Apps are ubiquitous in our digital lives, and health apps, whose numbers can now be counted in the thousands, are part of the mobile mainstream and our daily life.Mobile access to healthcare services can provide a great advantage to various stakeholders, such as healthcare professionals (including disease diagnosis apps, drug reference apps, and medical calculator apps),medical and nursing students (such as anatomy tools and electronic versions of medical books), and patients (such as chronic disease management apps ). For patients, mobile technology has the potential to improve patient education, self-management of chronic diseases and to enhance the possibilities for remote monitoring of patients.
An app overload is currently evident, where there is an app out there for everything. But have we really done well in this respect? Does quantity equal quality in the world of medical apps? What can we do better? What other the challenges in the design of future mobile health apps that are usable, effective and useful? What is the problem design space?
The mobile health industry has a problem: It has simply grown too quickly. Users can now download medical apps for self- monitoring (and diagnosing) of just about any condition and apps for general wellness, diet, and fitness are proliferating (it is in fact impossible to give an exact number of how many health and wellness app exist, as numbers change daily). Public health agencies, pharmaceutical companies, and numerous start-ups that have all released numerous apps in the past few years and as a result they have outpaced government regulators. Standards for interoperability to achieve seamless integration with more traditional models of healthcare delivery and the newly implemented Electronic Health Records (EHRs) as well as standardised mechanisms for providing security, privacy and confidentiality of patient data are required to ensure that health apps are designed to really be useful in the complex healthcare information system landscape. Even though the U.S. Food and Drug Administration (FDA) have tried to play catch up by releasing a set of draft guidelines , the finalised guidelines have not been widely implemented yet and more work in this area is required. These highly anticipated rules are expected to bring some clarity on issues such as the difference between a ‘medical app’ and a ‘wellness app’ and ‘diagnosing’ and ‘monitoring’. But will these new rules influence the design of future health apps and could they perhaps stifle innovation? Will these be a panacea to instill some responsibility to the release of high quality medical apps, and if so how ?
Designing for a mobile context is still a challenging and complex task. The design of mobile health services and the need to accommodate different contexts is even more challenging due to the users’ continuous and pervasive interactions. Different contexts of use, device characteristics, functionality and location affordances pose numerous challenges to the design of mobile health applications. Design guidelines and evidence-based principles on session mobility (i.e. the ability to maintain an active sessions while switching between terminals, devices etc) are required. Specific guidelines for the design of an emotional user experience is also required, especially for applications that provide a diagnosis for a sensitive condition. How can we design apps that ‘replace’ the traditional (hence confidential and secure) face to face doctor-patient interaction? How can we design health apps that instill trust, legitimacy and confidentiality? How can we design apps that improve the lifestyle of patients with long term conditions?
The lack of regulation for mobile health apps is also accompanied by very little evidence for the effectiveness of mobile health apps and consequently very little experience on how to best evaluate these apps. Usability guidelines for mobile applications are isolated, and specific usability dimensions that should be considered in a health context are very limited. Existing usability guidelines are insufficient to design effective interfaces for mobile applications due to peculiar features and dynamic application context in mobile. Current research In this field, demonstrates that user testing is often overlooked and focuses solely on the ease of use and user acceptance and ignores attributes such as cognitive load and learnability. Existing lab-based and ‘in the wild’ methods to inform the design and evaluate apps in their actual context also exist, however a holistic User Centred design framework to support the entire design and development lifecycle of mobile health applications is not available
In my opinion , the design of mobile health applications is largely a multi-stakeholder/discipline process which makes the need for a better framework for the regulation and evaluation even more pressing. We need clear recommendations on the use of medical apps that are supported by studies that evaluate their quality, effectiveness, scientific relevance, and cost benefits.