Guest Blog from: John Torous MD, Harvard
Last year, the British National Health Service (NHS) thought it was showing the world how healthcare systems can best utilize smartphone apps – but instead provided a catastrophic example of a failure to consider the social implications of technology. The demise of the NHS ‘App Library’ now serves as a warning of the perils of neglecting the technical aspects of mobile healthcare solutions – and serves as a call for the greater involvement of IEEE members at the this evolving intersection of healthcare and technology.
The NHS App Library offered a tool where patients could look online to find safe, secure, and effective smartphone apps to assist with their medical conditions. From major depressive disorder to diabetes, app developers submitted apps that were screened, reviewed, and evaluated by the NHS before being either approved or rejected for inclusion in the App Library. Millions of patients came to trust the App Library as a source for high quality and secure apps. Until one day in October 2015 the App Library was gone. Researchers had uncovered serious privacy and security vulnerabilities, with these approved apps actually leaving patient data unprotected and exposed. Further data highlighting that many approved apps also lacked any clinical evidence added to the damage. Overnight the NHS quietly removed the website (http://www.nhs.uk/pages/healthappslibrary.aspx) although the national press caught on and there was a public outcry.
As an IEEE member and a MD, I see both the potential and peril of mobile technologies like apps for healthcare. Mobile technologies like smartphone apps offer the promise of connecting millions of patients to immediate care, revolutionizing how we collect real time symptom data, and in many cases offering on the go and live health monitoring and support. But mobile technologies also offer serious security vulnerabilities, leaving sensitive patient medical information potentially in the public sphere. And without standards to guide development, the world of medical apps has become a chaotic and treacherous space. Simply go to Apple or Android app stores and type in ‘depression’ and observe what that search returns. A sea of snake oils, apps that have no security or data standards as well as no clinical evidence are being marketed directly to those who are ill.
The situation is especially concerning for mental illnesses. Many mental illnesses may be thought of in part as behavioral disorders and mobile technologies like smartphones have the potential to objectively record these behavioral symptoms. Smartphones also have to potential to offer real time interventions via various forms of e-therapy. Thus mobile technology holds the potential to transform how we diagnose, monitor, and even treat mental illnesses. But mental health data is also some of the most sensitive healthcare data that can quickly ruin lives if improperly disclosed or released. And the clinical evidence for the efficacy of smartphone apps for mental illness is still nascent. Yet this has not held back a sea of commercial apps that are today directly available for download and directly marketed to those whose illness may at times impair clear thinking and optimal decision making.
If there is one area where the societal and social implications of technology are actively in motion and needing guidance, mobile technology for mental healthcare is it. There is an immediate need for education and standards regarding consumer facing mobile collection, transmission, and storage of healthcare data. There is also a broader need for tools to standardize healthcare apps so that data is more unified and there is greater interoperability. Apple and Android each have their own healthcare app / device standards via Apple’s ReseachKit and Android’s Research Stalk – but there is a need for more fundamental standards. For mobile mental health to reach its promised potential of transforming healthcare, it first needs an internal transformation. A transformation led in part by the IEEE Society on Social Implications of Technology, global mental health campaigns (changedirections.org), forward thinking engineers, dedicated clinicians, and of course diverse patients.
If you are interested in tracking standards and developments in this area, please join the LinkedIn Mobile Mental Health App Standards group at: http://is.gd/MHealthAppGroup
John Torous MD is an IEEE member and currently a clinical fellow in psychiatry at Harvard Medical School. He has a B.S. degree in electrical engineering and computer sciences from UC Berkeley and medical degree from UC San Diego. He serves as editor-in-chief for the leading academic journal on technology and mental health, JMIR Mental Health (http://mental.jmir.org/), currently leads the American Psychiatric Association’s task force on the evaluation of commercial smartphone apps, co-chairs the Massachusetts Psychiatric Society’s Health Information Technology Committee.