David Harlow, host of HealthBlawg

The IMS Institute for Healthcare Informatics released a report on the ecosystem bloody mess of 40,000+ mobile health apps that are available today. Hat tip to Jane Sarasohn-Kahn for writing about it today at Health Populi.

From the executive summary:

Over time, the app maturity model will see apps progress from being recommended on an ad hoc basis by individual physicians, to systematic use in healthcare, and ultimately to an end goal of being a fully integrated component of healthcare management. There are four key steps to move through on this process: recognition by payers and providers of the role that apps can play in healthcare; security and privacy guidelines and assurances being put in place between providers, patients and app developers; systematic curation and evaluation of apps that can provide both physicians and patients with useful summarized content about apps that can aid decision-making regarding their appropriate use; and integration of apps with other aspects of patient care. Underpinning all of this will be the generation of credible evidence of value derived from the use of apps that will demonstrate the nature and magnitude of behavioral changes or improved health outcomes.

(Emphasis supplied.)

We are nowhere near this endpoint — integration of the use of health apps into health care management — right now, due to a number of factors.

Some of the issues highlighted by IIHI are not being addressed because of market failures. For example, systematic curation and evaluation of apps was a central part of the business of Happtique, but that has fallen by the wayside. HealthTap and Jiff have announced plans to carry forward this work, Cigna has its recently unveiled GoYou marketplace for Cigna members only, and Aetna has its CarePass platform. It remains to be seen whether any of these curation plays will be based on, or will meet, the criterion of generating credible evidence of value derived from the use of health apps.

There is a bias in the marketplace against the creation of walled gardens, but since the wished-for ecosystem is not ready for prime time, there are advantages to the curated walled gardens of apps that share a platform and that can share data with patients, with clinicians, with each other.

A foundational element necessary to any finding of efficacy and value — even assuming that there is some science or medicine backing up an app, which the IIHI report calls into question for most of the 40,000+ health apps out there — is the secret sauce of patient engagement. The vast majority of health apps are downloaded, used briefly, and then abandoned. If we are all glued to our smartphones, why can’t we be glued to our health apps? Until the addictive qualities of wildly popular apps are isolated in the lab and grafted onto health apps that seek to promote and reinforce healthy behavior change, we will continue to have 40,000 tail-chasers out there. (To be fair, some developers have focused on the fact that we are glued to our smartphones, and use their motion and activity as proxies for our health (e.g., ginger.io). This approach uses a different definition of “secret sauce.”)

Until these issues are solved, apps will not be recognized by payors and providers, and they will not be integrated with other aspects of patient care.

My clients, of course, are different :)  Not only are their apps perfect, but I have worked with them to solve the security and privacy issues in a manner that will ease their apps’ adoption by health care providers and by the general public.

Implementation of the recently finalized FDA mobile health app guidelines will affect a small subset of these apps, and the apps need to fit into a broader digital health ecosystem as well.

The broad push for “prescribable” apps has the potential to drive up prices without improving efficacy. Payors, providers and patients should all be concerned about ensuring an appropriate price to value relationship over the long term, and app developers need to be sensitive to this issue as well. As we move to broader adoption of global payment models, ACOs and similar risk-bearing entities will have a greater interest in testing apps and providing them at low or no cost to patients.

Bottom line: Health apps can help, the vast majority do not, and the opportunities for innovative, effective solutions are many. Collaborative patient-provider efforts to demonstrate efficacy (as Jane suggests) could help move the ball forward, andpatient-directed health data sharing that I have argued for could help facilitate that forward motion.

First Posted at HealthBlawg on 10/30/2013

David Harlow
David Harlow LD is a health care lawyer, consultant, blogger, and thought leader. He is Host of Healthblawg, an award-winning blog highly regarded in both the legal and health policy blogging worlds. He is also Principal of The Harlow Group LLC, a health care law and consulting firm based in Boston, MA. His 25 years of experience in the public and private sectors affords him a unique perspective on legal, policy and business issues facing the health care community. David is also associated with the Mayo Clinic Center for Social Media, the Society for Participatory Medicine, HealthWorks Collective, and FierceHealthIT.


  1. A patient can’t even get coordinated web sites from ACS. They seem to be in conflict with each other. I love the british Macmillan site, where there is a list of all clinics, ability for patients to communicate with each other, etc. And you sign in just once. You don’t have a 100 or more sites to sign into- to get so very little. Then you have so many different sites run by different cancer association, and the competition between hospitals. Yahoo-Google-Bing-ASK, all list the same hospitals over and over-Sloan-Kettering, MD Anderson, that Cancer Clinics of America-and not much else. Going to one of the many ACS sites isn’t much different. Someone somewhere should require the ACS to list every hospital- with cross indexing of state, type of cancers. The Brits can do this. This is a larger country-but the brits recognized the patients and doctors were not connecting with the correct cancer clinics. Macmillan publishing took over the problem as charity– by the way– Macmillan provided computer techs that knew how to set up a health care web site.

    I was on an ACS site, and decided to visit NCS, and I got a pop-up that the ACS blocked this because NCS is an unreliable site. I can enter NCS any time that I’m not on an ACS. Like an idiot, when I first was diagnosed-I did a search for American Cancer Society-and all I got were sites for raising money and selling wigs. I do not think much of the ACS or the lack of emotional care provided to patients through the Internet.


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