How Digital Health Apps are Empowering Patients | Deloitte US has been saved
By Emily May, research analyst, Deloitte UK Centre for Health Solutions
More than 90,000 new digital health applications (apps) were added to app stores in 2020—that’s an average of more than 250 new apps every day.1 Digital health apps range from providing a platform for services such as virtual doctor appointments and chronic-disease management to consumer health apps that help people manage their own health through tracking daily steps and accessing exercise and nutrition programs. The COVID-19 pandemic helped to accelerate the adoption of digital health apps, which could help drive a preventative, digital-first Future of Health.TM However, there are ethical and regulatory issues that should be considered.
Globally, more than 350,000 health apps are available from the various app stores. However, downloads and the corresponding use of apps are heavily skewed, with just 110 health-related apps downloaded more than 10 million times, accounting for almost half of all downloads.2 Apps that fail to follow guidelines, don’t function as intended, are out-of-date, or economically unviable due to the ongoing costs of continually updating to new operating systems, are typically removed from the app stores.3
How did COVID-19 impact adoption?
The pandemic help to spur a proliferation of symptom-checker apps, apps to manage lateral-flow-test results and apps that act as vaccine passports. Many new and existing digital health tools have also helped citizens mitigate some of the health impacts of COVID-19. These apps have enabled citizens to engage with clinicians through virtual visits, track their general health metrics and monitor and manage their health condition or symptoms remotely. Virtual consultation (telehealth) technologies have been scaled dramatically to help clinicians diagnose, monitor and care for patients remotely, contributing to a digital-first health care system.
In England, the National Health Service (NHS) app, which uses independent digital platforms, has helped users access their medical records, conduct health assessments, arrange and conduct video appointments, and order repeat prescriptions. The app also provides a library of trusted health symptom and diagnosis information and provides proof of vaccination (acting as a COVID-19 vaccine passport for travel). As the most downloaded free app in England (growing from 200,000 users in January 2020 to more than 16 million in September 2021), NHS app users have ordered almost 3.2 million repeat prescriptions and booked more than 268,000 doctor appointments from June to September 2021.4
This increase in use mirrors trends seen in health and fitness apps. In 2020, app downloads grew by 30% and time spent on apps increased by 25%, compared to 2019.5 This significant uptake is expected to continue post-pandemic as demonstrated by the increase in investment funding—with a record $24 billion of investments in digital health in 2020, globally, and average deal sizes increasing significantly to $45.9 million.6
Health apps are increasingly focused on health-condition management rather than wellness management (the proportion of such apps grew from 28% in 2015 to 47% in 2020). Mental health, diabetes, and cardiovascular disease-related apps account for almost half of disease-specific apps.7 Regulated, evidence-based, mental-health apps not only can help improve access to advice and support, they can help to reduce symptoms of anxiety and depression.8 While these apps can be used in conjunction with traditional, face-to-face therapy, they also can be used as the platform to provide synchronous or a-synchronous support from a mental health therapist. A growing body of evidence shows that these types of platforms have increased accessibility by removing social stigma and the challenge of traveling to an in-person appointment. They are also facilitating access for those who have previously shied away from face-to-face therapy.9
How is the UK tackling the ethical and regulatory considerations?
Some 88% of health apps have the ability to collect, and potentially share, user data. This makes the management and protection of data an important ethical consideration and one that requires compliance with regulatory standards.10
More specifically, the capacity to collect a vast array of personal data means health apps have the potential to create an increasingly powerful and personalized source of useful health data. This could be invaluable in facilitating earlier detection and diagnosis of disease and supporting technology-assisted clinical decision making. However, to realize their full potential there is a need to improve siloed data systems and methods of data analysis while maintaining user confidentiality. The Digital Technology Assessment Criteria (DTAC), officially launched in February 2021, provides national, tangible, baseline criteria for digital health technologies to give staff, patients, and the wider populations confidence that the apps they use are safe and well-built.11
In June 2020, the Medicines and Healthcare Regulatory Agency updated their MHRA App Guidance requiring developers to reassess their compliance and the classification of their products under medical devices regulations.12 Apps such as symptom checkers, ones that aid diagnosis, track skin-care imaging and reproduction health apps, all potentially fall under the new medical devices regulations, increasing the regulatory requirements and data collection rules for such apps.
About 28% of apps currently have no privacy policies, increasing the risks of consumers using mobile health apps.13 The NHS App Library intends to assess apps against stringent criteria to help patients and the public find trusted health and wellbeing apps.14
Moreover, in August 2021, NHSX launched the What Good Looks Like framework providing guidelines to support NHS trusts.15 This framework describes the common foundation which should be in place across the NHS. This can help ensure that digital systems meet the needs of their staff and patients within a secure digital infrastructure. It can also help to support the digitization of NHS services and build on the progress made in adopting digital tools during the pandemic.
What does the future hold for health apps?
Digital health apps are helping clinicians to work smarter. They are also empowering patients with easier access to advice and support while improving their understanding and management of their condition. In the future, clinicians and patients will likely be empowered by digital diagnostic and treatment paradigms, as noted in our report, Predicting the future of health care and life sciences in 2025. We also predict Medtech and related health applications will be crucial drivers of value-based care. Together these developments can contribute to the delivery of 4P medicine (medicine that is predictive, preventative, personalized and participatory).16
We expect health apps will play an important role in empowering patients to manage their health through digitally-enabled care pathways, broaden access to health care services, and increase participation and awareness of the wider populations’ health and wellbeing. Evidence-based health apps will likely be integrated into established clinical treatment pathways, with the aim of both improving outcomes of current treatments and increasing access to specialized, and, where relevant, personalized, therapies.
Health apps also have the potential to improve sustainability of health care. They can help reduce patient and clinician travel, allow for remote monitoring, treatment, and surgery, and remote medication management. However, to achieve this ambition, citizens need to trust that the health apps are collecting and analyzing data safely and effectively and in accordance with robust data standards and regulatory scrutiny; and, importantly, that clinicians are acting on the results.
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1. IQVIA | Digital Health Trends 2021
4. NHSX | 16 million NHS app users
6. IQVIA | Digital Health Trends 2021
11. NHSX | Digital Technology Assessment Criteria
12. GOV.uk | Medical Devices Software Applications
15. NHSX | What Good Looks Like
16. Deloitte | Medtech and the IoMT are crucial drivers of value based care