More than 43,000 healthcare apps are currently available for download in the Apple iTunes store. However, physicians are hesitant to recommend them, the most vulnerable populations (especially patients aged 65 or over) are the least likely to use them and many have very limited functionality.
A new report from the IMS Institute for Healthcare Informatics aims to overcome some of these barriers to help the healthcare industry take full advantage of latent potential in healthcare apps. "We sense a great deal of excitement about the role apps can play in care delivery," says Murray Aitken, the executive director of the IMS Institute for Healthcare Informatics. "This report aims to describe a way forward for apps in healthcare."
A summary of the organization's research over the past few months, the report's findings come from an analysis of the healthcare apps currently available in the iTunes store, along with interviews with physicians, CMOs and CMIOs to understand the current app landscape and providers' attitudes towards apps in healthcare.
"Even though there are a large number of apps, most of them have very limited functionality," says Mr. Aitken. The team of researchers sorted through all the consumer-facing, healthcare-related apps in the iTunes store and assessed each against 25 criteria related to the app's functionality. Researchers determined if the app provides healthcare-related information and if so, in what form, if users are able to enter health data, if the app provides guidance based on data entered, if the app has reminders or alerts and if the app allows for communication with a healthcare provider.
More than 90 percent of the apps analyzed scored less than 40 out of 100 on the researchers' functionality assessment. Of the approximately 10,000 apps that provide health information, less than half provide instruction or recommendations to users, and less than 20 percent are able to capture user data. The researchers found some more sophisticated apps, mostly designed for remote patient monitoring, that had a high level of functionality.
Additionally, the majority of apps focus on general wellness and prevention, rather than disease treatment or management. "When we aligned the apps to where they sit on the patient's journey…we found the majority are at the front end, with over 9,000 apps focused on prevention, and about 300 focused on further downstream," says Mr. Aitken.
Researchers also found apps rarely targeted the most at-need patients. "We know patients over 65 with multiple conditions are the largest healthcare consumer and incur the highest costs, yet there are relatively few apps that target this population," says Mr. Aitken. The researchers found just 27 apps in the iTunes store focused on seniors' health. Despite the lower prevalence of mobile devices among older patients, he still sees a disconnect between app supply and societal need. "There's not yet a close linkage between the areas of greatest healthcare need and the availability of healthcare apps," he says.
To add to the difficulty of finding a useful, appropriate app, the sheer number of apps available in iTunes and the online store's interface can make it difficult to browse and discover new apps. "This may be why overall app downloads are limited and concentrated on apps already being downloaded frequently," says Mr. Aitken. Half of the apps available have been downloaded less than 500 times, and five apps account for 15 percent of all downloads in the healthcare category.
Another barrier is hesitant physicians. "Physicians are generally enthusiastic about the potential apps bring to healthcare, especially around the idea of helping patients engage with their own health more directly," says Mr. Aitken. "Despite that enthusiasm, physicians are generally wary of recommending apps to patients," generally for concerns relating to lack of evidence about apps' effectiveness and safety, regulatory and liability concerns and data privacy concerns. Physicians are also hesitant to recommend apps when payers and wellness programs are in the early stages of recognizing them as part of the array of healthcare benefits that can be provided to patients, he says.
The way forward
Researchers' conversations with providers suggested physicians may be more comfortable recommending or prescribing apps with institutional approval from the American Medical Association or similar. Guidelines providing criteria for evaluating an app's clinical effectiveness or how information gathered from an app needs to be reviewed and integrated with care delivery would provide structure to what is still a very new idea, says Mr. Aitken.
Researchers also heard "loud and clear" from physicians that institutional approval from within their hospital or health system would make them more confident about selecting apps for patients, says Mr. Aitken. Sameer Badlani, MD, CMIO of University of Chicago Medicine, agreed, telling researchers: "When an individual physician says 'I like this app, you should use it,' it is very different from the CMIO or the associate CMIO saying, 'These are the endorsed apps from the organization, we have evaluated the app and physicians are welcome to use them.'"
In addition to soothing physician trepidation, Mr. Aitken believes apps need to undergo more clinical trials to prove their worth to the industry. "We need to build evidence, and confidence, that apps can improve outcomes and lower costs," he says. This should begin with observational studies to inform on apps' real-world use, and facilitate the creation of hypotheses to then be tested in randomized clinical trails. The clinical trials would provide the hard evidence on an app's effect on patient outcomes or other healthcare measures.
Mr. Aitken advocates for standardized security and privacy guidelines across the industry to help assuage patient and physician fears of unsecure or misused data. These guidelines should require apps to request consent before users enter data into the app, to only collect data that is necessary for the app's functionality, define a reasonable period of time for data retention and comply with all HIPAA regulations for protected health information.
To fully bring apps into the healthcare industry, however, Mr. Aitken believes they will eventually need to be seen as equal to a pharmaceutical prescription or other physician advice.
"The apps need to be integrated into the flow of information that is increasingly important for patient care," he says. "Once apps move into the mainstream of healthcare, we will see them realize their full potential in terms of improving patient outcomes and contributing to lower overall costs throughout the healthcare industry."
The top-rated apps
Following the functionality assessment of the available apps, researchers combined the functionality scores with user reviews to compile these lists of the top apps:
Top prevention apps:
Calorie Counter and Diet Tracker (MyFitnessPal)
Calorie Counter PRO (MyNetDiary)
Chest Trainer: powered by Fitness Buddy (Azumio)
Cycle Tracker Pro — TrainingPeaks GPS (Peaksware)
Quit It 3.0 (Tommy Kammerer)
Top provider-finder apps:
Healow (eClinicalWorks)
Vitals — your top 10 doctors! (Vitals)
ZocDoc — Doctor Appointments Online! (ZocDoc)
Top diagnosis or education apps:
HealthTap — free doctor answers to medical and health questions (HealthTap)
iTriage (Healthagen)
WebMD for iPad (WebMD)
Top prescription-filling apps:
GoodRx (GoodRx)
MyRefill Rx (Intelecare Compliance Solutions)
Walgreens (Walgreens)
Top compliance apps:
Dosecast (Montuno Software)
Pill Monitor free — Medication Reminders and Logs (Maxwell Software)
RxmindMe Prescription/ Medicine Reminder and Pill Tracker (RxmindMe)
Top diabetes apps:
Daily Carb — Carbohydrate, Glucose, Medication, Blood Pressure and Exercise Tracker (Maxwell Software)
Glucose Buddy — Diabetes Logbook Manager w/syncing, Blood Pressure, Weight Tracking (Azumio)
GoMeals (Sanofi-Aventis)
Top mental health and behavioral apps
ADHD Angel (Daniel Anderson)
Live OCD Free (Pocket Therapist)
T2 Mood Tracker (The National Center for Telehealth and Technology
Top musculoskeletal system and connective tissue apps:
Office-Fit (Medicus 42)
WebMD Pain Coach (WebMD)
Zimmer Arthritis 411 (Zimmer)
Top oncology apps:
Dr K's Breast Checker (Lingopal Holdings)
PCR Tracker (Cheryl-Anne Simoneau)
SkinKeeper (The Health Safari Pty)
Top nervous system apps:
Noteness (Martin Hartl)
Parkinson Diary (Health Wave Signals)
Young Epilepsy (Young Epilepsy)
Top women's health apps:
Ovulation Calendar Ladytimer Free (Vipos.com)
Period Diary (nanobitsoftware.com)
Pregnancy Tracker from WhattoExpect.com (Everyday Health)
Top children's health apps:
BabyConnect (Seacloud Software)
Baby Food Pee Poo Free (Colorful Drop)
Total Baby (ANDESigned)
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