“It’s 2018, and We Still Have No Idea If Mobile Healthcare Apps Work”

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It’s 2018, and We Still Have No Idea If Mobile Healthcare Apps Work by Milos Mudric (16 Oct 2018).

mHealth Insights

“What was the promise of reduced admissions and improved health outcomes in patients? This goal has not been achieved and is not happening how we thought it would”

I think we all know that a google search on your mobile is now the first thing Patients and Carers do so I think it’s important to realise that everyday mHealth keeps Patients out of hospitals it’s just that you can’t obviously measure people who don’t present at admissions.

“Usage of mobile devices in healthcare is basically what mHealth is”

Incorrect. This is from back in 2010 but think of mobile as the newest and least understood mass media.

“Scarce evidence for mobile app (mHealth). A recent overviews comes from the scientists from the Centre for Research in Evidence-Based Practice. Located at Bond University in Queensland, Australia. The scientists concluded that there is not enough evidence to decide whether providers should recommend the currently available mHealth apps to their patients”

This is a common misunderstanding about mHealth that logically derives from thinking that mHealth is about smartphones and the latest apps rather than the anywhere/anytime connectivity that you get with even the most easy to use feature phones.

The reality is giving your mobile phone number to a Patient or Carer is one of the most caring things you can do as a Healthcare Professional (even if Medics are being incorrectly taught that this is a sign of naivety).

The reality is looking something up with a Patient and sharing information from the internet with Patients is one of the most powerful things you can do as a Healthcare Professional (but we still don’t train or test Doctors to use the supercomputers they and their Patients are carrying 24×7).

“Data gathered from 4 databases since 2008. The team inspected four databases from 2008 onwards and the Journal of Medical Internet Research.  This collection identified only six systematic reviews with 23 randomized controlled trials (RCTs). Evaluations. Evaluating 22 standalone healthcare apps was the goal. These apps are mostly targeting obesity, mental health, and diabetes. Meanwhile, the mHealth Economics 2017 study states that major app stores feature around 325,000 unique health apps. So, in ten years, only 22 were apps evaluated. According to the researchers, “most trials were pilots with small sample sizes and of short duration. Risk of bias of the included reviews and trials was high.”

This ‘research’ is terribly flawed. It’s just a shocking headline to sell you on expensive research reports.

“The possible harm of under-researched healthcare apps. This lack of proven credibility lowers the chances of healthcare apps to become full-fledged care delivery tools used in clinical settings and in patients’ homes. Instead, apps that are healthcare apps will be either perceived as a huge market of novelty toys or even a harmful technology”

The reality is just as we see with books/leaflets etc smart professional people who have credibility can give it to mHealth apps that they have evaluated in fields where they have expertise.

“Non-studied apps: good, bad, or evil? One of the recent studies discovered that the use of fitness trackers and calorie-counting apps can exacerbate eating disorders — increasing eating concerns and triggering dietary restraints. So who do we believe?”

I think the reality is you use data so you don’t have to believe what people are claiming. The Japanese have had pedometers on their RakuRaku phones (easy to use mobiles that are popular with elderly Patients) for nearly ten years so there will be data available for those who need to have it (I think it’s obvious that we place far too much importance on sensor collected data when so little effort is spent just letting Patients use the mobile devices they already carry to share their information/story).

NHS-accredited apps is a library for apps that have been developed and studied for the healthcare system. This group of apps are put together claiming to help patients with many conditions. These conditions include disorders such as bipolar disorder, bulimia nervosa, and post-traumatic stress disorder (PTSD). Who tests the testers? Meaning how do we check for validity? These tests were found to be of questionable efficiency. These apps had no scientifically reviewed data to prove they are indeed helping patients with depression or anxiety caused by mental health disorders”

I think it’s important to appreciate that all the apps in these libraries that need to be downloaded from the AppStore or Google Play at which point there’s another customer rating score. So perhaps the bandaid of a NHS Accredited library is just another temporary stop gap and the NHS should work to help EDUCATE Patients/clinicians to use the app stores that exist or work WITH the mobile giants (Apple & Google) if it wishes to encourage Patients and Clinicians to use mHealth apps with more confidence.

“Another research, also touching upon the currently available apps for mental health, concluded that there is a significant gap. App vendors, the scientific community, and clinical stakeholders do not all match in their outcomes”

I think it’s time we started asking not what are Mobiles doing to our Mental Health but what they could be doing for it.

“Lack of consistency in outcomes hurts all areas of healthcare. This lack of collaboration in the creation of apps causes a stopgap in the system. Some claim to relieve the symptoms of complex psychological conditions. This will harm every party involved”

I don’t agree with this. Senior medics know that there is a huge lack of consistency in the effectiveness of drugs and the sick care industry makes do with that.

“Without solid proofs of efficiency, the resulting product can’t be openly suggested to anyone who may need it. This makes the situation where the user base won’t grow as fast as it could and should.  Providers won’t get improvements in patients’ health results. Patients certainly won’t be able to use reliable mobile self-management tools”

I think this is a very negative outlook eg. we know that Providers are wedded to paper based processes even though they know there are better, less expensive mobile optimised alternatives already freely available.

“The app “supposedly” helps identify the ovulation day, length of follicular and luteal phases. The app suggests on red and green days for having unprotected sex. Natural Cycles’ creators claim is that this app’s efficiency is comparable with traditional birth control methods. IF the app actually worked — it would be great. But something like a birth control method has to have a a much higher proof rate. proving it with the largest study of natural birth control methods. Still, even the app creators also admit the need for more research following their largest study of natural birth control methods. In January 2018, over 37 unwanted pregnancies among the Natural Cycles’ users at a major Swedish hospital. The app’s co-founder Elina Berglund initiated an internal investigation to find out that the algorithm’s efficacy rate stayed within the declared 93 percent. It’s not fun at all to see that there are unwanted pregnancies. This case got a loud public outcry because the efficiency of a birth control app is quite easy to track — and the cost of failing is obvious too. Natural Cycles’ developers made “hard to see through” (ambitious).”

I’m going to have to research this in more detail as I wonder how the hospital has settled the legal repercussions of this? If the app developer is still in business presumably the Hospital has covered them against claims.

“Now, let’s think again about all those thousands of applications that enter the market with ZERO proven research put into their creation. Basically, if we won’t be able to find out which apps really bring value to patients and providers, all new mHealth applications will be the waste of time and effort on ineffective or even harmful products”

I think this is a common misconception about the mHealth app market. That somehow Patients are a group of buffoons ready to put their lives in the hands of a developer in a garage making cookie cutter apps that they find on the App Store with zero positive ratings.

Surely the reality is mHealth apps that smart caring medics (eg. ones that have taken the mHealth training course that we helped develop) can identify apps that actually bring value for Patients and Healthcare Professionals and they can then prescribe them to their Patients fast tracking mHealth apps? Isn’t this what happens already with printed books/leaflets and websites that Medics recommend all day everyday to their Patients?

About David Doherty

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