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MN2020 - Preparing for the Medical App Revolution
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Preparing for the Medical App Revolution

June 25, 2013 By Annalise McGrail, Undergraduate Research Fellow

Smart phones and the apps that help them run have become so mainstream, the medical community is tapping into the technology to help lower access barriers, deliver higher quality care and hopefully drive down medical costs. Mobile health, or mHealth, is incorporating a wide range of apps, from a device called CellScope, that can record and transmit images of the middle ear, to a personalized diagnosis program partnered with the Mayo Clinic, called Better.

By 2010, 50% of physicians were already using smartphones on a daily basis, according to a Putzer and Park study. The industry is estimated to be highly lucrative with revenues predicted to reach $23 billion by 2017, according to the consulting firm PricewaterhouseCoopers. If the trend continues, the shift appears to be mutually beneficial with a Benton Foundation study estimating that the industry will reach gains in medical productivity of $305.1 billion by 2022.

Therefore, it is not a question of whether mHealth technology should be utilized, but rather how we appropriately implement it. While mHealth may be inevitable, its medical benefit is not a guarantee. The industry depends on individuals thoroughly understanding the potential problems, actively seeking solutions, and preceding forward with caution.

Regulation has been a key government concern. We currently lack effective means to determine which of tens of thousands of health care apps currently in the market are legitimate. The FDA began drafting regulatory guidelines in July 2011, but probably won't finalize and release them until October of this year. The industry's rapidly transforming nature is likely to blame for this delay. And there's no sign the industry is slowing down. A recent FDA statement explains that “[health care apps] are being adopted almost as quickly as they can be developed.” Therefore, individuals ought to be cautious of which apps they choose to trust and should verify results with their doctors.

It is also not yet clear how effective privacy protection will be. Joe Santilli, the CEO of SafeApp explains, “an app is like giving somebody the keys to the house.” App producers gain access to a breadth of sensitive information about their users. David Kotz, Computer Science professor at Dartmouth agrees, “[his] concern is that most producers of new hardware and software won’t be worried about your privacy or about the security of your data.”

In order to combat security issues Congressman Hank Johnson from Georgia introduced the Application Privacy, Protection, and Security Act. Johnson explains that the law “would require that app developers provide transparency through consented terms and conditions, reasonable data security of collected data, and users with control to cease data collection by opting out of the service or deleting the user’s personal data to the greatest extent possible.”  The bill faces an uphill battle on the Hill.

Cyber security presents another problem. Although uncommon, hackers can access personal information available on smartphones, and in extreme cases researchers have discovered a means that would enable a hacker to induce a heart attack from a pacemaker or inject a lethal overdose from a mobile insulin pump. Kotz explains that these “examples have awakened people to the realization that medical device makers must focus on issues they’ve previously ignored, namely wireless network and computer security.” 

Ultimately, there's little consensus on how much apps' can improve care. Telemedicine initiatives like HealthPartners’ 24/7 online clinic Virtuwell have been successful because they are effective means to treat minor problems. It improves accuracy and efficiency, all while providing physicians the time they need to spend with patients suffering from more serious conditions. However, many other apps intend to address chronic conditions. App developers often lack a medical background and consequently they are often dangerously inaccurate. Dr. Laura Ferris ran a study of apps claiming to detect skin cancer from a picture of a mole. One app had a 98% success rate, but the others failed to detect melanoma as much as 90% of the time. As a result, individuals ought to be careful when choosing to defer to the ease of a smartphone health care app.

Smartphone apps have the potential to revolutionize the health care industry by improving physician-patient communication, increasing access to care, and cutting costs. However, the industry presents a complicated range of problems that we are only beginning to fully understand. Resolving these concerns will require a responsive government, dedicated physicians, and diligent patients.

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