You know me, I’m enthusiastic about apps and online health content and innovating health care delivery. But we do have to be thoughtful about how we use and integrate new technology.
One in 5 smart phone users in the US has a health app on their phone. With over 50% of American adults owning a smartphone, that’s a lot of people with health apps walking around. Although the most common apps that people download typically tracks the food they eat or the exercise they complete, the over $700 million-dollar-a-year generating industry is teeming with new health products every day. In pediatrics, I see more phones out during the first newborn check and subsequent weight and feeding appointments than at any other time.
Most new parents that come to see me are tracking their baby’s poop, pee, feeding, diapers, or new milestones–and many are doing so using their phone. Subsequently, most of the children coming into our society today are not only tracked with technology, they will grow up with parents who use tools to help protect and support their lives. Using applications to prevent, diagnose, treat, and ultimately cure disease is not really just a dream anymore. It turns out these applications to support our own health are clearly becoming a part of the health care of the present-future.
The effectiveness of these apps remains imperfectly proven. Just last week, a study published in JAMA Dermatology found that apps advertised to improve diagnosis of cancer highly variable in their ability to help patients. Researchers and doctors at the University of Pittsburgh set out to study popular mobile and web-based apps designed to help patients identify potential skin cancers. Specifically, they evaluated apps advertised to pick up the most deadly type of skin cancer, malignant melanoma.
Skin Cancer Apps: Unreliable But Quick
- Researchers acted like patients, they searched app stores with search terms: “skin, skin cancer, melanoma, mole” to identify applications on the market.
- They then selected 4 apps to study that allowed the users to upload photos of moles. Researchers used 188 photos obtained in clinic from patients just prior to mole removal. The researchers had the benefit of knowing the ultimate diagnosis of all the 188 moles they uploaded to the applications. Of those 188 moles, 60 ended up being diagnosed as malignant melanoma.
- 3 apps worked by evaluating the photo and providing feedback (“atypical” versus “typical” or “problematic” versus “okay”). One app included in the study sent the uploaded mole photo for review to a board certified dermatologist.
- None of the apps were perfectly reliable. In all, 3 out of 4 apps missed 30% or more of the moles that were melanoma, categorizing them as non-concerning. The app that proved most effective in picking up skin cancer was the one that functioned more like a telemedicine app where individual photos were sent to a board-certified dermatologist. Even so, it still missed true melanomas (1 in 53) and wasn’t specific in diagnosis.
- In 3 of the apps, patients had a near instantaneous response–uploading the photo and getting a response. In the telemed app where it was sent out, responses arrived within 24 hours.
- Researchers concluded the study with concerns, “This potential [misuse of the apps] is of particular concern in times of economic hardship, when uninsured and even insured patients, deterred by the cost of copayments for medical visits, may turn to these applications as alternatives to physician evaluation.”
Don’t jump to too many conclusions. Just because these 4 apps don’t work well to diagnose skin cancer, it doesn’t mean we’re not moving in the correct direction. And this study doesn’t prove that patients use these apps without their doctors. Having improved ways to complete mole surveillance and chronicle changes in moles will be increasingly important for those with high risk skin conditions or family history. Some apps that track and store photos of moles for comparissons were not compared and may help educate and support patients. What we know now is that apps designed to triage or diagnose moles as “atypical” versus “typical” or “melanoma” versus “normal” may not be ready for prime time, especially if they don’t involve expert opinion. It’s important that you see your dermatologist or physician for expert mole checks and biopsies when indicated. If you’re worried about your moles, or moles on your children talk with a physician. And if you use the apps, do what most people online do when they come to a diagnosis, go in and consult with an expert for confirmation.