A new study published this week in the journal Health Affairs by Dr. Singh and colleagues examines the quality of mHealth apps across a broad range of illnesses ranging from depression to diabetes. The paper " Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain," (http://content.healthaffairs.org/content/35/12/2310.abstract) examined 137 patient facing apps directly available for download on commercial marketplaces for the Android and Apple smartphones. 

They evaluated each of the 137 apps across nine metrics:
1: Target Population
2: Functionality related to patient engagement
3: Average app store star rating across all version
4: Clinical Utility on 0-10 scale 
5: Usability by System Usability Scale
6: App’s reactivity to information that could indicate health danger, eg response to suicide 
7: Presence of a privacy policy
8: Data sharing and if secure 
9: Cost data on the app 

The results were interesting and provide the best pcicture to date of the quality of patient facing mHealth apps.

One of the most important findings was that app store ratings, eg stars, do not correlate well to either the quality or usability of health apps. A five star rating on the app store may look impressive, but actually is not informative whether the app will offer high quality medical information / services or even be engaging or easy to use. Another concerning result was that only 64% of apps had privacy policies.  This means one third of the sampled apps do not even outline what happens to users' sensitive and personal health data. Also of note, 60% of apps transmitted patient generated data in non-secrure forms. The authors also explored how appropriate the responses of these apps were to certain situations (eg how does a depression app react if a user indicates serious thoughts of self-harm). In the case of depression apps the result was around 25% appopriate responses which is low, and was low across many other conditions as well. 

Overall the study brings new data to the state of quality of patient facing health apps. The results suggest several areas for improvement especially in regards to privacy and safety. The number of missing privacy policies and amount of apps sending personal health information in non-secure forms is concerning - but something that we have the ability to quickly address. The high variability in clinical utility and usability scores and lack of correlation to marketplace star ratings suggests the needs for better ways to educate for patients and clinicians regarding finding a good app. Perhaps most concerning is the lack of appropriate responses from most of the sampled apps, suggestinh they may be offering incorrect or even dangerous information.

However, the situation also has a silver lining. Health apps are still in the early stages and the field is maturing. There is currently more research on health apps than ever before, and those results will guide a new generation of more useful, safe, and valid apps. There is now an increased focus on apps safety, evidence base, and usability. Things are beginning to chance and going forward can only improve. 

 Paper => http://content.healthaffairs.org/content/35/12/2310.abstract)
 News Story on This Study => http://www.cbsnews.com/news/health-apps-smartphone-miss-medical-emergencies/