Should the NHS endorse some health apps?
My smart phone comes with pre-loaded health and fitness apps. I can download multiple health apps from app stores. Symptom checkers, blood pressure monitors, couch to 5k runs and sleep cycle apps to name a few.
They help me quantify my health and well-being, record my activity and take readings on various health vital signs. I assume they are safe for me to use. Should I worry about this? Should the NHS recommend quality health apps to me?
I presently trust Apple, Samsung and Google to provide me access to health apps. They use, store and report my personal health data back to me. The technology is central to my health and well-being, all managed by me. Each organisation is a commercial in nature and I know they’ll be making a profit from this activity. I want to take charge of my own healthcare – these TED talks continue to make the point.
So which health apps, which developers of health apps and which organisations providing a market place for the health apps should I trust? Some GP’s are prescribing apps to patients, what criteria are they using when they do this? I am presently self-selecting health apps based on it being pre-loaded on my mobile device (so it must be OK).
An NHS endorsement of a health app might make me feel better about using it, safer that it’s be designed well, it might even be smarter to use an NHS endorsed health app that can connect with my NHS records. The NHS has had a first attempt at an app store, but since removed the service.
Some of the issues faced are…
There are so many health apps to choose from
Which apps should the NHS review and endorse? Why not let patients vote for the app we want checked by the NHS. Vote monthly via NHS Choices, Twitter, Facebook. It helps to focus on those apps that users are interested in. It puts the control with users and not app developers or delivery partners. It also doesn’t waste time on apps that users have a limited interest in. The One You campaign from Public Health England offers some apps, but could go further.
What standards should an app reach?
In the same way as the Government Digital Service has set digital delivery service standards, the NHS could adopt a similar approach for apps. Why not review and adapt these GDS standards and make them suitable for health app development.
What if I’m seriously injured/die because of an NHS endorsed health app?
Nobody wants to end up in the coroners’ court trying to understand why person ‘x’ died from using a health app. The NHS endorsing a health app should be an attempt to maximise the health benefits to the many. Getting into detailed clinical use cases for each health app won’t work. This appears to have been a focus point for the previous NHS attempt at an app store. There’s not enough time, resource or money in this fast paced market place to rigorously test each new health app. If the approach is to try and minimise the risk to all health app users, we’ll be here forever – testing every scenario that can be thought of. A set of clear health app development guidelines is what’s needed. Developers follow them and then get assessed. If they pass they get the NHS endorsement. Fail and they don’t. In other words – It’s safe enough for general use.
Partner up the NHS with commercial organisations
The NHS should explore deeper relationships with the app stores, rather than trying to create an NHS specific app store. Google and Apple app stores attract millions of users. I’d expect them to bite the NHS’s hand off for app endorsement. But they may not need the NHS. Apple are surging ahead and developing HealthKit and Google have Google Fit.
How long should an endorsement last?
Apps go through cycles of releases as bugs are ironed out and features added and removed. Health app endorsement can only be for the version assessed. The potential for updated versions to deliver change creates a never ending industry. I don’t think the NHS has the resources to keep pace with that. Perhaps some element of self-assessment once an endorsement has been provided could be a way forward. There will be risks to bear for everyone. We all have to approach the risks with our eyes wide open.
Roger Donald is Programme Head at NHS Digital.
Read more about assuring the quality of health information, including apps, on PIF’s Judging and assuring the quality in health information webpages.