Health Apps: "Mobile Applications for smartphones have strengths and weaknesses"

Interview with Dr. Stefan Becker, Medical Director of Transplantation, Clinic for Nephrology, University Hospital Essen

Medical apps like diabetes or high blood pressure diaries are becoming increasingly popular with smartphone users. There are many available choices out there but they are not always clear. Added to this is the question of how the data collected by the apps can be sensibly incorporated into treatment.


Photo: Smiling man with glasses and blue shirt - Stefan Becker; Copyright: privat

Dr. Stefan Becker; ©private

Dr. Becker, telemedicine or medical app? Which do you prefer as a physician?

Stefan Becker
: I don’t ask myself this question since you can use a medical app for telemedicine or just for documentation purposes for instance. What’s actually more important is the context and specific purpose of a device and compliance with the applicable data protection laws. What’s more, the user – physician or patient – needs to benefit from an application. The platform is secondary.

Patients typically use apps when they are alone at home. Not everyone is able to operate them; older patients, in particular, have a hard time. Do you still see room for improvement in this case?

Becker: So far, smartphone applications have both strengths and weaknesses since there is no integrated approach yet that considers all of the needs of individuals. To date, there is no one specific app that fits all chronically ill or other patients. Crucial to success – especially in the case of older patients – is the integration of this technology into the treatment and to instruct the patients accordingly.

Which patients are particularly well suited for health apps based on their disease pattern?

Becker: We conducted a comprehensive study with our ”iNephro-app“. The results were published just recently. We tested an application that assists patients in taking their medications as prescribed. The software was available via free download from the Apple app store. We simultaneously invited the users to participate in our study. Aside from demographic and anamnestic data, we subsequently analyzed activity. We were able to find out that especially patients over fifty with certain pre-existing conditions (cardiovascular diseases for example), who regularly need to take many different medications, showed a high level of acceptance. Needless to say, if people don’t currently own a smartphone, they won’t purchase one just to use this one app. However, patients who already use this technology in everyday life, benefit from this type of app – and they are likely to use it. Our studies substantiate this.

How consistently did patients use this app?

Becker: There is always a certain level of fatigue with all online choices in terms of use. That is to say, the app is initially exciting and used frequently. Interest dwindles during the second phase. You might say that only about 25 to 30 percent of users remain active after four weeks. The reasons for this may be complex. When a new app enters the market, many patients download it because they find it interesting. They only gradually realize whether it is the right product for them. When it comes to medication apps, for example, younger patients who potentially only take drugs on a temporary basis or just need to take a few of them regularly, only require this type of help temporarily. In contrast, our study showed that older smartphone users and those suffering from chronic diseases like to utilize these types of technical aids on a long-term basis. This is completely different in the case of children: the point here is to inform and motivate in a playful way and thereby deepen knowledge and behaviors.

Photo: Old woman with smartphone; Copyright:

Older patients benefit from health apps if they are adapted to their special needs; © ocskaymark

Sometimes apps turn out to be faulty. Recently, a diabetes app displayed a wrong bolus insulin dose for users. Do you caution patients when using apps?

Becker: It is important to check whether the app is considered a medical advice or not. If you measure your blood pressure by placing your finger over the camera sensor, you should be aware that this reading cannot be very accurate. If you need to measure your blood pressure due to therapeutic purposes, you should do so only with a medical device. What’s more, an app is not able to replace the role of a doctor. It is unwise to rely on a skin screening app, for example, to accurately detect melanoma skin cancer. In the U.S for instance, people frequently rely on apps if they have no health insurance or are not able to afford a visit to the doctor. This is understandable but also dangerous. Apps are not yet used all that frequently in Germany because a medical consultation continues to be the primary focus. This is why an app won’t need to replace a visit to the doctor- also as a result of statutory health insurance- but is able to support doctor-patient interactions instead. For instance, I would also like to see that diabetes apps are complementing the existing doctor-patient interactions, support and make them more effective and efficient but not replace them.

When it comes to medical apps, sooner or later the issue of data protection and security always comes up. So here it is: are you worried that important data of your patients could be accessed?

Becker: During the past few months, there have been targeted hacker attacks on health care institutions. This worries us of course. It requires interdisciplinary concepts and IT strategies to avoid potential harm to our patients. I want to see an increased cooperation between health care service providers and IT security companies to make services as secure as possible and thereby take on a pioneering role in the world.

Not only criminals but also many a health insurance company would like to have access to patient data. What are your thoughts about this?

Becker: There are indeed statutory health insurance providers who would like to act as data trustees for their patients. In a next step, private health insurance providers offer rates where insured persons can document their “healthy lifestyle” via an app and correspondingly participate in incentive reward programs. I believe this is worrisome against the background of our German statutory health insurance system that’s based on the solidarity principle: when I reward a patient for regularly using a health app to document his/her healthy lifestyle, for example, I make him/her transparent. Oftentimes patients are not aware of the potential drawbacks if they no longer use the app regularly after the initial excitement has worn off. One current example from Russia: a private insurance company offers diabetics who regularly monitor their blood sugar levels a special rate. Once they no longer measure their blood sugar levels, their insurance coverage expires. This is an interesting, albeit questionable approach – but either way, this would not be conceivable in Germany.

Photo: Simone Ernst; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Simone Ernst and translated by Elena O'Meara.