Written by Laura Maaske on January 31, 2013 in Research & Technology

It is now within reach of a physician who has a need to be met, to seek a small developer and developer and request that an app of his or her own be developed. So, for this final part in my ?You Imagine? series, I want to ask what makes a good and effective health app on any mobile device.

With over 17,000 health and medical apps available in iTunes, and with an average price at around $2.00, iTunes ?Health? and ?Medical? categories are two of the fastest growing sectors of app development. There are health games that offer, for example, quizzes to assess calorie content of various foods. There are GPS apps, order tracking apps, weight management apps, pedometers, diabetes regulating apps, and calorie counting apps, just to name a few. These apps might be associated with push notifications that offer users reminders to take meds or other health interactions.

According to Float Mobile Research, almost 80% of Americans want to use mobile apps to assist in their health decisions, and 40% of physicians believe that the mobile apps can reduce their patients’ need for office visits[1]. But which ones do people enjoy, which ones do people learn something from, which ones do people keep, and which ones effectively achieve their goals?

1. I like this app

Apps should be sociable, personal, engaging, interesting, and fun

To like an app, even for adults, it must be fun, personal, or interesting. Its visual appeal must grab our interest from the beginning, and not disappoint. A health app can not be overly complicated to use, and it must meet our expectations seamlessly as we begin to click and navigate through it. Because we are social creatures and find greater meaning in our personal ties, a health app must also connect us to friends, family, and our physician and health care providers. Certainly, it might also venture to introduce us to others who share our health concerns and our same health circumstances.

Pricewaterhouse Coopers Managing Director, Christopher Wasden, speaking at the Healthcare Information and Management Systems Society’s annual conference 2012, offered suggested that interoperability, or networking, is a great area of opportunity in the health app playing field. This potential has been slow to implement because, as my own clients express, there is concern about patient privacy. As security protocols are being addressed for electronic medical records (EMRs), and as the FDA regulations become clear to developers, patient privacy will be maintained while allowing patients to share personal data with exactly those they intend to.

Wasden’s suggestion that social networking is a key point to one of the most exciting capabilities of mobile devices. For people who own smartphones and tablets, social media and texting are preferred ways of passing information because they are personal. The tendency we have to check our devices and to check-in means that physician offices might reach their patients most effectively by tapping into this preference.

Mayo Clinic cancer patient educator Sarah Christensen, whose newsletter ?Living with Cancer? has over 60,000 subscribers, has learned from the experience of bringing resources to patients via iPad that social media is the key to reaching her patients[2]. She says this recognition of the social nature of the search for health and wellbeing, is the key to reaching people, and it breaks people from the limits of geography.

Some of the apps making great effort to offer an interesting and socially integrated experience include Runtastic (http://www.runtastic.com/), which manages exercise routines and aims to make it fun.

2. I’ve learned from this app

Apps should be intelligent and supportive of our learning needs, offering compiled health behaviors and even offering marketing informatics.

Certainly, apps can offer medical information in layer upon layer of complexity. But this alone is not always strong enough or useful enough insight; nor motivating for all. We want an app to be intelligent, to adjust to our behaviors and to offer something new from the outside world. Apps should be smart enough to suggest and make health suggestions that are unique and specific to our needs, strengths, weaknesses, and to our unique pattern of health choices.

Apps should work with the lifestyle and needs of both the doctor and the patient. iPads and iPhones prove their usefulness in a variety of new ways by the innate hardware features that complement such engaging software capabilities: functions like recording, light, and camera capabilities; or by offering the option to record specific data through devices such as attached stethoscopes, lenses, to be used for recording data. Using an iPad to record data, heart sounds, and integrate resources is a powerful step in the direction. Dr. Ariel Soffer is a South Florida cardiologist who developed an app allowing patients to take a photo of their veins and send the photo to for feedback[3]. It’s a simple idea, but powerful, time saving, and it efficiently integrates the healthcare system without violating strict patient privacy laws.

The app should be flexible and allow for different learning styles. People differ in which method of presentation reaches them best.[4] It might offer information in different formats: visual, text, and audio, for example. It might offer linear approach for some, and a linked approach for those who like to choose their own path towards knowledge[5].

3. I’ve kept this app

Apps should be integrated to the health care system, and integrated into our lives so that we return to them again and again.

In Tom Myers’ review article, What makes an effective Health App[6], he says, ?A good indicator of usefulness of an application are retention figures. That is how long does the app stay on the users device.?

This is quite a demand for an app. Even for my kids, the best shelf life for any single game has been months. And there have been a few games, as well that have remained on the iPad for a year now, which are only opened once a month. I would suggest that an app that is retained longest is not necessarily achieving its goals any more than one which is held onto for a couple of months. My children throw away a game when they have mastered it. And this is a good sign that they have moved on to something of a greater or different challenge.

I would suggest that, specifically, apps with short term goals, such as those teaching anatomy or physical therapy exercises would not need a long retention cycle. But those intended to be incorporated into a patient’s long-term health care plan should be capable to collect data of different types, or to access wide knowledge. But app retention would not be the sole factor to consider in determining the usefulness of a health app.

