Tips on picking, discussing apps with patients

David Stukus
David Stukus

By some estimates, there are between 50,000 and 200,000 apps intended to serve a medical need. These apps claim to manage symptoms of depression, improve care in patients with inflammatory bowel disease, manage diabetes as well as help patients with a myriad of other medical uses.

But not all apps are the same, cautioned David Stukus, MD, a pediatrician at Nationwide Children’s Hospital and member of the American College of Allergy, Asthma and Immunology.

“The quality of medical apps is highly variable. Most are not only not useful but could also potentially be harmful due to incorrect medical information or missing important details,” he told Healio Family Medicine.

“There are most likely 100,000 apps in the app store related to health and over 30,000 medical apps,” Matthew Faiman, MD, MBA, medical director, Cleveland Clinic Express Care Online, said in a separate interview. “But at the end of the day most of us recommend only around 50 apps at most to our patients.”

“Apps bring exciting potential but the field of mobile health is going through early growing pains,” Seth Martin, MD, MHS, an assistant professor of medicine at Johns Hopkins University and member of Healio’s Cardiology Today editorial board, added.

As a courtesy to its readers, Healio Family Medicine asked Martin, Stukus and Faiman for tips on picking a good app, discussing apps with patients who might be reluctant to use the technology and more.

Question: How can a primary care physician quickly sort through the glut of apps and find ones that are best for themselves and their patients?

Seth S. Martin
Seth Martin

Martin: Ask yourself a few questions: Does the app reinforce medical truths that we already know? For example, is it helping patients adhere to current medical therapies, or is it providing coaching reminders to conduct physical activity? Is the app reinforcing proven treatments in medicine to help empower patients to stick to these proven treatments? Other things to think about: Who made the app? Has it been tested? Is it endorsed by a medical society and what is that society’s reputation? Those apps that don’t have a strong endorsement might not be as reliable.

Conversely, if an app is producing a new unvalidated measurement (such as a BP reading using just a phone without a traditional BP cuff) that is going to be used to make clinical decisions, then PCPs and physicians in general should be wary of that information.

Stukus: It’s important to note that most apps are created by nonmedical professionals and the information on them is not always evidence-based. A ‘good app’ should contain correct information, augment but not replace pre-existing treatment, and be easy to use. The best apps combine aspects of behavioral economics and various types of motivation to help users maintain engagement.

Faiman: See if there are some clinical studies available to back up the app’s claims. At the end of the day most of us recommend only around 50 apps at most to our patients. What makes a good app is often of a personal nature. But if it can create value and engagement to a patient, then this is a plus. If there is clinical evidence that it can help manage a chronic condition, then that’s also a plus.

“The quality of medical apps is highly variable. Most are not only not useful but could also potentially be harmful due to incorrect medical information or missing important details,” David Stukus, MD, a pediatrician at Nationwide Children’s Hospital, told Healio Family Medicine.
Source: Shutterstock.

Q: Should PCPs and patients be concerned about data security when using apps?

Faiman: Definitely. Health systems can consider vetting apps internally and hosting an app on their website. or at least minimize the HIPAA data a patient is sharing with the app. When not going this route, the usual rule of buyer beware should apply.

Martin: When you discuss data in a hospital or during an office visit with a patient, that is all protected by HIPAA and privacy laws. When the data has been analyzed by mobile apps, there are not many well-standardized policies. Many apps don’t even have privacy policies, so it’s hard to say what’s being done with your information. The website imedicalapps.com can help PCPs decide which apps are best at providing data security as well as which app would work best for the need they are trying to fulfill.

Stukus: Health care providers and patients need to know that there is no regulatory process in place to evaluate the quality or efficacy for any of these apps. Very few apps have been properly studied to see if they actually provide any tangible benefit to patients. While apps offer a fun new approach to patient care, we simply have no idea whether they are actually useful, or even harmful. Most mobile applications are downloaded directly to a mobile device and do not have the ability to send or receive information from third parties. These apps are likely very safe with regard to protecting patient information as no one else can access them. However, any mobile application that sends or receives information from the user should absolutely be vetted to make sure that patient privacy is protected at all times. If the manner in which this is ensured is not readily available, then patients should only use those apps with extreme caution.

