White paper: Health apps: where do they make sense? White paper: Health apps from the perspectives of patients, standards and policies Based on a seminar held at the King’s Fund, London, 28 October 2013

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Conclusions Of The First Ever Cross-Stakeholder Pan-European Seminar On Health Apps/How patients, policy-makers, healthcare professionals and industry see the future

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Brussels, 12 March 2014   Published today in a new white paper [1], produced jointly by myhealthapps.net and the UK government’s ICT Knowledge Transfer Network (published by PatientView [2]) are key findings from a joint seminar held in London at the King’s Fund on 28 October 2013. The seminar was a cross-stakeholder European-based meeting looking at quality standards among health apps, precipitated by the imminent publication of the EU Green Paper on Mobile Health, to be published at the end of March 2014.  In attendance were major mobile manufacturers, app developers, representatives from the healthcare industry, academics, patient organisations as well as representatives from the European Commission DG CONNECT. The general consensus among these 60 attendees was that five key challenges need to be addressed:

Overhauling healthcare systems to make them patient-centric: apps as a catalyst:  In order for patients, the public and health systems to tap the full benefits of app technology, healthcare systems need to adapt so they are truly patient-centric and promote greater self-care. Apps can help here, if they can work together more seamlessly, integrating an individual’s data on multiple healthcare needs and routines. The great advantage of health apps is that the infrastructure of these products already exists outside health systems. Therefore, health apps might be able to catalyse any drive to make healthcare more responsive to patients. The personal and financial benefits of helping patients and the wider public take more control of their care are not in doubt:

  • 80% of instances of diabetes, heart disease and strokes can be prevented by better self-care.[3]
  • Self-care and the changing of lifestyle reduce the number of visits to the doctor–in turn, helping healthcare systems become more sustainable.[4]                 

Engaging doctors in the prescribing of health apps: Although patients and members of the public are embracing the health apps that are designed for consumers, healthcare professionals (who should be major advocates of mHealth as prevention measures and enabling better targeting of scarce resources) often lag behind and are poorly informed. If doctors prescribe health apps, these apps are likely to be trusted by patients.

Overseeing quality standards for health apps: If health apps are to move into mainstream healthcare, the regulatory requirements for prescribing apps will need clarification (and perhaps the creation of some sort of accreditation system). The key is trust. The consensus was that no single entity (app stores, mobile providers, patients, consumers) can do this in isolation. The likelihood is that several bodies might take on joint responsibility for curating the trustworthiness of apps and a single repository of public-oriented information on health apps could be created

Ensuring that health apps remain of a high standard throughout their lifetime: Health apps face significant challenges if they are to maintain high quality throughout their time in the marketplace. Medical information quickly becomes superseded; the regulatory environment is reformed or adapted; changes sweep away other elements of the systems in which health apps work. But app developers (and their funders) find the remodelling of apps to be both time-consuming and costly. One possible unfortunate consequence of implementing quality standards for health apps could be higher prices of the products for users, undermining a key virtue of health apps–their accessibility to the public

Considerations for policymakers wishing to oversee health apps: The adoption of smartphone technology will not create health inequalities, but rather can increase healthcare sustainability. The interfaces of smartphones and health apps need to improve to become more readily usable by older people and people with a disability. Regulations governing health apps are opaque and outdated. Developers are unaware of their legal responsibilities. Clarification is needed about whether health apps require a CE marking (that is, are classified as a medical device).  However, helpful advice for the developers of health apps is available from the EU and national regulatory agencies. Furthermore, the EU has made it clear that it does not want to discourage the burgeoning market for health apps by producing excessive red tape.

NOTES: About myhealthapps.net*

  • 370 apps with 25-30 new ones added each month.
  • Apps available in 47 different languages, from Albanian to Welsh, which can be selected for through the website’s filtering system.
  • Apps dealing with 150 different health specialties so there should be something for everyone: from exercise and diet apps through to disease-based apps for monitoring, tracking, providing information, providing support to manage symptoms, or even networking with family friends, carers or other people with a similar medical condition.
  • Apps for five different platforms: Android, Apple, Blackberry, Nokia, Windows, each with weblinks to relevant app stores, which can be selected for though the website’s filtering system.
  • App developers, funders and medical advisers are listed for each app so that you know who made the app and its level of trustworthiness.
  • Apps ranked by price, from lowest to highest or vice versa. 
  • Unique ‘heart’ rating system. In 2013 a study of 250 patient, disability and consumer groups from 16 countries around the world for myhealthapps.net revealed that the public and patients look for five attributes in their health apps: (1) Give people more control over their condition, or keep them healthy (2) Be easy to use (3) Be able to be used regularly (4) Allow networking with other people like them, or with people who understand them (5) Be trustworthy.[5] The health apps on the site have been allocated heart ratings according to the extent that each app exhibits the 5 consumer/patient needs (weighted according to level of importance).
  • Visitors to the site may leave comments about specific apps, though this functionality is moderated.
  • *myhealthapps.net derives no income from app developers or app downloads.

myhealthapps.net partners : European Health Forum Gastein, GSK, Janssen, NHS England, Novo Nordisk,  O2 Telefonica Europe, Vodafone Foundation

[1]Health apps:where do they make sense? Health apps from the perspectives of patients, standards and policies, white paper, PatientView, March 2014 
[2] http://www.patient-view.com
[3] World Health Organization, Preventing Chronic Disease: a Vital Investment, Geneva, 2005, p. xiii. 
[4] Debra de Silva, Helping People Help Themselves, The Health Foundation, UK, May 2011.
[5]https://alexwyke.files.wordpress.com/2013/10/health-app-white-paper-to-go.pdf