Regulating Mobile Health Apps

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[edit] About This Subject

The importance of regulating mobile health apps has been an area of concern amongst the medical community and the platforms that offer these services. The following articles were reviewed to demonstrate the positive effects of regulating mobile healthcare apps in order to establish standards and develop clear guidelines for the future of these applications.

[edit] Articles

[edit] Article 1

Privacy and Security in Mobile Health (mHealth) Research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432854/

[edit] Context

Research on the use of mobile technologies for alcohol use problems is a developing field, this data has the potential to yield new insights into the factors that lead to disease. Although the research literature in this area is sparse, lessons can be learned from other communities, such as cybersecurity or Internet security, which offer techniques to reduce the potential risk of data breaches or tampering in mHealth. This article focuses on privacy, confidentiality, and security in mHealth, areas ripe with research questions and opportunities whose times are overdue.

[edit] Summary

The Department of Health and Human Services, and the Office for Civil Rights, developed the Health Insurance Portability and Accountability Act (HIPAA), which provides defined policies and guidelines for maintaining privacy and security of a patient health information. Within the Act, the Privacy Rule sets national standards for protecting every individual’s health information, and the Security Rule sets national standards for protecting personal health information in an electronic format. Researchers must therefore abide by the Federal Policy for the Protection of Human Subjects, also known as the Common Rule. The Common Rule was introduced in 1991 to protect individuals participating in research activities. The Common Rule sets out detailed policies and guidelines about informed consent, adverse events, handling of biological data, and vulnerable populations, and many other health related issues. Based on the lack of current regulations in the technology field, this article proposed changes to the researchers of these platforms, specifically in mHealth to develop systems that enhance participant privacy. This article suggests changes such as a simple electronic or paper checklist of possible data points administered before data collection and/or a patient-facing data dashboard that will allow participants to exercise their rights to control and access their data. Another option was to create a context-aware system that the participant controls, specifically the privacy options, that could change based on factors such as location, and who is accessing the data to match the participant’s level of trust. Other suggestions include; creating new security protocols as a simple way to increase data security, for example, enabling WPA2 encryption on a wireless device enhances the security of information transmitted over wireless networks, or the addition of VPNs or authentication factors can also be applied to networks to protect data that can be transferred. Specific areas of focus suggested that more attention is needed in the deletion of personal information from the app once the user has uninstalled the app and better data encryption practices. Also, it was observed that some apps did not have a privacy policy, and that mobile vendors must mandate the need for apps to have privacy.

[edit] Strengths and Weaknesses

This article demonstrated many strengths, first it suggested privacy changes could have an ability to reach a large and broad sample of consumers that already collect and continuously stream data on a range of potentially sensitive and possibly illegal behaviors and events. Research shows that most Americans consider information stored on their mobile phones to be as, or even more private than the information stored in their personal computers. This is an apparent disconnect between perception of privacy and how personal data is used. This research therefore suggested ways to enhance technological literacy are needed. Continued strengths from this literature suggest that rather than the people having to voice concerns about the risks in health research and care, that the scientific community should increase its efforts to teach the public about privacy and security risks in these technologies. This article therefore proposes changes to mobile health apps by including the addition of specific data management processes for individual security and privacy. Lastly, it highlights ways to standardize requirements within these applications that will improve uniformity in research, and how these changes will provide more clarity for researchers as they design research protocols to support digital privacy and security for all users. One areas of study weakness was noted in the results section where the authors go into detail on how consumers need to be more aware, proactive and involved in measures to protect their information, however in the discussion the focus was more on the providers to make these applications more transparent. The article should be addressed to all parties with shared responsibilities in the management of personal and private health care related information.

[edit] Assessment

Conclusions of this study suggest that adopting standard guidelines and creating a regulatory framework for mobile health apps will help address the challenges and to avoid the security risks associated with these platforms. Key findings propose that regulators must develop standards that the developers need to adhere to ensure privacy and security of users. It also suggests that the Involvement of healthcare professionals on factors such as functionality, usability and security will enhance the trustworthiness of the apps and increase their adoption by trusted consumers. Therefore, developers and healthcare professionals must work together to establish standards and develop clear guidelines for app development. This study aimed to enlighten users, and to encourage their education within the benefits and risks of using mHealth apps.

[edit] Article 2

Laying the digital and analytical foundations for Canada's future healthcare system

https://www.cmaj.ca/content/cmaj/190/1/E1.full.pdf

[edit] Context

Many sectors have embraced recent advances in data management and advanced analytics; however, the health care system seems to be struggling to keep pace. The health care sector is among the most data rich, yet still only has a handful of health care entities that are making investments in data analytics to improve the benefits to users. Some of the critical factors identified that are impacting their current success include changes to data availability, their underlying architecture of programs, as well as within the quality assurance and governance of their overall platforms. Suggested improvements from this article include a higher focus on issues related to privacy and security, and within the capacity and skills to manage and analyze health care data. This article stresses urgency for the Canadian health care system to consider more thoughtfully how it can best prepare for a technologically advanced future, and how these changes are needed as technology will always play an increasingly fundamental role in this context.