Q: Can you offer some suggestions to help a PCP to warm a patient who is not as comfortable using apps up to the idea of using them?

Stukus: Before recommending use of any mobile health application, it is imperative that health care providers have experience with the app. They should know exactly what it does, what it doesn’t do, and if there are any clinical outcomes associated with patients who have actually used the app. They also should be able to provide instructions to their patients on how to download and use the app, as well as provide expectations for why the app may be helpful and how it can augment their care.

Martin: Start with an internet browser on a patient’s smartphone. Encourage them to use free time to read up on what they have recently discussed with you. Then start them with a wellness app to encourage physical activity or a calendar app for medication adherence. Start simple and don’t be too overwhelming.

Faiman: Often, having a persistent one-on-one discussion with a patient as to why they may benefit with a particular app is helpful. PCPs may also find it helpful to consider discussing what the goal is behind the app’s use: measuring calories, BP or some other metric and then placing it in the context of the patient’s own health history.

Matthew Faiman
Matthew Faiman

Q: Where do you see the capability of apps going in the future?

Martin: Potentially, they could provide truly personalized patient management using machine learning and n-of-1 trials which are basically a series of randomized crossover trials in a single patient that establish which treatment is best for a patient. But for now, I hope that we can stick to the basics and deliver engaging, user-friendly apps that make the patients’ medical experiences better, less overwhelming and help keep the patient on track and healthy. I want to put patients in control and implement what works rather than reinvent the wheel.

Stukus: In the future, apps will incorporate sensors to capture a biometric analysis and offer both historical and real time information about managing health conditions or risk for an acute event. We are not that far off from combining various forms of wearable technology that capture and analyze vital signs or other data, transmit it to an application that incorporates the data into an algorithm and then provides real time data to both the patient and provider. However, issues surrounding patient privacy, secure connections, and validity of the algorithms all need to be addressed before we get there.

Disclosure: Neither Faiman nor Stukus report any relevant financial disclosures. Martin reports receiving research funding/device support from Apple, Google, and Nokia.

David Stukus
David Stukus

By some estimates, there are between 50,000 and 200,000 apps intended to serve a medical need. These apps claim to manage symptoms of depression, improve care in patients with inflammatory bowel disease, manage diabetes as well as help patients with a myriad of other medical uses.

But not all apps are the same, cautioned David Stukus, MD, a pediatrician at Nationwide Children’s Hospital and member of the American College of Allergy, Asthma and Immunology.

“The quality of medical apps is highly variable. Most are not only not useful but could also potentially be harmful due to incorrect medical information or missing important details,” he told Healio Family Medicine.

“There are most likely 100,000 apps in the app store related to health and over 30,000 medical apps,” Matthew Faiman, MD, MBA, medical director, Cleveland Clinic Express Care Online, said in a separate interview. “But at the end of the day most of us recommend only around 50 apps at most to our patients.”

“Apps bring exciting potential but the field of mobile health is going through early growing pains,” Seth Martin, MD, MHS, an assistant professor of medicine at Johns Hopkins University and member of Healio’s Cardiology Today editorial board, added.

As a courtesy to its readers, Healio Family Medicine asked Martin, Stukus and Faiman for tips on picking a good app, discussing apps with patients who might be reluctant to use the technology and more.

Question: How can a primary care physician quickly sort through the glut of apps and find ones that are best for themselves and their patients?

Seth S. Martin
Seth Martin

Martin: Ask yourself a few questions: Does the app reinforce medical truths that we already know? For example, is it helping patients adhere to current medical therapies, or is it providing coaching reminders to conduct physical activity? Is the app reinforcing proven treatments in medicine to help empower patients to stick to these proven treatments? Other things to think about: Who made the app? Has it been tested? Is it endorsed by a medical society and what is that society’s reputation? Those apps that don’t have a strong endorsement might not be as reliable.

Conversely, if an app is producing a new unvalidated measurement (such as a BP reading using just a phone without a traditional BP cuff) that is going to be used to make clinical decisions, then PCPs and physicians in general should be wary of that information.

