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There's an app for that, but should there be?

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Elizabeth Newman
Elizabeth Newman

If you are an astute reader of McKnight's, you have probably seen mobile health apps featured in Product News or in New Products pretty consistently over the past two years. Many of the apps featured — one that can track a patient's gait, one for wound care information, another for controlled substances — are geared toward long-term care providers, not patients.

But some apps — like those that are meant to track blood pressure or give medication reminders — are geared toward your future residents. And that's where the trouble can arise, according to a group of experts writing in the New England Journal of Medicine. Their main argument is that more oversight is needed by the Food and Drug Administration, noting that while around 100,000 mHealth apps are on the market, only about a tenth of those have been cleared by the FDA.

Author Nathan Cortez, a professor and Dedman School of Law Associate Dean of Research at Southern Methodist University, spoke with me about the goals of the article, and his concern that some of these apps can be harmful.

Describing a scenario involving a diabetic patient, Cortez said he has found the quality of apps for those patients are not always reliable.

“If there are bugs in the software or a software flaw that is hard to detect, patients may get readings that are lower or higher than reality, and may be giving themselves too much or not enough insulin,” he said. “The risk is pretty clear with that kind of app.”

Mobile health apps have been touted as potentially solving some of the big problems in healthcare, namely lowering cost and broadening access to care. Plus, there is “an undeniable coolness factor,” Cortez said.

Cortez is, to a certain extent, fighting against the tide, and he knows it.

“There is tremendous enthusiasm for these products across the board,” he said. “But I draw a parallel to the dietary supplement industry: There's no good science behind them.”

Beyond the FDA — which I know is far from a favorite agency among long-term care providers — Cortez and I also discussed the role of healthcare providers using apps. If consumers think health apps are cool, some providers, especially physicians, think of an iPhone and its apps as the Holy Grail of healthcare.

Trained healthcare providers using apps — such as for imaging, measurements and other biometrics — is obviously less worrying than an 85-year-old senior diagnosing her pulmonary diseases through her smartphone.

“If there's a gradient and range of users we should definitely be most concerned about, it's lay users with no training,” Cortez said.

But he's also looked at automation bias with physicians using equipment, and found that they can trust computerized readouts and advice through automated processing too much.

“There is a risk of blindly trusting computers,” he said.

I suspect that's refreshing to hear for clinical staff increasingly told to rely on technology rather than their training or instincts.

And that brings us back to the role of the FDA. I tend to agree with Cortez — give the FDA more resources to evaluate what legitimately works among the many, many mobile health apps. Technology is great, but not at the expense of consumer safety.

Elizabeth Newman is the Senior Editor at McKnight's Long-Term Care News.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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