Will ‘an app a day’ make us healthier?

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It’s not often that I can claim to get excited about technology, but it’s hard not to after attending the Health 2.0 europe conference held this week in London (Nov 18th-19th). While it’s not exactly news that apps for healthcare are being developed for use by the public, what the presenters at Health 2.0 were able to showcase was how these can potentially go on to improve healthcare. The key word here is ‘potentially’.

Non-communicable diseases (NCD) are on the rise – globally, and according to the WHO the leading NCD risk factor for mortality is elevated blood pressure (16.5% of global deaths) followed by tobacco use (9%), raised blood glucose (6%), physical inactivity (6%) and overweight and obesity (5%). The association between risk factors such as obesity and chronic conditions such as Type 2 diabetes and cardiovascular diseases is well known. However, simply having this knowledge is not enough to prompt the majority of people to change their lifestyle choices. In addition, once they develop these chronic diseases another problem arises- adherence to treatment. Non-adherence is a major problem in healthcare and leads to serious complications, requiring more intensive levels of medical care. Also, a patient with more co-morbid conditions is likely to require care by a multidisciplinary team, including social care. This is where communication although vital, often suffers from some limitations.

These are areas where healthcare app and platform developers have been focusing their efforts. With so many online tools and apps being made available to general consumers, patients and clinicians, the common goal seems to be able to provide a useful, attractive tool that will enable users to perform functions such as: enhance self-tracking and promote behaviour change (eg Fitbit and BioBeats), assist adherence to treatment (e.g. MediSafe and PCC Hellas), to adapt ongoing treatment according to daily activities (e.g. SocialDiabetes) to improve communication between healthcare teams (e.g. Sermo, Fastguide and BestDoctors) and to improve the patient and health provider relationship (e.g. CyberDoctor, WelVU and Wellpepper). Pharmaceutical companies are also getting involved in the development of healthcare apps to aid pharmacovigilance (Drugee) and to help reduce adverse reactions to drugs based on individual patient characteristics (InterAct).

One thing all these tools have in common is the collation of data – lots and lots of data! So the following questions arise: what to do with all this data, and how useful is it all really going to be in the long–term? As pointed out by Jon Stamford from The Cure Parkinson’s Trust, the best app is the one that people are the most likely to use. Apps can’t be too demanding on users time, so an app that can collate data passively is going to be more attractive than one which requires the user to frequently input data. Another concern highlighted was regarding how to ensure people keep using the apps in the long-term. Adriana Lukas explained that while many people are keen on improving self-awareness, the initial enthusiasm most people will have in using an app will tend to fizzle out after about 3 months. Therefore, if the apps are not collating biometric data for long enough, the data will not be meaningful. One of the moderators of Health 2.0 sessions, Indu Subaiya highlighted that individual variability also needs to be taken into account. After all, not everyone will respond to all apps in the same way. How such data can be analysed to provide clinically meaningful information needs further investigation.

One platform that aims to draw meaningful information from biometric data is Tictrac. This allows the user to sync the various apps and devices they use to gather the information into one place. Such data can be mapped together to try provide insights into the causes of physiological responses e.g blood pressure, and drivers of behaviour (e.g. exercise). As Tim Kelsey from NHS England pointed out, tools only matter as far as they help patients and the public. How the NHS is dealing with clinical and patient data has been summarised in another blog post here.

Giving the patients a voice is necessary to ensure health systems are safer and more sustainable. In fact, empowering patients is becoming increasingly recognised as a way of driving medicine forwards. There have been a few recent examples thanks to the support of groups such as PatientsLikeMe, and MEandYou, where patients have driven the direction of research into their own diseases. A compelling example of why empowering patients is so important came from Maria Gjerpe who is a clinician suffering from ME. She described the frustration of suffering from a condition that has no known cure. As a participant on a pilot study, she responded positively to the immune drug Rituximab. Spurred by these promising results she proposed a double-blinded RCT with 140 patients plus controls, but was refused funding. So, via social media (especially Twitter and Facebook) she campaigned to raise money for the trial, and in 90 days raised 7 million NOK. A summary of this successful campaign can be found here.

This is a field still in its infancy,and a lot of open questions remain: How will meaningful data be derived? How will ethical concerns about openly sharing patient-level data be overcome? Are the tools efficacious and safe? What do we do with all this data?

It will probably be another 10 years until the true value (if any) of such tools will be proven. Until then it will be interesting to see how this field develops. After all, we may be entering a new era in healthcare.