Understanding the unintended consequences of healthcare apps

Dr Andrew Turner, Senior Research Associate, CLAHRC West, discusses the move towards ‘digital first’ care, the possible unintended consequences of healthcare apps, and how the DECODE study aims to improve the adoption of a range of digital health tools in primary care by understanding these unintended consequences.

We all know that people are living longer, but often with multiple long-term health conditions. Maintaining people’s quality of life in these circumstances requires a lot of support from the NHS.

At the same time, GP practices are under pressure to improve patients’ access to healthcare while coping with their own workloads and growing patient demand. Policymakers are proposing new ways to relieve the strain by using digital technologies such as phone apps to improve the convenience and reduce the cost of healthcare.

The move towards ‘digital first’ care is explicit in the new NHS Long Term Plan. It puts forward a vision in which “people will have more control over the care they receive and more support to manage their health, to keep themselves well and better manage their conditions, while assisting carers in their vital work.”

Hundreds of thousands of health apps are already available in app stores, targeting fitness, wellbeing and general health as well as specific conditions. As the Topol Review highlights, there are different logics driving innovation – there are apps designed to be used within healthcare systems “prescribed as digital therapeutics for self-monitoring and self-management”, and consumer health apps used by individuals independently of their contact with healthcare.

These developments are set against a backdrop of well-known challenges for healthcare app innovation. For example, evidence exists that some apps can help patients, but many have not had their effectiveness rigorously tested or the reliability of the information they provide assured.

The patient safety concerns this raises for health professionals who may want to encourage the use of apps are beginning to be addressed. In April 2017, NHS Digital launched the Apps Library, hosting a curated list of apps that could be trusted by the public and would help GPs recommend safe and effective apps to patients. And in March 2019 NICE published an evidence standards framework to aid the evaluation of healthcare technologies, including apps. Data privacy concerns are also prominent in debates about digital innovation generally, and this is no different as technologies expand into the health sector.

Some other possible consequences are less well understood, for instance, whether digital health tools will close or widen existing health inequalities, as well as what the impact will be on people’s relationships and communication with their GP, on GP workload and how GPs use health apps with patients.

Apps may under or over deliver their promised benefits or have the opposite effect to what was intended. They may generate new benefits not anticipated at the outset or have unforeseen negative effects. The practical reality of how new technologies are used, and by who, often generates unintended consequences. An understanding of these consequences is vital, so we can minimise the negative effects and harness the positive.

The DECODE study aims to improve the adoption of a range of digital health tools in primary care by understanding these unintended consequences. Healthcare apps that support patients to monitor and self-manage long-term conditions are a key technology being investigated in the study.

So how can the adoption and use of apps to manage long-term conditions in primary care be improved? We are giving healthcare app developers the opportunity to participate in the DECODE study.

Please answer our short survey about how to improve the implementation of healthcare apps for long term conditions

The DECODE study aims to produce guidance on the unintended consequences of digital health tools for patients, primary care, policymakers, developers and researchers, to improve the development, implementation and evaluation of digital health tools in primary care. Your views will help shape this guidance.