One recent piece, by Margaret McCartney, was published in the British Medical Journal titled “How do we know whether medical apps work?”  It is a nice short read, where Dr. McCartney lays out the overriding utilization of smartphones and tablets in our daily lives to both play games, manage our daily activities, and search the web. We have had no issue integrating these aspects into our social lives and enjoy them immensely (I need to look no further than the plethora of Angry Bird merchandise readily available). But when we look at mobile medical applications, there comes a pause.
Here is something that is brand new. Something that challenges the status quo, and has the potential to disrupt our standard perception of how medical interventions can be made. Dr. McCartney touches on the recently released study in JAMA Dermatology where the investigators compared several apps that identified melanoma and had a large discrepancy in their accuracy . Other researchers have noted the same issues with other dermatological related applications. Needless to say, many are wondering can we trust this new technology?
Dr. McCartney identifies that in England, the Medicines and Healthcare Products Regulatory Agency (MHRA) has been approving medical apps, and also the National Health Service recommends several apps (e.g. visual acuity checkers, iBreastCheck) for the population. But the issue that arises is that many of these apps are not promoting diagnostic techniques, rather serving as engaging ‘awareness’ apps. In the end, many of these apps refer patients back to their primary care provider for diagnosis or confirmation of anything they may find out of place.
Taking this into account, it is not hard to understand the issue: Why create something that does not fix a problem but may lead to further issues? This implies the safety and efficacy in these apps in serving the public and not leading to false or misleading information that could prove detrimental. The primary issue is identifying apps that are evidence-based and have the potential to be decision making tools for practitioners.
It must be said, there is not real oversight at this current time for the myriad number of medical apps. Not by the FDA, not by the MHRA. Mobile medical applications can get by plodding information as long as they do not skirt the narrow definition of apps that become diagnosing tools that then require oversight. But testing should be done to demonstrate their effectiveness, and they may require some prodding. Our professional organizations, societies, and health groups need to push developers to create applications that provide a service that is safe, efficacious, and demonstrates a sustainable way to help society.
1.Mccartney M. How do we know whether medical apps work?. BMJ. 2013;346:f1811.
2.Wolf JA, Moreau J, Akilov O, et al. Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection. JAMA Dermatol. 2013;:1-4.