mHealth, or mobile healthcare, is not only here to stay, but it's likely to play an increasingly significant role in healthcare management and delivery.
A MedTech Boston article notes, “With the reach of mHealth technologies spreading further, it is expected to become one of the most game-changing aspects in the current healthcare scenario.” An article in the Online Journal of Nursing Informatics states, “It is increasingly recognized that these technologies are vital nowadays to support patient self-management and most likely will continue to develop in importance and use in the coming years.”
Meanwhile, one research agency recently projected that the global mHealth apps market size is expected to reach $236 billion by 2026, expanding at a staggering compound annual growth rate of nearly 45% during the forecast period.
While mHealth has tremendous potential to improve the delivery of medical care, it is not without its shortcomings.
Mobile Healthcare: The Good and the Bad
Here are 10 pros and cons of mHealth.
Pro: Numerous mHealth app options
Recognizing the growing demand by consumers for digital health services, app developers have stepped up. As an article in The Information Society notes, there were more than 95,000 mHealth apps available in the iTunes store and more than 105,000 mHealth apps available in the Google Play store in 2018. Some reports place the total number of mHealth apps available today at more than 300,000.
Con: Quantity doesn't mean quality
Of those hundreds of thousands of apps, many — if not most — likely do little to help consumers with their health and clinicians with care delivery. An article from The University of Texas MD Anderson Cancer Center notes, quoting Dr. Karen Basen-Engquist, “Most companies don't conduct a study to determine if their app actually helped users change or improve their behavior.”
A FierceHealthcare report covering a Journal of the American Medical Association article includes the following quote from Dr. Aaron Kesselheim: “There are tons and tons of apps and very little in the way of guidance for physicians or consumers on how to separate the wheat from the chaff.”
There are other challenges associated with having so many options. Most apps ultimately fail. And by most, one research agency estimated that just 1 in 10,000 — or 0.01% — of all consumer mobile apps will be successful. While some developers may continue to support a struggling app, it's usually only a matter of time before a failing app is abandoned. This reality makes it difficult for consumers or clinicians to choose an app with lasting power.
Then again, the number of apps typically used by consumers is quite low. As a ZDNet report covering a recent mobile usage survey notes, “Most of us only use five of our mobile apps per day, yet we have 25 or more apps, often up to 50 on our phones. … Over four out of five [survey respondents] said they use less than 10 apps on a daily basis.”
Pro: Consumers are very receptive
For mHealth developers, the good news is that one of the apps used daily by many consumers happens to be an mHealth app. A national survey of U.S. smartphone users found that more than half reported downloading an mHealth app, with most respondents using the app at least daily. The most recent data available from Statista shows that there were an estimated 3.7 billion mHealth app downloads globally in 2017. That's up from 1.7 billion in 2013.
Results from the Accenture 2018 Consumer Survey on Digital Health found that, “…healthcare consumers continue to show strong use of digital technology for self-service care — and the numbers are rising each year. In 2018, 75% of U.S. consumers surveyed said technology is important to managing their health. Patients are increasingly open to intelligent technologies taking on elements of their care, such as medical consultations and monitoring. And they are using self-service digital health tools that go beyond websites. … Nearly half (48%) of healthcare consumers are using mobile/tablet apps, compared to just 16% in 2014.”
Con: Identifying what is and isn't a safe, helpful mHealth app is difficult
Many mHealth apps make claims that are not supported by reality, which can potentially harm consumers — an alarm that health experts have been sounding for years.
A 2014 Wired report highlighted the potential dangerous shortcomings of mHealth apps marketed as replacements for legitimate medical equipment, with one physician source saying, “These apps have no validated data compared with accepted reference standards and therefore are quite concerning.” Another source in the piece spoke about how the use of such apps could land a user in the emergency room and possibly even kill them.
A 2017 report from The Guardian leads with, “Fitness trackers and mental health apps could be doing more harm than good because they are not based on sound science, researchers have warned, comparing some health app developers to 'snake oil salesmen of the 1860s.'”
A 2018 mHealth Intelligence report notes that, “Researchers at the University of Sydney have found that many popular mHealth apps designed to help people with mental health concerns aren't giving the right [advice] on how and when to seek treatment.”
The U.S. Food and Drug Administration (FDA) is trying to police mHealth apps more closely and weed out those that are not legitimate. This is evident by a recent safety communication in which FDA warned the public not to use medical devices marketed to consumers that claim to help assess, diagnose, or manage head injury, including concussion or traumatic brain injury. The FDA warned that such tools — including mHealth apps marketed to coaches or parents for use during sporting events — have not been reviewed by the FDA for safety and efficacy and could result in an incorrect diagnosis, potentially leading to a person with a serious head injury returning to their normal activities instead of receiving medical care. The FDA has even issued guidance for mobile medication app developers.
However, with so many apps available, and so many new ones launching every day, the ability for FDA to effectively monitor mHealth is limited. As of early 2018, Medical Economics reported that only about 200 mHealth apps had received FDA approval.
