CyberSightings

In the Spotlight

Thanks to the accellerated diffusion of smartphones, the number of mobile healthcare apps has been growing exponentially in the past few years. Applications now exist that allow patients to manage diabetes, share information with peers, and monitor mood, to name just a few examples. Such “applification” of health is part of a larger trend called “mobile health” (or mHealth), which broadly refers to the provision of health-related services via wireless communications. Mobile health is a fast-growing market: according to a report by PEW Research (http://pewinternet.org/∼/media/files/reports/2011/pip_healthtopics.pdf) as early as in 2011, 17% of mobile users were using their phones to look up health and medical information, and Juniper recently estimated that in the same year 44 million health apps were downloaded (www.juniperresearch.com/whitepapers/mhealth_whitepaper/).

The field of mHealth has received a great deal of attention by the scientific community over the past few years, as evidenced by the number of conferences, workshops, and publications dedicated to this subject; international healthcare institutions and organizations are also taking mHealth seriously. For example, the UK Department of Health recently launched a crowdsourcing project named Maps and Apps (http://mapsandapps.dh.gov.uk/) to support the use of existing mobile phone apps and health information maps, as well as to encourage people to put forward ideas for new ones. The initiative resulted in the collection of 500 health apps voted most popular by the public and health professionals, as well as a list of their ideas for new apps (http://departmentofhealth.ideascale.com/). At the time of writing this column, the top-rated app is Moodscope (www.moodscope.com/), an application that allows users to measure, track, and record comments on their mood. Other popular apps include HealthUnlocked (www.healthunlocked.com/), an online support network that connects people, volunteers, and professionals to help learn, share, and give practical support to one another, and FoodWiz.co (http://foodwiz.co/), an application created by a mother of children with food allergies that allows users to scan the barcodes on food to find out instantly which allergens are present. Obviously, an app to help patients manage diabetes could not be missing from the list. Diabetes UK Tracker (www.diabetes.org.uk/How_we_help/Diabetes-iPhone-Tracker-app/) allows the patient to enter measurements such as blood glucose, caloric intake, and weight, which can be displayed as graphs and shared with doctors; the software also features an area where patients can annotate medical information, personal feelings, and thoughts.

The astounding popularity of the Maps and Apps initiative suggests the beginning of a new era in medical informatics. Yet this emerging vision is not without caveats. As recently emphasized by Niall Boyce in the June issue of The Lancet Technology (The Lancet, Vol. 379(9833), p. 2231), the main concern associated with the use of apps as a self-management tool is the limited evidence of their effectivenes in improving health. In contrast to other health interventions, mHealth apps have not been subject to rigorous testing. A potential reason for the lack of randomized evaluations is the fact that most of these apps reach consumers/patients directly, without passing through the traditional medical gatekeepers. However, as Boyce suggests, the availability of trial data would not only benefit patients but also app developers, who could bring to the market more effective and reliable products. A further concern is related to the privacy and security of medical data. Although most smartphone-based medical applications apply state-of-the-art secure protocols, the wireless utilization of these devices opens up new vulnerabilities to patients and medical facilities. A recent bulletin issued by the U.S. Department of Homeland Security (http://info.publicintelligence.net/NCCIC-MedicalDevices.pdf) lists five of the top mobile medical device security risks. (1) Insider: The most common ways employees steal data involves network transfer, be that e-mail, remote access, or file transfer. (2) Malware: These include keystroke loggers and Trojans, tailored to harvest easily accessible data once inside the network. (3) Spearphishing: This highly customized technique involves an e-mail-based malicious attack disguised as coming from a legitimate source, and seeking specific information. (4) Web: DHS lists silent redirection, obfuscated JavaScript, and search engine optimization poisoning among ways to penetrate a network and then, ultimately, access an organization's data. (5) Lost equipment: This is a significant problem because it happens so frequently. Even a smartphone in the wrong hands can be a gateway into a health entity's network and records. And the more that patient information is stored electronically, the greater the number of people potentially affected when equipment is lost or stolen.

In conclusion, the “applification of healthcare” is at the same time a great opportunity for patients and a great responsibility medical professionals and developers. In order to exploit this opportunity while mitigating risks, it is essential to put in place quality evaluation procedures that allow the effectiveness of these applications to be monitored and optimized according to evidence-based standards. For example, iMedicalApps (www.imedicalapps.com/) provides independent reviews of mobile medical technology and applications by a team of physicians and medical students. Founded by founded by Dr. Iltifat Husain, an emergency medical resident at the Wake Forest University School of Medicine, iMedicalApps has been referred by Cochrane Collaboration as an evidence-based trusted Web 2.0 Web site.

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