We’ve come a long way from the days when you had to turn off your mobile if you walked into a hospital. Nowadays, mobiles and apps are not just vital ways to stay in touch, but a part of many doctors’ clinical kit, providing information about drugs and diseases, and allowing them to view diagnostics. And that’s before we’ve even started on the impact of patient app use.

Apps for doctors

The most obvious use of apps is to provide information to doctors. Instead of having to look something up in a hard copy of a formulary, for example, which could easily be out of date, doctors can access real-time information via an app. Apps such as Wolters Kluwer’s UpToDate provide evidence-based information and treatment options for over 10,000 conditions. The information in the app is peer-reviewed and collated by over 5,000 clinicians. UpToDate also provides access to Lexicomp, the Wolters Kluwer drug database, with details about thousands of drugs. UpToDate is currently being used by over 100 hospitals and over 1,500 individual clinicians in the UK alone. It’s relatively low-tech, but a very useful tool.

But there are other apps which sound more science fiction at this stage. For example, Philips and Accenture recently demonstrated the use of a Google Glass head-mounted display to monitor a patient undergoing a surgical procedure. The surgeon was able to monitor the patient and react to developments during the procedure without having to turn away from the patient.

In Boston, MA, Dr Kenneth Mandl, a Harvard professor working at Boston Children’s Hospital on informatics, is changing the way that electronic health records (EHRs) work. With the support of a federal grant, a team at Boston Children’s Hospital has developed an interface for EHRs using standardised code that tells programmable apps where to find data. The interface, called the Substitutable Medical Apps and Reusable Technology (SMART) is free, to ensure maximum impact on healthcare. The idea is to open up the market for apps. Use is still at a very early stage, but several hospitals and groups of hospitals have begun to use it, with apps expected soon.

Apps for patients

But exciting though these developments may be, they pale into insignificance alongside the huge market for patient-held apps, whether health record-related, or for monitoring health.

For example, Kaiser Permanente, the US healthcare insurer-cum-provider, has made its entire health record system available to members via an app. With more than 95,000 downloads, Kaiser patients can now make appointments, check test results, order medicines and communicate with doctors via the app. It’s making healthcare at a distance increasingly viable and safe, with patients and doctors able to agree together when face-to-face is necessary.

Medicines management apps will also make queuing for a repeat prescription a thing of the past. With an app able to monitor health status and send the information direct to a surgery, medication can be adjusted, and the prescription sent automatically to a pharmacy. All you’ll have to do is pick it up. Apps that help patients manage their own medication, reminding them of when to take their medicine, and how much to take, also have huge potential to improve patient safety and compliance with medicine regimes. Yes, of course this kind of system often requires wearables as well, which again makes it a bit more science fiction at the moment, but it’s clearly on its way.

Regulatory issues

There’s one big issue hanging over the development of apps, though, and that’s how to make sure that they’re safe. In the UK, the NHS has started to build up a small but growing library of healthcare apps that have been vetted by clinicians and assessed as safe. In the US, the FDA is the crucial player, having issued guidance that sets out which apps might come under its definition of ‘medical devices’ and therefore fall to be regulated. For the most part, information-providing apps such as UpToDate probably don’t. But many of the more futuristic monitoring devices probably will. And while this will help ensure that they are safe for patients, there are many uncertainties in the FDA regime, which could cost developers tens of thousands of dollars, and has already led to several withdrawing from the US market.

If apps are to take off, and meet their full potential in healthcare, regulators and developers probably need to adopt a pragmatic approach. Over-regulation is likely to lead to lack of innovation, rather than safe products, because developers won’t be able to afford the costs. And that would be a loss to patients and healthcare alike.

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