Value of apps and wearables questioned

The potential for smartphone apps and wearable devices to have an effect on health outcomes has come under question in an article published by the BMJ.

In the head to head piece, Des Spence, a GP from Glasgow and former BMJ columnist, comments that there is a lack of evidence to back the use of these personal health tools as part of a wider healthcare plan.

“The truth is that these apps and devices are untested and unscientific, and they will open the door of uncertainty,” he says.

While Spence acknowledges that most of the tens of thousands of health apps currently available are “harmless (and likely useless)”, he suggests risks lie in their use alongside wearable devices, such as fitness tracking wristbands.

He proposes that the widespread use of medical apps in this way could lead to a tendency for over-diagnosis and anxiety for their users from an “unhealthily health obsessed generation”.

He also mentions that the wider uptake of apps is likely to benefit corporations more than patients, suggesting that current technologies, such as computed tomography and magnetic resonance imaging, are “already abused and overused by doctors for profit.”

Spence’s viewpoint is challenged in the BMJ by Iltifat Husain, editor of healthcare app review website iMedicalApps.com, and assistant professor of emergency medicine at the Wake Forest School of Medicine in North Carolina, US.

“The naysayers will argue that healthy people shouldn’t use health apps because there’s little evidence of benefit or that they may lead to unnecessary anxiety, meaning more work for primary caregivers,” says Husain.

“But apps have been around for more than ten years, on PDAs [personal digital assistants], and have been shown to improve outcomes and health.”

He remarks that the first trials of PDA apps for weight loss were published in 2013, long after PDAs fell out of favour, and that the reason for the lack of data on smartphones apps is due to the “novelty of these devices to researchers.”

Some studies have confirmed the accuracy of fitness devices such as Fitbit and Jawbone, although Husain acknowledges “there is no current evidence that these fitness devices improve outcomes or exercise compliance.”

However, he also suggests this should not be a barrier to uptake considering “there is no evidence that they cause harm.”

“If we wait for scientific studies to prove the benefit of apps, we’re going to get left behind – not only by our patients who are already using them but also by the industry dictating which tools people should us.”

The use of medical apps connected to wearables and other devices to support patient outcomes has become a growing issue for the healthcare services across the world.

In the UK, Southampton and South London and Maudsley NHS foundation trusts have developed platforms for their patients that make use of the Microsoft HealthVault platform, launched as long ago as October 2007.

More recently, Apple has energised the market by releasing HealthKit, a platform to house and connect healthcare and fitness apps available on iOS.

This will support the fitness aspects of the Apple Watch that is due to launch on 24 April; and is already being used by UK GP supplier Emis to enable patients to supply information to GPs thorugh its Emis Web system.

Last week Cerner announced it had developed an app for the Apple Watch in the US that allowed personal health data to integrate with a patient’s electronic health record by using HealthKit.

This followed two separate deals signed by digital health platform Validic – one with Cerner and one with Meditech. Both deals regard the integration of patient-generated data into patient portals and electronic patient records.