Healthcare applications on smartphones and devices are an exciting blend of old and new. The same healthcare practices that we are familiar with, whether it be viewing a scan or scheduling an appointment, are being implemented in mobile form, spreading access and increasing the swiftness of our prior forms. The way we access our healthcare has changed drastically and continues to improve due to this increase in technological applications and the capabilities of the devices in our own hands. Right at our fingertips is an abundance of information, systems, tools and tests. As developing applications (apps) becomes easier and easier and more consumers log onto devices accessing the marketplace of consumer software, healthcare applications are becoming more prevalent, and with that, assessing the quality of these applications is becoming more and more prudent.
Not many industries have captured and excited a class of technologies from physicians, to patients, financiers, gadgeteers, and policymakers as the healthcare industry does. It is predicted that mobile health smart phone applications will “save millions of lives, billions in spending, and democratize access to health care.” Nathan Cortez, The Mobile Health Revolution, 47 U.C. Davis Law Review 1173 (2014). Proponents argue that mobile health technologies will eventually completely dismantle our current system as we know it, improving and transforming the ways in which we deliver, consume, measure, and pay for care through mobile healthcare. Id.
The technological advancements in smart phone applications and mobile devices themselves have drastically changed the capabilities healthcare mobile applications. Nowadays, consumers can download health care applications covering almost every angle of healthcare. App developers have crafted mobile apps to address countless issues related to healthcare. For patient-consumers, there are apps that track their fitness, wellness, exercise, and diet… some apps even allow you to order prescriptions and meet with a medical professional via the smart phone application. For provider-consumers, there are applications that allow you to view scans, calculate dosages, and even digitize your medical devices like stethoscopes.
Fitness and wellness apps can easily be sold to people who are fairly healthy already and just want to stay fit, and hospital administrators realize that these apps can be used for chronic disease management and may keep people out of the hospital. The health app market is moving in a direction where a person with asthma would open an app and determine whether his or her asthma symptoms will be worse on a given day based on the pollen count, or a person with a heart condition might open an app and receive feedback on inconsistencies of that person’s heartbeat. Additionally, there are even apps where patients can meet with a doctor through their phone, receive a prescription from a dermatologist, and experience therapeutic care. Samuel J. Dayton, Rethinking Health App Regulation, 11 Ind. Health L. Rev. 713 (2014).
It’s apparent that these apps will continue to increase and improve, being built upon the existing apps and spreading as technology becomes more widespread. As these developments continue, many questions and concerns arise in creating these applications that manage healthcare and disseminated into the marketplace in regards to quality of care. Some pertinent inquiries that arise are as follows: if these doctors are being licensed and qualified, how their certification are assessed, if the information provided is based on a widespread customary practice or on a locality, if the apps are incentivized by certain pharmaceutical companies, and if this is really beneficial for patients themselves. Additionally, there are HIPPA and privacy concerns when transmitting private health information via online apps. Rather than addressing each of these complex and difficult topics on each and every health application that is out there, there may be a broader solution. Most healthcare applications are technically reliable in that they work, but their accuracy is largely dependent on where they source their background data from. The burden falls on consumers to understand where data and algorithms are derived from, and any incentives that the application may be sponsored by. Additionally, according to recent study by Endeavor Partners, two-thirds of people who use health and fitness apps stop using them after six months or less. Perhaps this is due to consumer apathy, but it may also be an indicator of the underlying quality of the apps.
If the healthcare apps that consumers use (whether as patients or medical professionals) had to pass through a certain threshold level of quality by a certification program or a regulatory body, consumers, the industry itself, and the apps would all grossly benefit. Applications should be verified as reliable and of a certain quality before entering the marketplace. Then, not only would these apps be more trusted, they would be better used. There would be less faulty applications in the marketplace either discouraging use, increasing distrust, and even disseminating false information. By increasing the threshold for quality of healthcare applications in the marketplace, regulators would also spread the trust and use of these apps more rapidly serving the entire medical community — bettering the way we deliver, consume, measure, and pay for care. However we verify these healthcare apps prior to being entered in the marketplace, whether it be through a private voluntary certification program by a medical professional organization or through a regulatory body such as the FDA, it seems prudent that as these technologies expand, we protect consumers and the healthcare industry from the harm of allowing app developers unrestricted access to disseminating healthcare applications.
