29 September 2014

Mobile medical applications – good or bad?

Almost 20% of smartphone owners use at least one mobile application to help them monitor their health. It is estimated that by next year the number of users of such applications in the world will reach 500 million. There is no doubt that the popularity of such programs is growing rapidly, but do they benefit our health? Is it possible that they actually do more harm than good?

According to the terminology of the US Food and Drug Administration (FDA), mobile medical applications are "medical devices that are mobile applications that meet the definition of a medical device and are an addition to a certified medical device or transform a mobile phone platform into a certified medical device."

To date, there are applications that allow monitoring of almost every parameter of health status, including body weight, physical activity, blood pressure, cholesterol and glucose levels in the blood, heart rate and sleep quality. There are even applications that allow you to detect malignant tumors.

And this list continues to grow. Earlier this year, articles were published describing new smartphone apps that, according to developers, are able to detect epilepsy and improve the quality of care for stroke patients. According to a later publication, experts from the University of Washington are developing a smartphone application designed for self-screening of newborns for jaundice.

Thus, smartphone users receive a huge amount of information about their health status in the literal sense of the word "in their hands". However, it is not surprising that the effectiveness of such applications raises certain doubts.

Do apps for counting calories and making a workout plan really help in the fight against excess weight?Last year, the Institute of Informatics in Healthcare, part of the IMS Health company, analyzed more than 40,000 medical applications available for download from the US Apple iTunes app store, paying special attention to the ability of these applications to have a positive impact on the health of users.

According to the results obtained, only 16,275 of the analyzed applications are directly related to patient care and treatment, while the rest provide information that in no way can improve the patient's health or well-being.

The most frequently downloaded applications are those claimed to be tools that help in following a diet, reducing body weight and improving physical fitness. The most popular are MyFitnessPal and FitBit – free apps that count calories and track changes in physical fitness.

Last year, MyFitnessPal was downloaded by 40 million users, however, according to a report by the IMS Institute, the effectiveness of these applications does not match their popularity. In fact, the effectiveness of calorie counting applications has been demonstrated only in a very small number of studies.

Similar conclusions were reached by scientists at the University of Massachusetts, who compared 30 popular applications for weight loss with traditional approaches to this issue.

The analysis showed that no more than 25% of the proven lifestyle change strategies for weight loss (such as controlling portion size or identifying the causes of overeating) were involved in 28 out of 30 applications, which indicates their potential inefficiency.

However, not all studies refute the effectiveness of weight loss apps. In 2012, scientists from Northwestern University in Illinois published data according to which an application that tracks nutrition and physical activity helped users reduce body weight by about 7 kg and maintain the achieved result for at least a year.

At the same time, the authors recognized that the application was effective only when used in combination with other auxiliary programs, such as lectures on nutrition and physical activity.

Can medical applications pose a health hazard?Ineffective weight loss applications are just one side of the issue.

Some experts believe that the effectiveness of other medical applications can be literally "a matter of life or death."

Last year, researchers at the University of Pittsburgh evaluated the accuracy of the results provided by medical applications designed to detect skin cancer.

To do this, they tested on 188 photos of skin neoplasms (60 melanomas and 128 benign tumors) three applications that use algorithms to determine the probability of malignancy of a neoplasm, and one application that sends photos for evaluation to a dermatologist.

It turned out that even the most effective of the applications using algorithms rated 18 out of 60 melanomas as neoplasms with a "low probability of cancer". The authors note that the use of such applications for self-diagnosis can delay the detection of a tumor, whereas in this case, early diagnosis is an extremely important factor in the success of subsequent treatment.

The researchers note that the developers of these applications claim that they are intended for educational purposes and cancer diagnosis should be carried out in medical institutions. However, the results of the study still cause concern, since there is a fairly high probability of abuse. So, in conditions of a shortage of funds, people who do not have insurance or even have insurance, but are kept from visiting doctors by additional payments, can use such applications as an alternative to a medical examination.

Medical data is not required for the development of medical applicationsIn order to develop a medical application, it is not necessary to be a doctor or use a source of medical information, which, according to experts, is a potential source of problems.

The report of the American Academy of Orthopedic Surgeons explains this as follows: "Usually the approval process requires that the application complies with all company regulations, and its contents comply with the stated. However, this process does not validate the data entered into the program for medical accuracy and functionality before the application becomes available to the public."

As a result, we have an easily accessible library of non-validated and independent expert evaluation of mobile medical applications that can be used by patients, students and specialists with equal success.

