Medical apps for smartphones: lack of evidence undermines quality and safety

Abstract

Increasing numbers of healthcare professionals are using smartphones and their associated applications (apps) in daily clinical care. While these medical apps hold great potential for improving clinical practice, little is known about the possible dangers associated with their use. Breaches of patient confidentiality, conflicts of interests and malfunctioning clinical decision-making apps could all negatively impact on patient care. We propose several strategies to enhance the development of evidence-based medical apps while retaining their open nature. The increasing use of medical apps calls for broader discussion across medicine's organising and accrediting bodies. The field of medical apps is currently one of the most dynamic in medicine, with real potential to change the way evidence-based healthcare is delivered in the future. Establishing appropriate regulatory procedures will enable this potential to be fulfilled, while at all times ensuring the safety of the patient.

Developing mHealth Apps with Researchers: Multi-Stakeholder Design Considerations

“…However, it has been noted that Apps are often designed with little health professional involvement [5,6] and that end-user Apps are often produced from the healthcare system perspective rather than with a user-centred approach [7]. In addition, the importance of a number of other stakeholder considerations are evident, including ethical and other research governance requirements and potential for interaction with healthcare informatics infrastructure within the research institution or provider organisation(s).…”

Digitizing diagnosis: a review of mobile applications in the diagnostic process

“…5 The relevant regulatory bodies in many countries have not yet established guidelines and regulations for overseeing medical apps, and are struggling with how to deal with the vast numbers of new apps flooding the market. At the time of writing, NHS England was working on a bilateral framework with the US Food and Drug Administration (FDA), which in September 2013 released a set of guidelines by which medical apps are to be regulated in that country.…”

“…Given the novelty of contemporary digital health technologies such as apps, the apparent benefits they promise and their unintended consequences have not been sufficiently investigated [4][5][6][7]. We argue that apps should be viewed as sociocultural artefacts and worthy of social analysis [6].…”

“…Medical practitioners have begun to use apps and other digital technologies as part of their practice [5,15]. At least one American medical school is requiring its students to use iPads using a variety of apps [16].…”

“…Several writers and researchers in medicine and public health have drawn attention to such benefits [19][20][21][22][23]. However, other commentators have noted that there are numerous significant potential harms that are posed by the use of apps for medical and health-related purposes, including conflict of interest and transparency, ethical, and privacy issues, as well as those relating to accuracy of content, healthcare delivery and the doctor-patient relationship [5,16,[24][25][26]. Despite the progressive and rapidly expanding entry of digital health technologies such as apps into healthcare service provision [3,7,27], researchers in the health services literature have yet to fully investigate these topics.…”