II. How Healthcare Applications Are Being Used
A. Types of Consumers
There are an abundance of healthcare applications available for download on our smart phones and devices. In order to discern a key distinction between some of these apps, it is important to recognize that some are geared towards patients while others are more specialized for healthcare professionals, providers, and administrators. We can discern them as a consumer-patients and consumer-providers. No matter the type of application used in the marketplace or the distinction between consumers, when they are marketed, directed, and used by either patients and providers alike in the healthcare industry, all applications should be a certain level of quality. If applications on either side of the spectrum can be guaranteed recommended or certified, approved, or regulated by a particular process, they will be more trusted and relied upon, increasing the benefits and quality of care for both spectrums of the healthcare industry. Healthcare applications that do not pass a certain level of scrutiny will be eliminated, while will reduce the risks of using apps that aren’t accurate or reliable. No matter the type of consumer, whether patient or provider, the applications used for healthcare industry purposes should be verified, albeit the value of their verifiability may vary between the different types of apps and the risks associated with them. B. Types of Apps
The marketplace is populated by an assortment of healthcare smart phone applications. As noted, some are targeted for patients, while other are crafted for physicians/providers and other medical professionals. The breakdown of the different types of applications highlights the difference importances each category has value and a need for a certain threshold of quality. Requiring an elevated standard for healthcare applications, whether by certification or regulation, is imperative for all categories albeit for different reasons.
In “The Mobile Healthcare Revolution”, Cortez breaks down current applications into six different types — 1) connectors, 2) replicators, 3) automators and customizers, 4) informers and educators, 5) administrators, 6) loggers and trackers. All healthcare applications should undergo scrutiny before entering the marketplace, but some types may deserve a higher threshold before gaining approval to be used and marketed to consumers.
The first type of healthcare application, connectors, are programs used to amplify a devices functionality. For example, viewing and analyzing CT scans, MRIs, and other diagnostic tests. One such application is “GE Healthcare Vscan View.” This application is for made for physicians and puts scans right in the palm of their hand remotely. It’s a helpful tool for physicians that need to quickly assess patients at the point of care. Viewing scans on their mobile devices allows for a quicker diagnoses and support for quick and immediate decisions. Vscan includes how it should be used in different clinical settings, information about how training programs can be structured to use the application, and case studies demonstrating the clinical and economic impact Vscan can have on hospitals.
Connectors, the applications that physicians are using to view and analyze medical records, need to be assessed and approved prior to entering the marketplace. It is imperative that an application that a medical professional uses to make a diagnosis, especially a quick one, is accurate. If this type of application displayed scans in a way that was not true to size or could not allow for high quality zooming, it could severely alter a diagnosis that is made. Additionally, if the app malfunctions or glitches often because the app is not hosted on an adequate server, a hospital or group of physicians begins who relies the application could put them out of luck if they have a standard of implementing this technology into their practice.
Another type of healthcare application is replicators. Replicators turn the smartphone or device into a medical tool itself by functionally replacing the medical device. For example, blood glucose monitors and stethoscopes which operate by using the built-in microphone to amplify body sounds and accelerometers. One such application is “Eko Stethoscope,” which allows for digitizing of a physician’s stethoscope. With this application, you can record, playback, and securely share patient heart and lung sounds with the app. You can also visualize heart and lung sound waveforms in real time, share recorded sounds, sync reports, and add notes to your recordings for future reference. Replicators are especially important as well for certifying or regulating before they enter the marketplace. Physicians that utilize replicators may want an application to be verified before they invest their time into using it, so a certification would increase the usages, and thus propel better quality of care through it’s intended use.
A third type of healthcare applications are automators and customizers, which use patient date to generate custom diagnoses or treatment recommendations. They use questionnaires, algorithms, formula, medical calculators and other software to aid in clinical decisions. These types of apps can automate tasks such as dosages and scores. One such application is “Dosing Calc Humate-P.” This dosage calculator application is intended for US healthcare professional use only. Through this program, you can input weight, type of surgery, and other important data points to determine appropriate dosages for surgery. The application contains information for various types of drugs and also includes minimum duration of treatment, dosing guidelines, safety information, and prescribing information. It is clearly evident why healthcare applications of this sort must pass a certain threshold of credibility for usage in the healthcare industry. If medical professionals are to rely on this type of application in making dosage decisions for patients, the information and calculators within the system need to be precise, accurate, and reliable. Professionals may avoid using applications of this sort unless they are certified or verified by a particular agency. If the application is guaranteed that it passes a certain threshold of reliability, they may be more apt to trust and use the program, making quality of care more efficient and accurate in a faster manner. Yet if applications of this type are disseminated into the marketplace without being verified and they are inaccurate or their algorithms malfunction, it could be detrimental to a professional’s practice or a patient’s health.
