After our post last Friday on the difficulty even experts have in evaluating health apps, this week we find that the Commonwealth Fund sets out a framework for conducting such evaluations. (Commonwealth Brief) The premise behind the value of mobile apps is that they will help engage patients, both in decision-making and in self-management, especially of chronic conditions. The authors in particular suggest that they can “empower high-need, high-cost patients to self-manage.” I find that somewhat hard to swallow, since a large junk of this sub-segment has dementia and/or is institutionalized and/or is too ill to handle these tasks. And it is pretty clear that mobile apps have their greatest audience among younger, healthier people. But I digress. The researchers looked at apps for chronic diseases that were patient-facing. The primary categories set up for the evaluation framework include capability to engage; safety, meaning respect for privacy and security and how the app responded to the entry of “dangerous” information and quality, which related to reliability and usability of information. They created a pyramid of techniques by which to rate engagement. From least to most, these were: educational content, alerts or reminders, recording and tracking data, displaying and summarizing data, providing guidance, enabling communication with providers or family, providing support through social networks and supporting behavior change through rewards. Using this framework, well less than half of all apps were even judged to be possibly useful in engaging the patient. The authors then go into detailed evaluations on three common apps using the framework. Coupled with the other research, this paper suggests that mobile apps have a long way to go to becoming a meaningful tool in achieving better health outcomes.
