A review of more than 1,000 healthcare related-apps found that less than half appeared to be useful for their potential for patient engagement while also offering high quality and safety, according to an issue brief published by New York City-based The Commonwealth Fund.

With Commonwealth Fund support, lead authors Karandeep Singh, MD, and David Bates, MD, and colleagues developed a framework for evaluating mobile health apps for their patient engagement potential, quality and safety.

According to the issue brief, the researchers conducted a systematic search of iOS (Apple) and Android app stores and an analysis of apps designed for those with chronic illnesses to assess which apps are likely to be useful in patient engagement efforts.

“Usefulness was determined based on the following criteria: description of engagement, relevance to the targeted patient population, consumer ratings and reviews and most recent app update,” Singh and Bates wrote.

The research team searched for apps using the following terms: alcohol, arthritis, asthma, bipolar, cancer, cirrhosis, cognitive impairment, chronic obstructive pulmonary disease, COPD, coronary artery disease, dementia, depression, diabetes, drug abuse, elderly, heart disease, heart failure, high blood pressure, hypertension, kidney disease, liver disease, lung disease, obesity, pain, smoking and stroke, according to the issue brief.

Among the 1,046 health care–related, patient-facing applications identified by the search, the researchers found that 43 percent of iOS apps and 27 percent of Android apps appeared likely to be useful. The research team also developed criteria for evaluating the patient engagement, quality and safety of mobile apps.

The researchers developed an engagement pyramid to gauge how apps are meeting the needs of patients with differing levels of healthcare engagement. Those patients least activated in their own care, for example, may face health literacy or social barriers to care which can be addressed through health education, reminders and recording of health information. “Moderately activated patients who are informed and able to keep track of their health may benefit from being able to visualize and summarize their health information, receive guidance on next steps and communicate with family members and health care providers,” Singh and Bates wrote.

The researchers applied their evaluation framework to a sample of apps, including an app that anonymously connects users with trained “active listeners” for emotional support, counseling and therapy to help address depression, anxiety and stress and a medication management app that provides users with medication reminders, refill alerts, drug interaction warnings and the ability to track medication side effects.

The researchers concludeded that, just as treatment needs to be tailored to the patient, apps need the same customization because mobile health apps “appeal to different audiences by offering varied functionalities.”

“App quality and safety do not necessarily align with functionality and must be considered separately. In developing this framework, we discovered several apps that sacrificed quality or safety in the pursuit of added functionality,” Singh and Bates wrote. “Using a framework that considers the engagement, quality, and safety of mobile apps is critical for stakeholders to identify trustworthy apps that serve the needs of high-need, high-cost populations. While apps have tremendous potential to engage high-need, high-cost populations, a minority of patient-facing health applications on both the Apple and Android stores appear likely to be useful to patients.”

Read the entire issue brief.