It’s a runaway train – the upsurge of health and well-being apps

The upsurge of health and well-being apps has been prevalent over the years. Not to mention its recent boost in abundance that obviously doubled tenfold during the COVID-19 era, as almost everything are being done in various digital ways whenever possible or if our technology allows for it. These health and well-being apps can be used for health data collection, care delivery, monitoring purposes as well as health promotion and care engagement. Whilst they offer vast opportunities to augment care for various health-related goals, they also have the potential to disrupt proper care when what it can offer is not done right or otherwise lack the right information for the right user. As a healthcare professional, this thought reminds me of the five rights in medication administration – the right patient, the right drug, the right time, the right dose and the right route (high-five nurses!).

The issues of quality and safety are two important things that should be addressed with all health-related apps as it is set to become a significant source of health information and guidance. Apps that fall under the medical device category are bound by regulations and policies within the European Union such as the Conformité Européenne or widely known as the CE marking and acts, directives as well as policies for regulating medical devices. On the other hand, there are health apps that fall under the non-medical device category, like apps for health promotion that are commonly used to supplement the education of children on health behaviors and risk preventions or apps that promote mindfulness, relaxations or simply offer health information. Non-medical device apps are those that are not used in any way to diagnose, prevent, monitor, treat nor alleviate a disease, injury or handicap as defined by the European Commission (2017).

If we look at some literature, some say it’s like the “Wild West” for health apps under the non-medical device category. Imagine the cowboys, outlaws and who knows what else were out there way back then in a desert-ish town, where everyone just do what they want as they please.  Speaking of metaphors, let’s update it in another way and make it somehow closer to our digital age – it’s a runaway train! Although, we have regulations on data protection and privacy for everything digital when it comes to use of personal information, regardless of whether it’s a medical or non-medical device app, it is not just enough when we are talking about a person’s health and well-being. Big things came from small things so a wise man once said, imagine what a little misinformation or misuse that apparently does not have an immediate or direct effect to our human physiology can lead to in the long run. Uncontrolled, unregulated and unchecked health apps like a runaway train, poses as a looming predicament.

 

The Qvalidi Tool project led by the Qvalidi Consortium and the University of Turku’s Department of Nursing Science recognize the need to address the degree of quality and validity of health and well-being apps under the non-medical device category. To recognize these shortcomings is definitely a good start to devise solutions to bridge the gap. The project developed a comprehensive checklist in 2019 based on research and up-to-date guidelines to support the development, evaluation and reporting of health and well-being apps. Currently, the on-going study designed a practical and easy-to-use evaluation scale and will be tested to establish its psychometric properties.

 

Author’s Information:

Kaile Kubota

MHSc, MSN, RN, Doctoral Candidate (DPNurs)

Department of Nursing Science, University of Turku

kakubo(at)utu.fi

References:

Albrecht, U., Von Jan, U., & Pramann, O. (2013). Standard reporting for medical apps. Studies in Health Technology and Informatics, 190, 201–203. https://doi.org/10.3233/978-1-61499-276-9-201

European Commission. (2017). Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and93/42/EEC (Text with EEA relevance.) https://eur-lex.europa.eu/legal-content/ EN/ALL/?uri=CELEX:32017R0745

Hamari L, Parisod H, Pakarinen A, Skogberg M, Aromaa M, Leppänen V, Salantera S. (2020) Digitaalisten terveys- ja hyvinvointisovellusten kehittäminen, arviointi ja raportointi: Qvalidi 2019- tarkistuslistan kehittäminen ja sisältö. Hoitotiede 2020, 32 (1), 52-66.

Tomlinson, M., Rotheram-Borus, M., Swartz, L., & Tsai, A. (2013). Scaling Up mHealth: Where Is the Evidence? PLoS Medicine, 10(2), e1001382–e1001382. https://doi.org/10.1371/journal.pmed.1001382

Wisniewski, H., Liu, G., Henson, P., Vaidyam, A., Hajratalli, N. K., Onnela, J.-P., & Torous, J. (2019). Understanding the quality, effectiveness and attributes of top-rated smartphone health apps. Evidence-Based Mental Health, 22(1), 4–9. https://doi.org/10.1136/ebmental-2018-300069