually been in a waiting room for at least 5 years…

An analysis of about 1,000 patient-facing health apps targeted at individuals with chronic illnesses has found that only 43 percent of iOS apps and 27 percent of Android apps are useful for that purpose

This is a common conclusion made by those who misunderstand the mobile app market and don’t appreciate how low the barrier to entry is for app stores or the powerful democratising opportunity this has created for real healthcare innovators.

It should be obvious to anyone commenting on mHealth in 2016 that you can make a cookie cutter app in 5 mins and upload it to an app store so that it’s available across the world tomorrow but that does not mean it’s any good, that any real Patients (you don’t count other 12 year old app developers who are using it as a template for their mHealth app build experimentation) will ever be interested in downloading it or that anyone is going to be using it. The long tail nature of the internet means we had the same conclusion being drawn of that in the early days but just as Google helped us sort quality content we now have AppStores doing that and going one better and providing controls (on how and by whom data is handled, shared, etc) and enabling directly published feedback from app customers to work to rate apps and help them be discovered by others.

Funded by The Commonwealth Fund, the study evaluated 376 apps available in the Apple iTunes store and 569 apps in the Android Google Play store to determine usefulness based on the following criteria: description of engagement, relevance to the targeted patient population, consumer ratings and reviews, and most recent app update. Overall, 161 (43 percent) iOS apps and 152 (27 percent) Android apps were deemed as being “possibly” useful; of that total, 126 apps exist on both platforms.

This is very similar to the immature approaches I’ve seen being taken to understanding mHealth by the researchers at the NiH & Duke University. I have no idea why anyone would think a researcher studying at a University is going to be well positioned to judge the pros and cons of an app. If you can do that take the best app, make the improvements and you’re now the leading app developer for that disease area – trust me there are thousands of brands out there that want your talent and I’m sure you’d also get funding if you just knocked on the doors of some of these billionaires with the line “I have the number 1 rated and most widely used app by Patients with BLANK”


There were a lot apps that we call ‘limited engagement’ on Android—about 90, compared with about 25 that were iOS,” observes Karandeep Singh, MD, an author of the study and assistant professor in the University of Michigan Medical School’s Department of Learning Health Sciences. According to Singh, there were significantly more Android apps than iOS apps that were not recently updated—200 Android apps (35 percent) were last updated before 2014, while 63 iOS (17 percent) apps were last updated before 2014. The study found that 33 iOS apps (9 percent) were found to have poor ratings or reviews, compared with eight Android apps (1 percent)

If you’re interested in this you can get a much better idea of what’s going on in the long tail of apps by reading commentary from mobile industry analysts, I’d recommend this starter piece by Tomi Ahonen. In 2016 I think University Professors should be doing more valuable things than making conclusions based on the lack of quality in Zombie apps (this is how the mobile industry refers to these easy to produce, old and unused apps) as it’s like someone trying to understand modern human behaviour by analysing the behaviour of bodies dug up in a graveyard.

While apps have tremendous potential to engage high-need, high-cost populations, a minority of patient-facing health applications on both the Apple and Android stores appear likely to be useful to patients,” concludes the study”

Another great reason for Healthcare Provider organisations to invest in providing mHealth training to staff so that they are able to help direct Patients and Carers to the quality apps and services that we know are making a huge difference and are desperately needed.

This lack of app usefulness for consumers is particularly disconcerting given that a separate recent study by research2guidance found that app stores like Apple iTunes and Android Google Play will remain the main distribution channel for mHealth apps until 2020….   …The research firm concludes that both Apple and Google are “complicit” in the marketing hype around many of these apps

I think this is all part of this odd idea that it’s bad to encourage mHealth apps because Patients are so stupid and gullible they’ll not know what to do. It reminds me of the naive FinTech analysts who used to think mobile banking would never work because scammers would just SMS people fake links that they’d be so stupid they’d click to send the contents of their savings accounts offshore.

One of the main promises of mHealth apps is that they help their users change their behavior,” according to the firm. “The majority of mHealth apps today don’t even come close to living up to this promise because they lose their users after a few days and thus have no chance to change any behavior.

I think there’s someone here who needs to read Eric Topol’s brilliant The Patient Will See You Now. The reality is as soon as that mHealth app developer works out how to make a behaviour changing app that is popular they’re a millionaire and companies want to acquire them and the world’s biggest and most valuable brands (Apple and Alphabet the companies that own the smartphone OS platforms that will be the first to know of their success) will want to acquire, copy or partner with them.

The focus on chronic diseases is largely based on the high cost of treating those patients and the promise that apps could help reduce these costs by changing the behavior of patients over a longer period of time,” states the firm’s report. “In most cases, this is still an unfulfilled promise, as most of the apps are failing to retain their users for even a few weeks.

I think this statement highlights the need for a much greater understanding of mHealth. It’s not just going to be mHealth apps that Patients download to their smartphones that will help us evolve beyond our broken 2000 year old healthcare model to manage the needs of Patients with chronic diseases. It’s also about the opportunity for healthcare provider organisations to go Mobile First so that Patients can feel confident using the apps that are already on their mobiles (think SMS, Caller ID, Web, Camera, Calendar, Healthkit apps, Researchkit apps, etc) and to embed mobile connectivity into the dumb medical devices that Patients already live with so that they and their  Families and Carers can have an easier time without having to resort to potentially risky DIY hacking efforts.

In summary: the ‘majority’ of mHealth apps will be me-too copycat apps that fail to ever even get downloaded by Patients but this is a good thing as Patients are protected by AppStore rating mechanisms and it means new ideas and apps aren’t facing high barriers to market entry. As with other app markets distribution follows a long tail model so it’s only going to be a small minority of mHealth apps that will be engaging and useful to Patients and Carers so let’s stop making wholesale claims that imply mHealth apps are rubbish and start committing to training Clinicians so that they’re comfortable recommending and working with Patients who use high quality mHealth apps as this is where the big mHealth app benefits will be felt.



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