WHY THERE IS SUCH A FRENZY ABOUT MEDICAL APPS
Roll back the calendar just six short years and you encounter a pivotal period in world history, the “pre-iPhone era”. Perhaps statements such as this make you roll your eyes, but it is becoming increasingly difficult to ignore the influence of Apple on everything from how individuals approach daily tasks to how entire industries function. There is little debate that Apple’s success has had a stimulating affect on the global economy. In fact, many have speculated that the recent release of the iPhone 5 will create a measureable boost in the US economic numbers for the 4th quarter of 2012 (as of this writing, no statistics have borne this out). Yet while many areas of the economy have benefited from Apple’s products and services, the sector poised for the largest growth over the next several years is the healthcare industry. PricewaterhouseCoopers recently issued a report estimating the future worth of the mobile health market at 23 billion US dollars by 2017.
To appreciate Apple’s influence on the healthcare industry, you need to look no further than your local hospital. Mobile computing applications (‘apps’) perform a myriad of functions such as assessing vital signs (i.e. blood pressure), performing abdominal ultrasound studies and delivering the latest research results to doctors at the patient’s bedside. One of the factors driving this growth is the medical communities enthusiasm toward the use of mobile apps in medicine. Clinicians utilize smartphones (and therefore apps) at a higher rate than the general public. Physicians smartphone use ranges from 30-80%, depending on the sources (Buijink, Evidence Based Medicine, 2012; Franko, J Med System, 2012; Manhattan Research Group, Epocrates) and nurses and physicians assistant use ranges from 31-71%. Given the ability of mobile computing to improve the efficiency and quality of healthcare delivery, it’s no wonder why clinicians are excited about medical apps.
It’s worth pointing out that the medical community’s enthusiasm toward technology is rooted in the idea that it can improve the quality of care delivered. The excitement is not focused on the technology itself, but what that technology can provide for our patients. Robots and lasers perform minimally invasive surgery and decrease hospital stays, imaging mediums identify pathology in the body without the need for surgical exploration, hardware can ensure your heart functions correctly (pacemaker), sensors can monitor vital signs, and blood-glucose levels in diabetes.
These technological advancements, while critical for the advancement of medicine, also come with unique burdens. There is a need to ensure the quality, validity and ultimately safety of these technological advancements as well as the accuracy of the information delivered from these new tools. This is why federal organizations, such as the FDA, have taken an active role in evaluating smartphone applications in healthcare. Even the medical literature from journals that we consume as clinicians, instrumental in dissemination of research findings that influence clinical practice, must go through a rigorous peer-review process. All of this is in place to establish trust in what and how healthcare is delivered.
Medical apps are no different, and we can see the exponential rise of medical apps available for purchase and installation on mobile devices. Currently however, few of these apps are required to pass any type of medical validation or quality assurance process before they are available for sale in app stores. In effect, 100 percent of submitted medical apps are “accepted” for public and professional use, as long as they meet the generic technical requirements established by the app stores for all apps. Contrast this with the acceptance rate of submitted research in some of the top medical journals in the world. (see TABLE 1)
Peer review has been defined as “a process of self-regulation by a profession” and is the pivotal component that provides validity and integrity to the dissemination of medical information. It ensures a high level of trust in the content we consume from medical journals.
A recent article published in Evidence Based Medicine (BMJ Group) summarized the dilemma as it pertains to medical apps nicely:
“It has been proposed that medical apps should be peer-reviewed by clinical experts and that regulatory measures should be increased in order to safeguard quality of care. Regulation and guidance are urgently needed. Medical professionals must be made aware that some apps contain unreliable, non-peer-reviewed content so that they can choose carefully which apps to use in clinical care.”
“We are convinced that, to some degree, medical apps should be regulated, and that they need to be thoroughly peer-reviewed in order to ensure validity. Medical applications should have an assured quality, be scientifically sound and cost-effective in their use.”
- Buijink AW, Evid Based Med, 2012 (PMID = 22923708)
The need for quality assurance of medical apps has been identified at the highest regulatory levels, as the FDA has stepped in and provided draft guidance on the regulation of medical apps. There has even been talk about the FDA standing up an Office of Mobile Health and Medicine.
It seems to be clear that the solution needs to have a multifactorial approach that includes multiple stakeholders: app developers, regulation entities, and consumers. There are several resources available to clinicians to help fill this large gap:
- 1) Peer Review for Medical Apps (MedicalAppJournal.com): The Medical App Journal has stood up the very first online, open-access peer-review system for medical apps. The peer-review process is multi-faceted, allowing only clinicians in the specialty area of a particular app to review that app, and providing a transparent disclosure of their credentials and any potential conflicts of interest.
- 2) App Certification (Happtique.com): A company called Happtique has stepped in and taken a slightly different, and complementary approach. Their curation efforts are targeting both apps for clinicians and patients. They have recently stood up an app certification process with the purpose “to help users identify apps that meet high operability, privacy, and security standards and are based on reliable content.”
- 3) Reviews & Commentary on Medical Apps and Mobile Health (iMedicalApps.com): A very popular blog that provides commentary and information about all things related to mobile medicine health, from apps and mobile medical devices to trials revolving around apps, and interviews with app developers. Their target is physicians as they claim to be the “leading physician publication on mobile medicine.”
Resources like these are valuable for clinicians because they evaluate the value, safety, and reliability of apps in healthcare delivery. Some are more specific in scope than others. The Medical App Journal, for example, has a primary focus only on apps that can be used by clinicians in clinical practice (rather than those for patients). The list of reviewers is continuously growing, and includes faculty members, fellows, and seasoned clinicians in a wide variety of medical specialties and disciplines. Regardless of who reviews an application, the review must still meet certain criteria and provide a fair systematic appraisal of the app or it will not be accepted for publication. This results in a system of checks and balances that provide a quality peer-review process. The Medical App Journal not only fills the void for a standardized peer-review process, but is also inclusive of all healthcare professions and includes reviews by pharmacists, nurses, physical therapists, and other healthcare professionals as well.
Open Access: All published peer reviews are open for comment so that the developers and readers (other clinicians) can comment and agree/disagree or add in other ways to the nature of the review. Each published peer-review also provides the app with an objective Clinometer rating scoring different components of the app (Navigations, User Interface, Content, Value). At the same time, users can also provide ratings on a similar, but separate system that can break down the reviews by smartphone device, profession, and discipline providing a graphic and intuitive method for assessing perception of app values across many different aspects.
Curation: Each app page becomes a 1-stop collation of information related to the app as developer’s videos, other editorial comments, and reviews are also aggregated in a separate section. This provides a “1-stop shop” for all information related to that app.
Our aim is to help fill that gap for clinician-consumers – critical appraisal and peer-review of medical apps.