A woman undergoes an eye examination using of a smartphone at a temporary clinic by International Center for Eye Health at Olenguruone in the Mau Summit, west of Kenya’s capital Nairobi, Oct. 29, 2013. (Reuters)
Health and medical apps are becoming part of daily life. They track fitness, provide useful health indicators, and even create new health care opportunities in developing countries. But despite their promise, unregulated apps are raising concerns about safety as well as the security of patient data.
While health and medical apps can be useful, Kevin Pho, MD, co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices advised consumers to approach them with caution.
“They are often not regulated by any scientific body; and health app makers sometimes don’t have physician expertise to back up their claims,” he said in an email interview.
In some cases, apps that boasted diagnostic features turned out to be fraudulent.
“The IMS Institute for Healthcare Informatics found that fewer than 25 percent offered patients legitimate medical information,” said Pho. “Apps that claim to diagnose – such as those that say they diagnose skin cancer – were found to miss cancer 30 percent of the time.”
He said apps that are vetted and recommended by a physician are likely to be safe. But he advised patients to work with their doctors “to ensure the safety and efficacy of any health app they use.”
That also depends on what the application is for, said Morgan Reed, Executive Director of ACT | The App Association, in an interview. Physicians are always eager to see their patients take better care of their health, if that is what the app encourages them to do.
“There are those kinds of applications that I don’t think are necessarily ones that you have to consult your physician first,” he said. “But if you are using a mobile app to help you increase your exercise and you are unsure if that exercise is appropriate for you, then absolutely you should consult with a physician first.”
Apps that provide medically-actionable information should be used in consultation with a physician and regulated, said Eric Topol, MD, Director of the Scripps Translational Science Institute and Chief Academic Officer, Scripps Health. “There has to be oversight,” he said.
“You don’t want to give insulin for the wrong glucose,” he said. “You don’t want to give blood pressure medications for high blood pressure when it’s actually low.”
Medical apps are already embedded in some hospitals. And Reed, who pointed out that some are used to monitor vital signs as patients are ferried to the hospital, sees great promise in remote-monitoring apps, particularly for keeping an eye on the disabled and the elderly.
These apps also provide a viable option in regions where health care systems are struggling to cope, or in rural areas where doctors are in short supply. And their biggest impact there will likely be due to what Topol described as their “leveling effect.”
“I call it “flattening the earth,” he said, “because this works just as well and it is a leapfrog for people in developing countries.”
The information the apps provide creates “more parity,” he said, allowing people in those regions to “have the same medicine – at least on the diagnostic side and the monitoring side – anywhere in the world just because wherever there is a mobile signal, there is a capacity to render better health care.”
But that collected treasure trove of information can be a double-edged sword, particularly where mobile technology has outpaced consumer protection laws. And the privacy and security of patient information are a major concern for Topol, author of The Patient Will See You Now.
“That’s center stage right now,” he said, “because … there is no protection about that data. And … unknowingly, unwittingly, that data is being used by others without any potential re-identification of where it came from.”
Topol, Pho and Reed all agree that protections are needed, especially since many apps use patients’ personal information to generate revenue.
“If you’ve been given a free application and you can’t figure out how it is being paid for, then the chances are high that it is being paid for by using your information for advertising,” said Reed.
He suggested that users research their apps before installing them to see what becomes of their collected data.
“Before you start sharing your significant health information, yes, you should absolutely do it,” he advised.
Pho’s advice is for patients to be careful about disclosing personal information on health apps and to consider related cybersecurity risks.
“Privacy Rights Clearinghouse, a consumer advocacy non-profit organization, looked at both free and paid health apps, and found that 72 percent of them had security and privacy risks, including connecting [to] third party sites without a user’s knowledge or sending health data without encryption, making it vulnerable to hackers,” he said.
Even if patient privacy is secure, many doctors are not supportive of mobile apps and wearable sensors that let patients collect and interpret their own data, said Topol.
“When people are collecting their data on themselves and having software and algorithms to interpret it for them, the doctors basically are losing control,” he added. “And this doesn’t go over well.”
As a result, he said doctors often dismiss patient-generated data as flawed, even when the information is gathered through tested and approved bio-sensors. But that, in his view, is a bad attitude. He said Scripps has been testing the accuracy and the impact of this technology, with very good results.
“And this is when it becomes really important,” he said. “Up until now, you know, there really wasn’t anything that was being tracked through sensors that was making a difference.”
But capturing streaming medical data in the real world in real-time “is very different than the way medicine’s been practiced for the last two millennia, which is, you know, coming into the doctor’s office for a snapshot. And now we’ve got the whole life movie of a person,” he said.
