Recent analyses published in BMC Medicine have concluded that “…widely available health apps meant to help patients calculate their appropriate insulin dosage, educate themselves about asthma, or perform other important functions are methodologically weak.” Paul Wicks, PhD, and Emil Chiauzzi, PhD, in their commentary on three linked studies that evaluated the quality of medical apps, point out that many insulin dose calculators are generating the wrong dose recommendations and that asthma apps, although more interactive in recent years, haven’t improved in quality, with peak flow calculators experiencing the same problems as insulin calculators.
The original analyses, performed by Kit Huckvale from the Imperial College London, UK, and associates, revealed that 91% of the insulin dose calculators “lacked validation to check the quality of user input” while 67% may have been producing inappropriate dose recommendations. Equally disturbing was the fact that seven out of ten calculators were not able to provide documentation to show the formula being used to make the calculation. There were no differences in quality between paid and free apps or between apps available from either the Android or Apple stores. The miscalculated dosages often encouraged patients to take a higher insulin dose than was warranted, increasing the likelihood of hypoglycemia.
The analysis of asthma self-management apps found that 33% lacked correct instructions on how to prepare the inhaler and position one’s mouth when administering medication. Wicks and Chiauzzi go on to say that: “Peak flow calculators, which provide a measure of how well lungs are functioning, had similar shortcomings to the insulin dose calculators in nine of the apps assessed.”
The third analysis by Huckvale et al reviewed the security and privacy settings on medical apps that had been in the accredited NHS Health Apps Library. They discovered many shortcomings, including the fact that apps were storing medical data in such a way as to make them susceptible to data breaches. One app even transmitted data that the app’s privacy policy specifically stated would not be transmitted.
Wicks and Chiauzzi suggest that stakeholders consider several possible remedies to improve the quality of medical apps, including a consumer education program and more government regulation. They also suggest that app store owners may need to step up, ensuring “transparency of algorithms (whiteboxing), data sharing, and data quality.”
Specifically, Wicks and Chiauzzi give 5 approaches:
Make sure to read the commentary by iMedicalApps Editor Dr. Satish Misra last week that gives his take on how medical and health apps can be vetted better. His solution is in line with many of Wicks and Chiauzzi’s – empower both physicians and patients.