Despite the fact that some applications contain legal information, they are not required to provide information about restrictions and data sources. The result of this is a well-founded concern about the possibility of the emergence of health-threatening applications.

Last year, the FDA published the final version of the guidelines for developers of mobile medical applications. The agency announced that it will focus its work on regulating a small number of medical applications recognized as associated with high risks for users. These include mobile applications designed to be used as an addition to certified medical devices, as well as transforming a mobile platform into a certified medical device.

It was also noted that since many mobile medical applications do not meet the definition of a medical device formulated in the Federal Law on Food, Medicines and Cosmetics of the USA, their regulation does not fall within the jurisdiction of the FDA.

Despite the fact that the appearance of the FDA guidelines is a serious step towards ensuring the safety and effectiveness of mobile medical applications, experts believe that there is still a lot of work ahead. It is obvious that an extremely important step is to involve more professionals in the medical industry in the creation, development and expert evaluation of applications.

Exchange of information between a doctor and a patientDespite the fact that some people doubt the effectiveness of medical applications, many believe in their ability to transform the healthcare sector for both patients and medical professionals.

In addition to health monitoring, many applications can improve the efficiency of healthcare by improving the quality of information exchange between a doctor and a patient.

One of the latest examples of such applications is Apple HealthKit, the final version of which became available on September 25 after two weeks of software problems.

This tool provides iPhone and iPad users with an "easy-to-read dashboard containing information about their health status and physical fitness." This is achieved by combining information collected by other medical applications.

The novelty of this application is that it allows you to send this information to your doctor. For example, according to the explanations on the Apple website, the user can choose to automatically send data about his blood pressure to the doctor.

In June of this year, Google announced the creation of a similar platform called Google Fit, but the date of its appearance on the market is still unknown.

Apple HealthKit is not necessarily "the beginning of a revolution in healthcare"According to Apple representatives, the appearance of HealthKit can serve as the starting point of a revolution in healthcare.

However, many experts do not share this opinion.

In this case, the question of the accuracy of the information arises again. While obtaining data on a person's health status can be useful to a certain extent, a doctor cannot guarantee the accuracy of the readings of all mobile applications used by patients, such as blood pressure and glucose monitors. Therefore, it is unlikely that we will ever reach a level where it will be enough for a doctor to look at the patient's mobile phone screen to make a diagnosis.

Another unpleasant point is that HealthKit can affect the mental state of users, causing them increased anxiety about their own health. A key aspect of HealthKit's usefulness is the correct interpretation of the data provided by this application. There is a fairly high risk that, after seeing a sharp decrease in one of the indicators, a person may perceive it as a serious problem, whereas in reality the value will not go beyond the normal range.

Of course, there is also the problem of protecting personal information. Most recently, Apple had problems related to the fact that hackers gained access to intimate photos of celebrities stored in their profiles on iCloud, an Apple–owned data storage system. This raises the question: is the data provided by HealthKit secure? Medical News Today asked this question to Apple, but the answer has not yet been received.

However, despite everything, the HealthKit application has many advantages. For example, it can be extremely useful for patients with diabetes mellitus who need constant monitoring of blood glucose levels. In this case, traditional finger pricks and analysis of a drop of capillary blood using a glucose meter can be replaced with a tiny implantable sensor that sends information to HealthKit or another similar application.

Pregnant women can also use HealthKit to monitor their health indicators, as well as fetal heartbeat.

Using HealthKit in clinical trialsHowever, apparently, Apple is using HealthKit to push its "medical revolution" much further than the doctor-patient relationship.

Recently, the use of the platform in two independent clinical trials was announced. As part of one of them, Stanford University scientists are using HealthKit to track the blood glucose levels of children with diabetes.

In the second study conducted by Duke University specialists, HealthKit is used to monitor blood pressure, body weight and other health parameters in patients with heart disease and cancer.

Until the accuracy of the data provided by all medical applications is confirmed by convincing research results, their effectiveness will be questioned.

However, based on the rapidly growing number of downloads of such applications, both consumers, medical professionals, and researchers are positive about their appearance. Apparently, in the future, everything that can be presented electronically will be presented electronically. Medical applications will be used to schedule doctor visits, track side effects of treatment, monitor compliance with the therapy plan and much more. All this will inevitably lead to radical changes in the relationship between patients and the healthcare system.

Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru according to Medical News Today:
Health apps: do they do more harm than good?29.09.2014

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