Most of the apps allow users to share their health information with others, but the researchers found that often this was through insecure methods. Half the apps allowed sharing by email, and 17 percent allowed text-message sharing. The apps were tested in 2015, after the launch of Apple and Google options for secure sharing of health information, but only a minority allowed this kind of sharing. And only one allowed users to share data directly into the electronic health record that their medical team uses.
Only two-thirds of the apps had a written privacy policy spelling out how they protect or use the information supplied by users. This is better than previous studies of all mHealth apps have found, but still troubling to the researchers because the apps in this study were supposed to be the most top-notch.
"Clearly there is a large-scale proliferation of apps happening related to health, and people have made the switch over to smartphones," says Singh. "But the question is, to what extent are apps serving the needs of patients with chronic diseases, and their caregivers, as opposed to generally healthy people seeking help with wellness."

He adds, "We found that the consumer-generated rating on the app store is a very poor marker of how usable an app is, and whether a physician would recommend it. Clearly, the work is not done once consumers have rated an app. Going forward, we need to evaluate apps on the basis of what would it take for physicians, and organizations that issue clinical guidelines, to start recommending them to patients."
Singh led the study with senior author David W. Bates, M.D., M.Sc., the chief innovation officer at BWH, with funding from the Commonwealth Fund. The study grew out of previous work by the Robert Wood Johnson Foundation and the National Academy of Medicine to look at mHealth and its implications for the population of patients who use the most health care, and account for a huge percentage of the nation's health care costs.

The team evaluated apps aimed at people who live with asthma, arthritis, diabetes, high blood pressure, depression, lung disease, liver disease, kidney disease, heart failure and addiction to drugs, alcohol or tobacco. They also looked at apps for people who have survived a stroke, battled cancer, been diagnosed with memory loss or dementia, or are obese or living with pain.

These "high need, high cost" patients, who often face social and economic barriers to health care, and have complex health needs, have been seen as a key group for mHealth options.

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