Larklife (http://lark.com/) is one example of an app that is well incorporated into the user’s lifestyle. Lark offers daytime and night-time wristbands to monitor patients sleeping and waking activity. It logs this data into the mobile device.

4. This app changed me

Apps should have goals, directed for outcomes. They should change a behavior or health outcome the user desires changed, and by be implemented into the healthcare plan.

Any health app should be designed with a goal in mind. Often this goal is some health outcome. Alain Labrique, director of the Johns Hopkins Global Health Initiative, and many before him in the field of interactivity research, suggests that apps are more effective when they engage the users in a responsive way. Some send reminders to keep patients, particularly with those whose medical conditions need monitoring, on their medical or prescription regimens. This goes beyond simply social connectedness as discussed above.

Labrique believes apps that are designed well to engage and offer reminders can tip bad behaviors in favor of good choices, and that sharing information with one’s health care provider, or with others who experience the same health issues, is a more effective approach to keep a patient’s health on track. The simple reminders and tracking of choices can help people to be aware and to take control in a more active way. Labrique believes these apps increase a person’s tendency to think about their health, and that this is an advantage over the fairly infrequent reminders that health care providers offer during doctor visits.[7]

Christopher Wasden also suggests that apps be designed with a target in mind for changed behavior: to be focused on some particular outcome. Wasden’s fifth key to success for a mobile app is that it be socially integrated. Good behaviors require friends for support. And finally, Wasden suggests that a good app is fun and engaging: visually dynamic and interesting to use.

Some apps specifically might be working on these types of changes. Few have been tested for outcomes. One example of a tested mobile health effort involved a study of 204 participants aiming to improve their diet. Participants used mobile devices with remote coaches. As a result of these mobile health interventions, participants were doing better at the end of the study: eating more vegetables and fruits, engaging in less sedentary leisure activities, and decreasing their fat intake.[8]

This understanding of effectiveness will be the next place to be moving, in the exploration of mobile devices and the implementation of health apps into our everyday lives. One app making great strides in this endeavor include, RunKeeper, which offers rigorous personal training, heart graphs, location tracking to monitor exercise patterns, and goal-setting strategies. Keas, Retrofit, Beeminder, and Lift are other apps which focus on goal-setting. These are all robust apps and time will tell which strategies work best.

It is a continued marvel for those of us who grew up in a world where even clunky computers were a novelty, that we can hold so much power in the palm of our hands. But our expectations for these devices soar beyond our imaginations. We want these tools to be fun, interesting, engaging, incorporated fully into our health care plan, socially connected to other people and to our physician, and most of all, effective in the intended function for each app. Maybe we would even like an app to change our lives!

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[1] Mobile Apps: 10,000 Ways to Improve Your Health ? and Counting Nick Martin, Vice President of Innovation, Research and Development at UnitedHealth Grouphttp://www.fahp.net/assets/newsletterandwidgetarticles/May/2012%2004%20mobile%20health%20apps%20_matthew%20yi_.pdf
[2] Using iPads in Patient Education: Realities and Lessons from the Front Lines of Healthcare. Posted on August 20, 2012. Susan Collins, MS, CHES, RD, SurroundHealth. http://blog.surroundhealth.net/2012/08/20/using-ipads-in-patient-education/
[3] New apps a shot in the arm for doctor-patient communication. August 27, 2012. Nicole Brochu, Staff writer.http://articles.sun-sentinel.com/2012-08-27/health/fl-doctor-smartphone-apps-20120823_1_health-apps-new-apps-smartphone
[4] Enhance Patient Compliance. Targeting Different Learning Styles. Volume 16 ? Issue 8 ? August 2003.http://www.podiatrytoday.com/article/1852
[5] Learning Styles: Understanding Your Learning Preference http://www.mindtools.com/mnemlsty.html
[6] Microlab Devices. ?What makes an effective health App ? Webinar Review? http://www.microlabdevices.com/what-makes-an-effective-health-app-webinar-review/
[7] Hopkins Researchers Aim to Uncover which Mobile Health Applications Work. By Meredith Cohn, The Baltimore Sun. March 14, 2012 http://www.baltimoresun.com/health/bs-hs-mobile-health-apps-20120314,0,2590424.story?page=1
[8] Multiple Behavior Changes in Diet and Activity: A Randomized Controlled Trial Using Mobile Technology. Original Investigation | May 28, 2012. Bonnie Spring, PhD; Kristin Schneider, PhD; H. Gene McFadden, BS; Jocelyn Vaughn, MA; Andrea T. Kozak, PhD; Malaina Smith, BA; Arlen C. Moller, PhD; Leonard H. Epstein, PhD; Andrew DeMott, BA; Donald Hedeker, PhD; Juned Siddique, DrPH; Donald M. Lloyd-Jones, MD. Arch Intern Med. 2012;172(10):789-796. doi:10.1001/archinternmed.2012.1044. c   Original Investigation | May 28, 2012

by Laura Maaske. Read my full original article in “Med Monthly Magazine” here. See also my writeup on new technology in the medical school classroom here: Flipping the Medical School Classroom.