Dr. Leslie Kernisan recently wrote a great piece about app prescribing, asking, “Should I be prescribing apps, and if so, which ones?” Since Happtique is all about integrating apps into clinical practice, I jumped at the chance to add to this important discussion.
Dr. Kernisan is right to be concerned and somewhat skeptical about app prescribing. More than 40,000 health apps exist across multiple platforms. And unlike other aspects of the heavily-regulated healthcare marketplace, there is little to no barrier to entry into the health app market—so basically anyone with an idea and some programming skills can build a mobile health app. The easy entry into the app market offers incredible opportunity for healthcare innovation; however, the open market comes with certain serious concerns, namely, “how credible are the apps I am (or my patients are) using?”
When Happtique launched, we focused our initial energies on bringing clarity to this crowded market. While the interest in mobile health was skyrocketing, it was really hard to find specific health apps. Commercial app marketplaces bucketed apps into just two categories: “Health & Fitness” and “Medical”—forcing patients and providers to scroll through dozens of pages of apps in search of the “right” one. With the help of doctors, nurses, and medical librarians, Happtique classified nearly 20,000 apps into over 300 topic-specific categories related to health care profession, disease state, or specialty.
As we sorted through thousands of apps, two important ideas occurred to us. First, healthcare isn’t a traditional consumer product. Healthcare consumers, i.e., patients, have always relied on a trusted advisor—a clinician—to tell them what products (pharmaceuticals) and services (treatments) to purchase. In other words, patients want providers to help them select the right apps for their health management plans. Second, we realized that providers are not going to recommend apps to patients if they are not confident that the app is secure, delivers credible content, safeguards user data, and functions as described.
To address those issues, Happtique has spent the last year developing the Happtique Health App Certification Program (HACP), which launched earlier this month. Working with Intertek and clinical organizations like the AAMC and CGFNS, Happtique‘s certification program will test health apps against a set of published standards and performance requirements that encompass operability, privacy, security, and content. Apps meeting these standards will receive the Happtique Certification Seal. We think this program will go a long way in helping build patient and provider confidence.
Another important factor in building clinical confidence in apps is research. Let’s face it: doctors love data. And we’re starting to see some empirical evidence about health apps. For example, WellDoc ran a randomized, controlled trial to test effectiveness at improving health outcomes using their FDA-approved DiabetesManager app. The study found that the average decrease in A1C (a strong indicator of average blood glucose levels) for patients using the app was around 2.0%, as compared to 0.68% for patients not using the app. Certainly, some health conditions will benefit more from apps than others. But as the number of health apps continues to grow, more clinical trials around apps will provide much-needed validity to the concept of app prescribing.
While app certification and data from trials will help address Dr. Kernisan’s concerns about which apps to prescribe, she also notes that ease of prescribing is essential for widespread adoption of apps into clinical practice. Happtique agrees. Our mRx™ Mobile Health Platform not only allows clinicians to securely prescribe apps, but also to send patients videos and documents. Imagine sending discharge papers or a post-op instructional video directly to your patient via email. No more wondering if the rehab exercise sheet made it home—the mRx™ Platform allows the prescribing clinician to see whether the patient has clicked the link to download content and can resend to patients, if necessary.
App prescribing offers an unprecedented opportunity to increase patient engagement and improve care management. To become a meaningful part of patient care, the clinical recommendation of apps must be, in Dr. Kernisan’s words, “thoughtful and person-centered.” That’s why it’s important to remember that while the prescribing technology is automated, the actual prescribing of apps is not. Clinicians still have to choose which apps, videos, and content to send to their patients. Happtique hopes that our Certification Program and prescribing platform, coupled with emerging app efficacy trials, will help providers identify and integrate health apps into a whole-person approach to managing healthcare.
Ben Chodor is the CEO of Happtique, a company whose mission is to integrate mobile health into patient care and daily life.
Who is making the guidelines for these certifications?
Happtique is innovative and on to something that will have great benefits for patients. But is it going down the same path as pharmaceutical companies? There is a conflict of interest when the company profiting can assemble the group that provides oversight. There is a better choice.
The public wants nurses, not on the periphery, but assuring information is used in their best interest. Nurses are at the patients bedside 24/7 and understand the patient experience and have that special nurse-patient bond. They earned unparalleled consumer trust , evidenced by the CNN/USA Gallup Poll rating nurses as the #1 most trusted profession, and can influence the consumer and products they buy.
Hospitalization is a time when patients and family are motivated to listen and learn about mobile applications that are in their best interest. The bedside nurse, using a professional and empathetic approach, could engage the patient and caregiver and determine if the application is a good choice. If not, another option will be considered. Nurses, by collaborating with an interdisciplinary team of professionals, could select the most effective applications, and integrate these in the patient’s care plan and discharge instructions. Visiting nurses could continue evaluation in the home.
The Nurse Portal is an initiative that will connect millions of nurses worldwide, at point of care, and provide a platform with a robust selection of social media tools. No new hardware is needed. This cost effective vehicle facilitates participatory design and usability testing that will add value to health applications with easy access to coveted real-time data.
Patient advocates and business innovators working side-by-side to build better health applications. Sounds good!
Ben, thanks for this post.
I was wondering if Happtique will ever be able to show me what other geriatricians have liked or downloaded? That would be useful to me, far more than a specialist certifying an app. (I find that generalists, and geriatricians in particular, have different priorities than the specialists do.)
Also, I can no longer find my way into the Happtique app store…didn’t there use to be a link from the home page? thxs, leslie
Lets talk about non-credible apps for a moment
Have you ever run into a what might be called a “malware” or “black” app that collects user information it shouldn’t? Do you think consumers be concerned about the potential for this? As you say, with little to no government oversight there seems to be nothing to prevent this from happening
If I’m a hospital CIO I’m not sure I’m happy about my users installing random stuff on their devices
Second thing – probably a bigger deal – to what extent do you evaluate content? Do you screen for misinformation? In this context, what does credibility mean to your company? There is a lot of spam masquerading as credible health content on the Web already – as anybody who has searched for reliable answers to almost any serious health question can tell you. With marketers all over apps as a awesome new tool, this is something some docs I’ve spoken with are worried about ….