[edit] Summary

The growing incorporation of advanced analytics into an increasingly digital health care environment in Canada is promising. The challenges however lie within the evidence to support that contention, and that better patient outcomes and efficiency are required within the analytics itself. Advanced analytics have great potential to inform patient prognosis, to improve treatment and patient outcomes, and to enhance the efficiency of our health care system. Recent advances in information technology such as within access and improvement in storage, within the management and data processing abilities, as well as within the interest in applying advanced analytics to large clinical data repositories, that have offered insight into the potential gains from a greater investment into digital health care and analytics.

[edit] Strengths and Weaknesses

Strengths from this study include the analysis of advanced analytical approaches that have been used to increase precision in predicting user factors, such as the likelihood of death or disability, or in reference to hospital discharge among patients with stroke. A secondary strength was their inclusion of Canadian Health care data, as well as within their incorporation of the Canadian Institute for Health Information report, that outlined key building blocks in leveraging health care data to improve health within data availability, underlying architecture, quality assurance and governance, as well privacy and security. One of the weaknesses associated with this article include statistics that do not support these ideas from an investment perspective. The authors identify that lack of return on investment could impact its resonance within mobile health platforms, and to these researchers knowledge there was no clear return on investment that has yet to be demonstrated in this research. Therefore, future research would benefit from incorporating these concepts into their study. Lastly, the dependency on a “data-friendly” culture is difficult to achieve in such a diverse market of consumers. Future studies may want to focus on a specific demographic of consumer to correlate this relationship.

[edit] Assessment

As other industries are quickly developing intricate digital environments, health care is being left behind. This article stresses the need for new initiatives intended to improve patient care using advanced analytics. Suggestions include an approach to derivation and validation from a clinical prediction rule, as well as compliance within recommendations to employing effective communication strategies. This research aims to support positive change within mobile health technology, and to invest in advanced analytics for Canadian health care. Improvements within these analytical algorithms, and dedication to the quality assurance and governance of their applications, improves the capacity and skill to manage and analyze health care data for all involved.

[edit] Article 3

Mobile exercising and tweeting the pounds away: The use of digital applications and microblogging and their association with disordered eating and compulsive exercise

https://www.tandfonline.com/doi/full/10.1080/23311886.2016.1176304

[edit] Context

Recent social media research suggests that content featuring fitspiration messages on blogs and microblogs has increased. This study examines the association between user consumption of various types of social media, and reports of disordered eating and compulsive exercising as a possible connection. Results from this research demonstrate that the use of mobile phone applications and microblogs were associated with reports of disordered eating, and that the use of mobile phone applications was positively related to compulsive exercise behaviors.

[edit] Summary

Online health messages come in the form of Traditional Blogs, which are discussion or informational websites that consist of topical entries, Microblogs, which differ from traditional blogs due to their smaller content size, and Mobile Phone Applications, which are computer programs designed to work on smartphones, tablets, and other mobile devices. To date, there has been limited research on the role social media may play in internal or external appearance or behaviour. This research focuses on how mass media can be a great transmitter of societal ideals for both children and adults. Although media do not necessarily drive an individual’s actions, they can exert an influence on a person’s values and beliefs. The purpose of this study was to examine the association between the type of fitspiration social media individuals use, and negative health behaviors such as disordered eating and compulsive exercise. The degree to which social media use might be linked with demonstrations of disordered eating was a major aim of this research which concluded that more work was needed to determine what that association looks like and what the risks might be for using certain digital platforms.

[edit] Strengths and Weaknesses

Strengths of this study include the valid connections made between these applications and the potential adverse health consequences on users. Strengths from this study also stem from the positive demonstration of data collection within these platforms, and how collected user information can help create connections and establish better guidelines for the providers. Limitations to this research lie within the results which indicated that microblogs and traditional blogs were not significant in an individual’s need to compulsively exercise. These were two of the four dimensions studied within their research which lessened the impact of their results, it did however also highlight the applications that made the most impact on individual behaviour, which was significant. Also, although the sample size was large, most participants were Caucasian females, and 1 in 10 cases of eating disorders involves a male. Future research should include more male participants and aim for a more demographically and geographically representative sample.

[edit] Assessment

Mobile phone applications today are more interactive, allowing users to generate more extensive feedback from other users than traditional blogs. It makes sense that spending time on traditional blogs was not associated with disordered eating or compulsive exercise, given that traditional blogs consist of an online diary filled with emotional experiences with sporadic feedback from fellow users. Research findings indicate that frequently use of mobile phone applications is significantly related to both compulsive exercise and disordered eating. The current investigation examined the impact of social media on disordered eating and compulsive exercise. The first research question inquired about the relationship between social media use and disordered eating and resulted demonstrated a significant association between individuals’ use of mobile phone applications and reports of disordered eating. The second research question examined the relationship between social media use and compulsive exercise behaviors, and mobile phone applications were implicated in both unhealthy eating and compulsive exercise behaviors. This literature suggested that future research should incorporate a longitudinal study design in order to determine cause and effect of social media and negative health behaviors, and further assessing the relationship between the type of social media use and unhealthy behaviors to add depth to understanding other salient personality characteristics and individual differences that may impact the results.

[edit] Ryan Kasperski March 16th, 2020

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