Recommending health apps

An app is a piece of software which can run on the internet, smartphone, computer or any other electronic device. Health apps can be divided into five main categories:

• Apps for healthy living - These form the majority of health apps. They focus on healthy eating, physical activity, smoking prevention and mental wellbeing.
• Apps for clinical diagnosis - Examples include symptom checkers, digital imaging, lab results review
• Apps for remote monitoring - Examples include remote heart monitoring, glucose levels, telehealth services
• Apps for personal health records - They keep a record of personal health information
• Apps for reminders - They focus on medicines compliance

Because there is a lack of supporting evidence for most health apps and the majority are not regulated in any way, users have to rely on user ratings or app store reviews to determine effectiveness.

Health apps that claim to diagnose or manage health conditions by analysing clinical data or test results could be considered medical devices. These would then come under regulation administered by the Therapeutic Goods Administration (TGA) and would need to be registered on the Australian Register of Therapeutic Goods (ARTG).

Patients are most likely to approach their GPs for advice on healthy living apps.

The steps below will help you assess the quality of a healthy living app and advise your patients on what to look for.

1. Review app description, user ratings and reviews:

• User ratings and reviews found in app stores can be helpful in determining usability and functionality.

2. Identify whether the app is intended for its use:

• Is the app interesting and engaging? The more a user is engaged with the app, the more likely they will continue to use it. Does it use gamification, a points-based reward system, interactive visuals or customised advice?
• Does the app use simple and clear language? Does it also use visual representation of information?
• Does the app use evidence-based information? Is it clear where the information comes from? Is it a reliable and respected source of health advice?
• Does the app include behaviour change constructs? Effective healthy living apps often include the following behaviour change constructs:
  • self-monitoring capabilities
  • relapse preventers
  • ability to make and track realistic goals
  • integration of recipes or exercise videos
  • knowledge building using evidence-based information
  • social support by integrating social networks and sharing capabilities.

3. Pilot the app:

Consider a pilot to assess the app features, functionality, usability and content accuracy.

Ask patients:

• whether they found the app to be useful and whether they are continuing to use it
• whether they would recommend the app to others
• whether they changed their behaviour or had clinical improvements while using the app.

• If the app is a medical device: is it registered on the Australian Register of Therapeutic Goods (ARTG)? If not, you can’t be certain of its efficacy.
• Apps collect a vast amount of data: unfiltered data creates information overload, which is not useful for monitoring. Apps with built-in analytical tools help users filter useful information.
• Privacy breaches to personal data: the flow and movement of data creates questions regarding informed consent and privacy. Your patients should check Terms and Conditions and be mindful that data is being collected and how this data might be used by the app and for other purposes.

RACGP

Privacy and managing health information in general practice

TGA

Understanding regulation of software-based medical devices