Which Health Apps Are Accurate and Safe?

Neil Chesanow


May 14, 2013


For all the public hoopla about health, fitness, and medical apps, 2 large obstacles are blocking physician buy-in.

One is the overabundance of these apps: over 40,000, by some estimates. Finding the right app is like finding a needle in a haystack. The other is the lack of a certification process. Anyone can write a health, fitness, or medical app today, and just about anyone does. But whether a given app is accurate, functional, safe, and malware-free is anyone's guess.

That, at last, is about to change.

Happtique, a mobile health solutions company that maintains an online catalog of over 15,000 as-yet-unevaluated health, fitness, and medical apps, has taken on the Herculean task of separating the wheat from the chaff. It will do this by first having a technology firm scan the apps for malware and other security issues, and assess their interoperability. Physicians and other clinicians in relevant specialties will then evaluate the apps for functionality, user-friendliness, and content.

Apps that pass both the technical and clinical evaluations will then be designated "certified," meant to be a seal of approval. Happtique CEO Ben Chodor hastens to add that Happtique won't rate apps; rather, it seeks to set baseline standards for app performance, content, and safety. "We want to do what the American Dental Association did for toothpaste," he says. "They never picked Crest over Colgate. They said, 'These guys followed the standard for good toothpaste. You pick the flavor and tube you like best.'"

How App Certification Works

App certification was less an inspired idea than a client request. Happtique is the for-profit arm of the Greater New York Hospital Association, which includes over 250 hospitals in New York State. Member hospitals were finding their doctors and patients increasingly pressing to use health apps in patient care.

"A bunch of hospitals told us, 'We want to start engaging with patients through apps,'" Chodor recalls. "'But we're never letting a clinician of ours give an app to a patient unless it's been vetted by other clinicians. And then we'll pick the ones we like best."

How does Happtique recruit clinicians to serve as app evaluators? It doesn't. "We only work with professional societies," Chodor says. "We don't contract directly with physicians. Right now we're contracting with the Association of American Medical Colleges (in Washington, DC) and the Commission on Graduates of Foreign Nursing Schools, based in Philadelphia. By the time we launch around mid-May, we'll make 2 or 3 other partner announcements."

Two concept reviewers, selected by the professional societies under contract, then evaluate an app using 11 content standards and associated performance requirements developed by Happtique. "The deals we're working out with different societies are that if it's a cardiology app, cardiologists will review it. If it's a dermatology app, dermatologists will review it. The key is that the material is reviewed by experts in the field, not just general clinicians," Chodor says.

"The concept reviewers will look at the content using the app or device itself," notes Sandy Maliszewski, MSN, JD, MBA, Director of Happtique's Health App Certification Program. "It's not like they're looking at paper. They're actually living with the functionality of the app and how the content is presented to evaluate what we believe are some very minimal foundational starting points for content."

App content review is not akin to peer review of an article in a clinical journal. References, for example, need to be solid, but they don't necessarily need to be the "best" or most current in the judgment of the content reviewers. Once an app has been certified, it's then up to individual doctors to decide whether its approach to content in their specialty meets their needs.

But even a review process this basic should make it much easier for doctors and other providers to recommend apps to patients with greater confidence. For instance, over 130 apps for diabetes management are listed in Happtique's catalog -- a daunting number. Several have been approved by the US Food and Drug Administration, but the agency's concern is patient safety in app use. Content, functionality, and security issues aren't the focus.

It's likely that once these apps undergo Happtique's certification process -- which app developers are eager to submit to, seeking a seal of approval -- perhaps 15-30 apps will receive a thumbs-up, a more manageable number among which to comparison shop. The first 8-10 apps in several specialties are expected to be certified later on this month. Thereafter, app certification will be an ongoing process. The more partnerships Happtique forms, the faster it will proceed.