Out of 1200 New Mobile 'Infectious Disease' Apps, 12 Are Vetted

July 22, 2013

By Rob Goodier

NEW YORK (Reuters Health) Jul 22 - Clinicians increasingly turn to mobile device applications for drug information - but researchers who combed through 1,200 mobile apps for infectious disease information have approved just 12 of them.

They add those to 12 that were previously vetted, for a total of 24 suitable for medical professionals.

"Healthcare providers need to critically evaluate medical apps just like they do a medical article," Debra Goff, a pharmacist at the Ohio State University Wexner Medical Center who was involved in the study, told Reuters Health by email.

"Before any healthcare provider uses a medical app to guide them in managing patients they must look to see if the source and authors are reliable," Goff added.

She and her team published their review online July 9 in Clinical Infectious Diseases.

The twelve applications they recommended fall into three main categories. "Pediatric Infectious Disease" includes American Academy of Pediatrics (AAP) Red Book, Nelson's Pediatric Antimicrobial Therapy, Infectious Diseases in Children, CDC Vaccine Schedule for Adults and Children, and SHOTS STFM 2012 (Society for the Teachers of Family Medicine) immunization schedules.

"Infection Prevention and Control" includes the Infection Control Pocketbook.

"Clinical reference" includes Sepsis Guide, CDC (U.S. Centers for Disease Control and Prevention) Health Information for International Travel 2012, The Yellow Book, Fluview, CDC Influenza (Flu), ACP Immunization Advisor, and Management of Candidemia in the Stewardship Era

The use of mobile devices among medical professionals has soared recently. As many as 90% of physicians may look up drug information on a mobile application, and 40% may use an application once or twice a day, according to a survey the researchers cite. That survey was done by Epocrates, the company behind one of the most popular medical applications. Epocrates was included in Goff's review.

Regulators are trying to catch up. The U.S. Food and Drug Administration provided regulatory guidelines for mobile medical applications in July 2011 (see https://1.usa.gov/13YXzTG).

A year later, the FDA passed the Safety and Innovation Act, which called for the creation of a risk-based framework for regulating health information technology. The goal was for regulations that would encourage innovation while protecting patients. Nearly a year after that, in May 2013, the Obama administration created a workgroup with representatives from the FDA, the Federal Communications Commission, and the Office of the National Coordinator for Health IT, to fulfill the provisions in the act.

Debate ensued among business and advocacy groups: a month later, two coalitions each sent a public letter to the Obama administration, one calling for swift FDA action and the other urging the FDA to wait for the work group's conclusions.

The mHealth Regulatory Coalition, which includes Verizon, AT&T, Philips, Samsung, and others, asked for FDA rules on mobile medical applications as soon as possible.

"The immediate release of final guidance will benefit industry, enable more predictable investment in innovative mHealth technologies, and help ensure patient safety," the coalition wrote in its letter. The letter is available on the website of MobiHealth News (see https://bit.ly/11aemzf).

In contrast, a coalition of 120 businesses, hospitals and advocacy groups asked for more time for the work group: "Oversight must be implemented in a balanced way that also fosters innovation and encourages adoption of these technologies." (This text, too, is available on the website of MobiHealth News: https://bit.ly/16VnaYx).

Goff and her colleagues think the FDA might not be the best choice for this kind of software regulation.

"It's a slippery slope and controversial to have the FDA regulate apps," Goff told Reuters Health.

She added, "Although it seems necessary to have regulatory oversight of diagnostic apps for patient safety reasons, certifying all medical apps seems less clear. For example, reliable paperback publications like the "Sanford Guide to Antibiotics" or the "Johns Hopkins Antibiotic Guide" are in the pockets of most (health care providers). The app version of both guides provides the same reliable information clinicians have depended upon for decades. Would 'certification' from a new certifying agency including the FDA, provide additional value to these apps?"

In their review, the researchers waded through hundreds of games and industry promotional materials that were ambiguously labeled as "medical" applications.

"This was the biggest challenge we had in writing this review, trying to find relevant infectious disease apps," Goff says.

"We found so many that 'look good, feel good,' meaning they were simple to navigate and visually appealing, but unfortunately were not accurate," Goff says.

Many of the applications that they rejected were out of date, or not relevant to U.S. healthcare. Part of the problem may stem from online "app stores" that ambiguously define medical applications, the researchers found. Both Apple and Google (Android) suffer from that problem, Goff says.

Updating applications and ensuring their relevance may be especially difficult in the field of infectious disease.

"Infectious disease apps pose a few unique challenges compared to other medical apps," says Dr. Anne Meneghetti, who directs clinical communications for Epocrates and who was not involved in the study.

Among the difficulties, information in the field is dynamic with frequent updates to clinical guidelines. And oversimplified data can mislead non-experts, who, for example, may not realize that the site of an infection can affect the efficacy of a drug, or that infections can vary from region to region, Dr. Meneghetti says.

Despite those pitfalls, medical applications have the potential to deliver guideline updates and other information to doctors more quickly than other sources, such as journals and word-of-mouth recommendations.

"Clinical apps are a modern necessity at the point of care. They support safe prescribing, help improve patient care and save clinicians time," Dr. Meneghetti told Reuters Health.

SOURCE: https://bit.ly/17ynb74

Clin Infect Dis 2013.

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