If you were a physician, would you prescribe an app to your patient? This was one of the more interesting questions that were asked in class last term. Being a physician myself and knowing the benefits and limits of mobile health applications (mHealth), I was intrigued. I’d say yes but what do other physicians think?
In the US, a survey of more than 3000 physicians by Manhattan Research found that more than a third of them have recommended mHealth apps to their patients in the past year. In the first quarter of 2014 there were more than 100,000 apps listed in the mHealth sections of Apple App Store and Android. Fitness apps form the biggest category with more than 30% of all apps listed in the Health and Fitness and Medical app sections of Apple App Store, Google Play, BlackBerry Appworld and WindowsPhone Store listed as fitness trackers or exercise guides.
There are different types of risks that may be associated with the use of mobile apps and they could affect diverse stakeholders from patients, to professionals and to organizations. These risks include loss of reputation, loss of privacy, poor quality patient data, poor lifestyle or clinical decision, inappropriate but reversible clinical action, and inappropriate and irreversible clinical action (Lewis & Wyatt, 2014).
I believe that prescribing mobile health apps as medications should be subjected to the same principles that govern the rational prescribing of drugs and other treatment. The act of prescribing is the culmination of the consultation process, one of the hallmarks of the patient-doctor relationship. As a medical professional I have spent years mastering the art and science of prescribing and the principles of rational prescribing have been repeatedly taught to us as medical students, the refinement of which we find as we go along with our clinical practice. As pointed out by Maxwell, prescribing is a complex task requiring “diagnostic skills, knowledge of medicines, an understanding of the principles of clinical pharmacology, communication skills and appreciation of risk and uncertainty.” Furthermore, he highlighted what rational prescribers should attempt to do: “maximize clinical effectiveness, minimize harms, avoid wasting scarce health care resources and respect patient choice” (Maxwell, 2009).
Recall that the duty of a healthcare worker puts primacy in the welfare and safety of the patient and the maximization of benefits from treatment. Mobile apps as they exist today have associated risks. With this in mind, it is important to be aware of these risks and to have skills to discern which mobile health apps would be beneficial and which would cause harm.
The impetus for physicians to start prescribing mobile apps as part of the treatment regimen of patients is undeniable. Doctors in the United Kingdom have been encouraged to prescribe “apps that are free or cheap for patients in an attempt to give patients more power and reduce visit to doctors” (Wardrop, 2012). It is the duty of the prescriber to know the benefits and the risks associated not only with mobile health apps but also any and all kinds of treatment that he would consider for his patient. Doing so is a clear application of the principles of maximizing clinical effectiveness and minimizing harms.
The role of evidence-base medicine in prescribing mobile apps comes to mind when considering maximization of clinical effectiveness. In this process, it pays to look at the state of current evidence of mobile apps that can be prescribed as “medications” or adjunct to medications. Clearly not all mobile health apps are created equal and not all of them have clinical safety and efficacy trials backing them as new drugs would have. This is where the danger lies and what makes many doctors reluctant to prescribe mobile health apps to their patients. For instance, Kevin Pho, of kevinmd.com – a popular website for clinicians and patients alike, cited quality and security risks associated with mobile apps as well as the need for clinical trials to prove the effectiveness before he would start prescribing them (Pho, 2014).
In the end it all boils down to due diligence on the part of the health care professional to ensure the safety and effectiveness of mobile apps before they are used as part of therapy.
Haffey, F., Brady, R. R., & Maxwell, S. (2013). A Comparison of the Reliability of Smartphone Apps for Opiod Conversion. Drug Safety , 36 (2), 111-117.
Lewis, T. L., & Wyatt, J. C. (2014). mHealth and Mobile Medical Apps: A Framework to Assess Risk and Promote Safer Use. Journal of Medical Internet Research , 16 (9).