Pro: mHealth is accessible to many people
According to a survey conducted by Pew Research Center, as of June 2019, the share of Americans that own smartphones is 81%. Breaking this figure down further, 96% of adults ages 18-29, 92% of adults ages 30-49, 79% of adults ages 50-64, and 53% of adults 65-plus own a smartphone.
In short, a healthy majority of U.S. adults use technology that can run mHealth apps.
Con: mHealth is not accessible to everyone
As these and other smart device ownership figures demonstrate, not all U.S. adults use smart devices, meaning that mHealth is inaccessible to many consumers. This includes large numbers of individuals who would likely benefit significantly from helpful technology: the elderly.
Potentially further complicating matters is research showing that the lifecycle of a smartphone is steadily increasing, notes a CNBC report. “In 2016, American smartphone owners used their phones for 22.7 months on average before upgrading. By 2018, that number had increased to 24.7.” Depending upon the age of the smartphone (and, in some cases, the model), new apps or updated versions of existing apps may struggle to run on an older phone or may not run at all.
Pro: There's a wide variety of mHealth applications
As the MD Anderson Cancer Center report shared earlier states, “From helping you wake up rested to getting couch potatoes ready for a 5K, there really is an app for everything.”
It's difficult to argue with that sentiment. In 2010, Apple registered the trademark for “There's an app for that,” and this essentially continues to be the case.
Con: mHealth lacks effective regulatory oversight
Unfortunately, as touched on earlier during the discussion about the FDA, many apps receive little to no government attention, which can result in a slew of problems.
As an article in The Lancet notes, “In most countries, medical device regulation applies only to a subset of high-risk health apps that have well-defined medical purposes. However, most health apps available on the market target a wide range of health-related issues, including diet and exercise, pregnancy, and mental health, while still being considered nonmedical devices.”
The United States is one such country lacking extensive regulatory oversight, notes a Journal of Medical Internet Research (JMIR) report. “The rapid growth of mobile health apps has resulted in confusion among healthcare providers and the public about which products rely on evidence-based medicine. Only a small subset of mHealth apps are regulated by the FDA.”
Many apps have significant privacy and security shortcomings, notes a Business Insider report. “A recent analysis of mobile health apps found their data-sharing practices to be excessive, which creates privacy risks that should make providers wary about prescribing mHealth apps to their patients, per a British Medical Journal study.”
Pro: Some mHealth apps deliver quantifiable benefits
While most mHealth apps provide little measurable value for consumers and clinicians, there are several measurable ways mHealth helps improve care and quality of life. We previously shared some of our favorite mHealth apps that deliver results. Here are just a few other examples:
- Mobile MIM — As a MobiHealthNews report notes, Mobile MIM was one of the first medical applications to debut in Apple's AppStore when it launched in 2008. It was the first app cleared by the FDA for viewing images and making medical diagnoses based on computed tomography, magnetic resonance imaging, and nuclear medicine technology. Mobile MIM allows radiologists to read images anywhere with wireless access and engaged in touch-based interaction with images.
- My Dose Coach — Available from Sanofi, this app is used for adjusting basal insulin doses for those on injections, according to a diaTribe report. The app uses fasting blood glucose and hypoglycemia data to recommend changes in doses if readings are too high or too low.
- Meds 360° — Our medication management app, Meds 360° provides clinicians with a comprehensive view of a patient's medication history, helping reduce medication errors and ensuring medication adherence following care encounters, among other uses and benefits.
- ASCCP Mobile — The American Society for Colposcopy and Cervical Pathology (ASCCP) app helps with the management of cervical cancer screenings, allowing clinicians to quickly look up recommendations and guidelines.
Con: Clinicians are unsure whether to recommend mHealth apps
For reasons discussed in this article and others, clinicians are often on the fence about whether to advise patients to use mHealth and what apps are worthwhile.
As the JMIR article shared earlier notes, “Doctors struggle with which apps to recommend for patients and patients don't know which apps may be useful. Physicians must consider the value of an mHealth app before they recommend one since most apps have been created without medical expert involvement or appropriate testing validation.”
A BMC Medicine column states, “Health-related apps have great potential to enhance health and prevent disease globally, but their quality currently varies too much for clinicians to feel confident about recommending them to patients. The major quality concerns are dubious app content, loss of privacy associated with widespread sharing of the patient data they capture, inaccurate advice or risk estimates, and the paucity of impact studies.”
An Inside Digital Health report notes, “… for now, many physicians and nurses have serious doubts about the trustworthiness of mHealth apps. They question whether the apps are scientifically accurate, whether they are more effective than printed patient education materials, and whether patients will use mHealth apps once the novelty wears off.”
And yet, as this same report states, such a perspective seems to be in contrast with how clinicians often view mHealth. “On the other hand, clinicians are more willing to use medical apps that directly meet their professional needs, such as digital drug reference guides and clinical decision support systems.”
Accelerating clinician adoption of mobile and digital tools is an industry focus. This is seen in the American Medical Association's (AMA) 2018 roll out of its Digital Health Implementation Playbook. An AMA article noted that the playbook … “packages the key steps, best practices, and resources to accelerate the adoption of … digital health innovations and helps physicians extend care beyond the exam room.”
It will be interesting to see how this and other such efforts influence the future of mHealth use and adoption.
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