In 2010, the American Dialect Society chose “app” as Word of the Year. This is perhaps a testament to the ubiquity of mobile phones and the apps that make it useful. App is of course, short for “application” though I think no one called it that until the iPhone 3G ad in 2009. I certainly didn’t when I first started using a mobile device (then called a PDA or personal digital assistant) as a medical resident in 1997, the Palm Pilot Pro. One of the earliest apps then was Epocrates, a drug database. Palm Pilots have gone the way of the dinosaurs as mobile phones became smartphones which could run apps. There are many apps now available for use by both doctors and patients. Joseph Conn writes that medical apps are no longer a novelty today and I agree.
For this week’s #HealthXPh tweet chat on March 15 (10 am Manila Time), the discussion will focus on the use of medical apps by healthcare providers and patients.
T1 What questions do you need to ask before downloading a medical app?
Visser and Bouman (Student BMJ, 2012) warn that “doctors should be wary when using medical apps.” They raise the following points:
- In case of malfunction, an app can be “recalled” but that only prevents new downloads.
- Apps that collect patient data pose a risk to confidentiality.
- Apps that are used in clinical decision making should be peer-reviewed.
- Drug company-sponsored apps raise the issue of conflict of interest.
T2 Should healthcare providers prescribe medical apps?
There are a bewildering number of medical apps available for patients. Should healthcare providers sift through these apps and help patients decide which medical apps are useful? Would healthcare providers be liable if patients are harmed from using these apps? Jonah Comstock reports in mobihealthnews –
A staggering 90 percent of chronic patients in the US would accept a mobile app prescription from their physician, as opposed to only 66 percent willing to accept a prescription of medication, according to a recent survey from health communications firm Digitas Health.
Interestingly, there is a prescription-only, FDA-approved app for those with type 2 diabetes called BlueStar, developed by WellDoc.
T3 What kind of apps should FDA regulate?
In Sept 2013, the FDA issued the final guidance for mobile medical applications. In that document, only apps that are intended to be used as an accessory to a regulated medical device or transform a platform into a regulated medical device will be regulated. For apps that pose minimal risk to patients and consumers, FDA will exercise “enforcement discretion” only. This means that manufacturers will not be required to register these apps with FDA. These include apps that:
- Help patients/users self-manage their disease or condition without providing specific treatment suggestions;
- Provide patients with simple tools to organize and track their health information;
- Provide easy access to information related to health conditions or treatments;
- Help patients document, show or communicate potential medical conditions to health care providers;
- Automate simple tasks for health care providers; or
- Enable patients or providers to interact with Personal Health Records (PHR) or Electronic Health Record (EHR) systems.