App makers have created more than 165,000 mHealth applications. Many aim to help people track their condition day-to-day, stay on track with medication or at-home testing, share information electronically with their care teams and get education and encouragement between doctor's appointments. Theoretically, this could help them avoid emergencies and long-term problems - and reduce the high cost of their care.
The researchers call for app developers to do better at alerting users about dangerous levels and giving them a course of action - such as calling for help if they're feeling suicidal or alerting their key contacts if their blood sugar is dangerously low and they're at risk of passing out.
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"Do we really want our mHealth apps to be passive observers, or should we expect that they do more than that, and model themselves after crisis hotlines with specific action plans?" Singh asks.
The lack of direct advice to the user may have something to do with how mHealth apps are regulated, Singh and his colleagues note. Apps are regulated by the Federal Trade Commission, which can respond to misleading claims, the Office for Civil Rights of the Department of Health and Human Services, which oversees compliance with health privacy laws, and the Food and Drug Administration, which can require app makers to remove their apps from the app store but does not have to review most mHealth apps before they're made available.
Clinicians also need to adapt their thinking to the new age of mHealth apps that their patients are likely using, he notes. "Clinicians still think of apps the way they think of pen and paper - a patient enters information that they need to track, and then communicate it to their health providers on the phone or when they have an appointment," he says. "But if the information logged in an app is important, it should get dealt with right away. We need to think about care models that allow information to be acted on in real time - so that a blood pressure of 250 uploaded at 3 a.m. gets prompt attention."
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