Additionally, there are healthcare applications which serve as informers and educators providing medical references and educational text to inform and educate. “Anatomy 4D” is a healthcare application that provides an interactive 4D experience of human anatomy. The app uses augmented reality and other cutting edge technologies to create the perfect vehicle for 21st century education. Viewers can experience a tour of the human body and heart, revealing the spatial relationships to our organs, skeleton, muscles, and body systems. Consumers can learn and explore the human body in detail, zoom in for in depth detail, and receive additional information through the application. This application can be marketed to healthcare professionals and patients alike for various purposes. For obvious reasons, it’s important that information is accurately communicated to either side of consumers. Patients undergoing a surgery may want to know where a certain organ is, and if it’s displayed through the healthcare application in the wrong place, they may be wrongly prepared or confused. Additionally, healthcare professionals could use this app to brush up on their own knowledge or even to explain a procedure to their patients. Misstated information could effect their own decisions or undermine informed consent to a patient when explaining a procedure using the app.
A fifth type of healthcare applications are administrator apps, which provide office functions like scheduling appointments. There is an application by One Medical Group (named “One Medical”) which makes it easy to get care and manage appointments through a mobile device. If a consumer-patient is on the go and needs to schedule an appointment with a doctor or find a nearby office, or even just request a treatment for a common issue, this app makes the doctor’s office available remotely. The application offers appointment booking, messaging with your provider, video visits, prescription renewals, and basic health records such as vaccines, medications, and allergies. Though somewhat less salient in terms of averting risks, these types of applications are also important to be verified or certified. If any such person could register as a provider, it could set up fraudulent transactions or situations. Especially in emergency situations where a consumer-patient is looking to connect with a nearby medical professional, it’s important that the information provided through this healthcare application is accurate and reliable. The more trustworthy these types of applications are, the better for the public.
Lastly, loggers and trackers record decisions about general health and wellness and includes apps like diet trackers, calorie counters, exercise regiments, etc. One type of application of this sort in the marketplace today is “Glucose Monitor” which turns a device into a personal glucose and weight monitor, using data visualization, statistics reporting, built it reminders and more. For tracking, you can input your blood pressure, weight, BMI, cholesterol, and more. The app also offers medical correlation which shows how your vital signs change in accordance with different medications and different meals. This type of application is targeted for the patient group of consumers and is equally important for passing a certain threshold before being disseminated into the public. When patient-consumers download these apps and begin relying on them, it is imperative that their information is accurate and their charts/graphs are easily discernible to the average consumer. If applications contain wrong information or even portray the information in a confusing manner, it could be detrimental to a patient’s health. Even if the application is merely confusing, it may discourage use leading the consumer-patient to quick using the application after a short period of time, and thus does not advance the overall goal of increasing quality of healthcare through mobile applications. Patient-consumers may be discouraged from investing time or money in additional healthcare apps if they had a negative experience with one…. Thus it’s important that all healthcare applications in the marketplace targeted for consumer-patients, especially for apps that monitor, automatize, and customize, that they are of a certain level of quality.
All together, these different categories of technology make up the mobile health industry marketed to and used by both consumer-patients and consumer-providers. There are constantly new and innovative applications and technologies coming to fruition, so this list may not be completely exhaustive especially for future technology, but it gives a good overview of the various types of applications available to a broad range of consumers. As evidenced, all applications in the healthcare world need to pass a certain threshold of reliability, accuracy, and trustworthiness. No matter the consumer group or the application type, to net more positive growth towards a better quality healthcare industry utilizing mobile healthcare applications, apps should pass a certain level of quality. Apps in the marketplace that don’t pass this level of adequacy will discourage further use and trust by both patients and providers, and could also be detrimental to the quality and timelines service by providers and the overall health of patients.