This paper examines the state of the art in mobile clinical and health-related apps. A 2012 estimate puts the number of health-related apps at no fewer than 40,000, as healthcare professionals and consumers continue to express concerns about the quality of many apps, calling for some form of app regulatory control or certification to be put in place. We describe the range of apps on offer as of 2013, and then present a brief survey of evaluation studies of medical and health-related apps that have been conducted to date, covering a range of clinical disciplines and topics. Our survey includes studies that highlighted risks, negative issues and worrying deficiencies in existing apps. We discuss the concept of ‘apps as a medical device’ and the relevant regulatory controls that apply in USA and Europe, offering examples of apps that have been formally approved using these mechanisms. We describe the online Health Apps Library run by the National Health Service in England and the calls for a vetted medical and health app store. We discuss the ingredients for successful apps beyond the rather narrow definition of ‘apps as a medical device’. These ingredients cover app content quality, usability, the need to match apps to consumers’ general and health literacy levels, device connectivity standards (for apps that connect to glucometers, blood pressure monitors, etc.), as well as app security and user privacy. ‘Happtique Health App Certification Program’ (HACP), a voluntary app certification scheme, successfully captures most of these desiderata, but is solely focused on apps targeting the US market. HACP, while very welcome, is in ways reminiscent of the early days of the Web, when many “similar” quality benchmarking tools and codes of conduct for information publishers were proposed to appraise and rate online medical and health information. It is probably impossible to rate and police every app on offer today, much like in those early days of the Web, when people quickly realised the same regarding informational Web pages. The best first line of defence was, is, and will always be to educate consumers regarding the potentially harmful content of (some) apps.

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Mobile medical and health apps: state of the art, concerns, regulatory control and certification

Increasing numbers of healthcare professionals are using smartphones and their associated applications (apps) in daily clinical care. While these medical apps hold great potential for improving clinical practice, little is known about the possible dangers associated with their use. Breaches of patient confidentiality, conflicts of interests and malfunctioning clinical decision-making apps could all negatively impact on patient care. We propose several strategies to enhance the development of evidence-based medical apps while retaining their open nature. The increasing use of medical apps calls for broader discussion across medicine's organising and accrediting bodies. The field of medical apps is currently one of the most dynamic in medicine, with real potential to change the way evidence-based healthcare is delivered in the future. Establishing appropriate regulatory procedures will enable this potential to be fulfilled, while at all times ensuring the safety of the patient.

https://ebm.bmj.com/content/ebmed/18/3/90.full.pdf

Medical apps for smartphones: lack of evidence undermines quality and safety

The use of mobile medical apps by clinicians and others has grown considerably since the introduction of mobile phones. Medical apps offer clinicians the ability to access medical knowledge and patient data at the point of care, but several studies have highlighted apps that could compromise patient safety and are potentially dangerous. This article identifies a range of different kinds of risks that medical apps can contribute to and important contextual variables that can modify these risks. We have also developed a simple generic risk framework that app users, developers, and other stakeholders can use to assess the likely risks posed by a specific app in a specific context. This should help app commissioners, developers, and users to manage risks and improve patient safety.

mHealth and Mobile Medical Apps: A Framework to Assess Risk and Promote Safer Use

Over the past few decades, we have witnessed a dramatic rise in life expectancy owing to significant advances in medical science and technology, medicine as well as increased awareness about nutrition, education, and environmental and personal hygiene. Consequently, the elderly population in many countries are expected to rise rapidly in the coming years. A rapidly rising elderly demographics is expected to adversely affect the socioeconomic systems of many nations in terms of costs associated with their healthcare and wellbeing. In addition, diseases related to the cardiovascular system, eye, respiratory system, skin and mental health are widespread globally. However, most of these diseases can be avoided and/or properly managed through continuous monitoring. In order to enable continuous health monitoring as well as to serve growing healthcare needs; affordable, non-invasive and easy-to-use healthcare solutions are critical. The ever-increasing penetration of smartphones, coupled with embedded sensors and modern communication technologies, make it an attractive technology for enabling continuous and remote monitoring of an individual’s health and wellbeing with negligible additional costs. In this paper, we present a comprehensive review of the state-of-the-art research and developments in smartphone-sensor based healthcare technologies. A discussion on regulatory policies for medical devices and their implications in smartphone-based healthcare systems is presented. Finally, some future research perspectives and concerns regarding smartphone-based healthcare systems are described.

https://www.mdpi.com/1424-8220/19/9/2164/pdf

Smartphone Sensors for Health Monitoring and Diagnosis.

There is an increased interest in smartphone applications as a tool for delivery of health-care information. There have been no studies which evaluated the availability and content of cancer-related smartphone applications. This study aims to identify and analyze cancer-related applications available on the Apple iTunes platform. The Apple iTunes store was searched for cancer-related smartphone applications on July 29, 2011. The content of the applications was analyzed for cost, type of information, validity, and involvement of health-care agencies. A total of 77 relevant applications were identified. There were 24.6 % apps uploaded by health-care agencies, and 36 % of the apps were aimed at health-care workers. Among the apps, 55.8 % provided scientifically validated data. The difference in scientific validity between the apps aimed at general population versus health-care professionals was statistically significant (P < 0.01). Seventy-nine percent of the apps uploaded by health-care agencies were found to be backed by scientific data. There is lack of cancer-related applications with scientifically backed data. There is a need to improve the accountability and reliability of cancer-related smartphone applications and encourage participation by health-care agencies to ensure patient safety.

Smartphone Apps as a Source of Cancer Information: Changing Trends in Health Information-Seeking Behavior

antagonist production, activation of blockade of death receptor Fas (CD95), modulation of dendritic cell properties, increased expression and signalling through the inhibitory Fc receptor, Fc-c RIIB and enhanced steroid sensitivity. In our case, the exact mechanism of action of IVIG remains unclear. IVIG therapy may be considered as a new therapeutic option in resistant forms of IGDA. More case reports and trials are required to demonstrate the efficacy of this treatment in patients with IGDA.

Medical professional involvement in smartphone 'apps' in dermatology.

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)64577-8/pdf

A.D. Hamilton

Papers

Medical professional involvement in smartphone 'apps' in dermatology.

Smartphone apps in microbiology—is better regulation required?