Clinical considerations

Each day clinicians spend time with patients and families to educate them on health promotion and disease prevention topics. The traditional devices used for these tasks have been paper handouts, guidelines, and pamphlets. Studies support room for improvement in this area,13 and mobile apps could assist in the health promotion and disease prevention conversation. Prior to discussing the use of mobile apps with patients, it is important for the clinician to consider the following: 

  • Technology access. Does the patient have reliable wireless internet access and a device that is compatible with mobile app software? A mobile device, such as a smartphone or tablet computer, is required to use apps. Some apps may only be available for specific platforms and operating systems. 

  • Technology and language literacy. Is the patient comfortable with using technology? Is he or she physically capable of reading on small screens and using touchscreens with dexterity? Several manufacturers are beginning to produce smartphones with features to assist older adults with modern phone gadgetry, such as the Pantech Flex, Jitterbug Touch, and Samsung Galaxy Note II.14 Most widely available health apps are English-language only. 

  • Financial hardship. While some apps are free, others require a fee to download, may charge ongoing subscription fees, or require in-app purchases for full functionality. Most mobile phone data plans have monthly limits, and the charges for exceeding the limit can be high. Patients might not be aware of the app fees or the potential hidden costs of high usage.

  • Patient motivation. Younger patients and early technology adopters may be more interested in using apps to track and manage their health. Some apps provide incentives for use, such as “gamified” apps that award users with points, badges, or rankings, and apps that integrate with social media to allow users to share their app activity with friends.15,16
  • Evidence-based content. Clinicians have completed extensive training to provide treatment and care for their patients. Apps vary widely on the amount of credibility and scientific data that they provide to patients. For example, an app based on content obtained from the free online encyclopedia Wikipedia is vastly inferior to an app recommended by the Agency for Healthcare Research and Quality (AHRQ).17 The guidelines in the next section of this article can assist clinicians in determining the credibility of mobile apps.

  • Privacy/confidentiality. Health apps can pose privacy risks for users. Many popular apps connect to advertising and data analysis sites, and they may transmit unencrypted data.18 Better known apps from more established developers are more likely to have funds available for comprehensive data security. Although patients may be able to opt out of certain information-sharing practices by apps, they should assume that any information they impart by using a mobile app may be shared. 

With 100,000 mobile health apps published for the iOS (iPhone) and Android systems in the first quarter of 2014,19 patients and clinicians may be experiencing “app overload.”3 Patients and clinicians are overwhelmed with the huge supply of potential apps and the difficulty of finding the correct app for their specific use.

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Compounding this problem is the issue of “app fragmentation,” in that multiple apps are sometimes required to provide education and disease management for patients.3 In other words, one app does not always cover all of the patient’s or clinician’s needs. 

One suggestion from the literature for improving app overload and fragmentation is to work toward a situation in which only one app is needed as a “gateway” to access a wide variety of information.3 An example of a current gateway app for public health is First Aid by the American Red Cross or Microsoft’s HealthVault; the use of Epocrates by clinicians is also moving that app toward gateway status for health professionals.3

There is also discussion that gateway apps need to allow for personalization to prevent information overload within the app—for example, an 80-year-old patient with osteoporosis has different needs related to bone health than a young pregnant woman.3