PAGE BREAK

Stukus: It’s important to note that most apps are created by nonmedical professionals and the information on them is not always evidence-based. A ‘good app’ should contain correct information, augment but not replace pre-existing treatment, and be easy to use. The best apps combine aspects of behavioral economics and various types of motivation to help users maintain engagement.

Faiman: See if there are some clinical studies available to back up the app’s claims. At the end of the day most of us recommend only around 50 apps at most to our patients. What makes a good app is often of a personal nature. But if it can create value and engagement to a patient, then this is a plus. If there is clinical evidence that it can help manage a chronic condition, then that’s also a plus.

“The quality of medical apps is highly variable. Most are not only not useful but could also potentially be harmful due to incorrect medical information or missing important details,” David Stukus, MD, a pediatrician at Nationwide Children’s Hospital, told Healio Family Medicine.
Source: Shutterstock.

Q: Should PCPs and patients be concerned about data security when using apps?

Faiman: Definitely. Health systems can consider vetting apps internally and hosting an app on their website. or at least minimize the HIPAA data a patient is sharing with the app. When not going this route, the usual rule of buyer beware should apply.

Martin: When you discuss data in a hospital or during an office visit with a patient, that is all protected by HIPAA and privacy laws. When the data has been analyzed by mobile apps, there are not many well-standardized policies. Many apps don’t even have privacy policies, so it’s hard to say what’s being done with your information. The website imedicalapps.com can help PCPs decide which apps are best at providing data security as well as which app would work best for the need they are trying to fulfill.

Stukus: Health care providers and patients need to know that there is no regulatory process in place to evaluate the quality or efficacy for any of these apps. Very few apps have been properly studied to see if they actually provide any tangible benefit to patients. While apps offer a fun new approach to patient care, we simply have no idea whether they are actually useful, or even harmful. Most mobile applications are downloaded directly to a mobile device and do not have the ability to send or receive information from third parties. These apps are likely very safe with regard to protecting patient information as no one else can access them. However, any mobile application that sends or receives information from the user should absolutely be vetted to make sure that patient privacy is protected at all times. If the manner in which this is ensured is not readily available, then patients should only use those apps with extreme caution.

PAGE BREAK

Q: Can you offer some suggestions to help a PCP to warm a patient who is not as comfortable using apps up to the idea of using them?

Stukus: Before recommending use of any mobile health application, it is imperative that health care providers have experience with the app. They should know exactly what it does, what it doesn’t do, and if there are any clinical outcomes associated with patients who have actually used the app. They also should be able to provide instructions to their patients on how to download and use the app, as well as provide expectations for why the app may be helpful and how it can augment their care.

Martin: Start with an internet browser on a patient’s smartphone. Encourage them to use free time to read up on what they have recently discussed with you. Then start them with a wellness app to encourage physical activity or a calendar app for medication adherence. Start simple and don’t be too overwhelming.

Faiman: Often, having a persistent one-on-one discussion with a patient as to why they may benefit with a particular app is helpful. PCPs may also find it helpful to consider discussing what the goal is behind the app’s use: measuring calories, BP or some other metric and then placing it in the context of the patient’s own health history.

Matthew Faiman
Matthew Faiman

Q: Where do you see the capability of apps going in the future?

Martin: Potentially, they could provide truly personalized patient management using machine learning and n-of-1 trials which are basically a series of randomized crossover trials in a single patient that establish which treatment is best for a patient. But for now, I hope that we can stick to the basics and deliver engaging, user-friendly apps that make the patients’ medical experiences better, less overwhelming and help keep the patient on track and healthy. I want to put patients in control and implement what works rather than reinvent the wheel.

Stukus: In the future, apps will incorporate sensors to capture a biometric analysis and offer both historical and real time information about managing health conditions or risk for an acute event. We are not that far off from combining various forms of wearable technology that capture and analyze vital signs or other data, transmit it to an application that incorporates the data into an algorithm and then provides real time data to both the patient and provider. However, issues surrounding patient privacy, secure connections, and validity of the algorithms all need to be addressed before we get there.

Disclosure: Neither Faiman nor Stukus report any relevant financial disclosures. Martin reports receiving research funding/device support from Apple, Google, and Nokia.