mobile apps for chronic disease management: lessons learned from myfitnesscompanion®

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ORIGINAL PAPER Mobile apps for chronic disease management: lessons learned from myFitnessCompanion ® Peter Leijdekkers & Valerie Gay Received: 3 October 2012 / Accepted: 6 February 2013 / Published online: 15 February 2013 # IUPESM and Springer-Verlag Berlin Heidelberg 2013 Abstract Nowadays, many health and fitness applications (apps) can be downloaded from app stores, changing the way people manage their health and chronic diseases. This paper reflects on 7 years of experience in mobile health and fitness app development. It analyzes the uptake of a health and fitness app, myFitnessCompanion®, by the healthcare industry and end-users dealing with chronic disease man- agement. The use of myFitnessCompanion® is analyzed from an end-user perspective. The app is available via Google Play since February 2011 and the research presented is based on data collected from 5500 + users over a period of 7 months. The paper also discusses how mHealth apps could be distributed in the near future, as well as, the use of Personal Health Record (PHR) systems such as Microsoft HealthVault, and the impact of regulations on the future of mHealth apps. The conclusion highlights the challenges and opportunities for app developers in the mHealth industry. Keywords mHealth . Health and fitness apps . Chronic disease management 1 Introduction Mobile Health apps, hereafter referred to as mHealth apps, are health and fitness related applications running on mobile devices such as smart phones and tablets. An increasing number of people use mobile apps to monitor their health or fitness and gradually they are being used for prevention, diagnosis and treatment. These apps can be personalized and tailored to the user s condition and can be used in the comfort of their home, office, or even on the move. They are a step towards ubiquitous healthcare, i.e. access to healthcare anywhere, anytime, thereby allowing chronic disease patients to self-manage their condition using mobile devices and wireless sensors. The mHealth application market is booming, and will continue to grow substantially over the next few years, according to a study conducted by Frost & Sullivan in 2011 [1]. The growing availability of health and fitness apps and increasing number of people using smart phones and tablets encourages the healthcare industry to exploit the possibilities offered by health and fitness apps. According to the Global Mobile Health Market Report 20102015 [2], more than a third of the 1.4 billion smart- phone users will use some kind of mobile healthcare appli- cation in 2015. At the time of writing (December 2012), thousands of health and fitness apps are available for down- load on Google Play [3]. Of those, 396 Apps use some sort of sensor (e.g. weight scale, blood pressure monitor, accel- erometer, GPS) to collect or derive physiological data. An app can be downloaded for free or a few dollars that helps the user losing weight, monitor their blood pressure or guide the user in their workout exercises. People from more than 190 countries download apps everyday and a total of 10 billion downloads have been recorded up to December 2011 [4]. Our team has developed such an application called myFitnessCompanion® [ 5]. It uses wireless sensors (Bluetooth, Wifi), or manual entry, to collect physiological data. It works on Android phones & tablets and offers personalized exercise tracking and monitoring of weight, food intake, blood pressure, asthma, blood glucose, HbA1c (glycated hemoglobin), cholesterol, temperature, P. Leijdekkers (*) : V. Gay Faculty of Engineering and Information Technology, University of Technology, PO Box 123, Broadway 2007, Sydney, NSW, Australia e-mail: [email protected] V. Gay e-mail: [email protected] Health Technol. (2013) 3:111118 DOI 10.1007/s12553-013-0044-9

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Page 1: Mobile apps for chronic disease management: lessons learned from myFitnessCompanion®

ORIGINAL PAPER

Mobile apps for chronic disease management: lessons learnedfrom myFitnessCompanion®

Peter Leijdekkers & Valerie Gay

Received: 3 October 2012 /Accepted: 6 February 2013 /Published online: 15 February 2013# IUPESM and Springer-Verlag Berlin Heidelberg 2013

Abstract Nowadays, many health and fitness applications(apps) can be downloaded from app stores, changing theway people manage their health and chronic diseases. Thispaper reflects on 7 years of experience in mobile health andfitness app development. It analyzes the uptake of a healthand fitness app, myFitnessCompanion®, by the healthcareindustry and end-users dealing with chronic disease man-agement. The use of myFitnessCompanion® is analyzedfrom an end-user perspective. The app is available viaGoogle Play since February 2011 and the research presentedis based on data collected from 5500+ users over a period of7 months. The paper also discusses how mHealth apps couldbe distributed in the near future, as well as, the use ofPersonal Health Record (PHR) systems such as MicrosoftHealthVault, and the impact of regulations on the future ofmHealth apps. The conclusion highlights the challenges andopportunities for app developers in the mHealth industry.

Keywords mHealth . Health and fitness apps . Chronicdisease management

1 Introduction

Mobile Health apps, hereafter referred to as mHealth apps,are health and fitness related applications running on mobiledevices such as smart phones and tablets. An increasingnumber of people use mobile apps to monitor their health

or fitness and gradually they are being used for prevention,diagnosis and treatment. These apps can be personalized andtailored to the user’s condition and can be used in thecomfort of their home, office, or even on the move. Theyare a step towards ubiquitous healthcare, i.e. access tohealthcare anywhere, anytime, thereby allowing chronicdisease patients to self-manage their condition using mobiledevices and wireless sensors.

The mHealth application market is booming, and willcontinue to grow substantially over the next few years,according to a study conducted by Frost & Sullivan in2011 [1]. The growing availability of health and fitness appsand increasing number of people using smart phones andtablets encourages the healthcare industry to exploit thepossibilities offered by health and fitness apps.

According to the Global Mobile Health Market Report2010–2015 [2], more than a third of the 1.4 billion smart-phone users will use some kind of mobile healthcare appli-cation in 2015. At the time of writing (December 2012),thousands of health and fitness apps are available for down-load on Google Play [3]. Of those, 396 Apps use some sortof sensor (e.g. weight scale, blood pressure monitor, accel-erometer, GPS) to collect or derive physiological data. Anapp can be downloaded for free or a few dollars that helpsthe user losing weight, monitor their blood pressure orguide the user in their workout exercises. People frommore than 190 countries download apps everyday and atotal of 10 billion downloads have been recorded up toDecember 2011 [4].

Our team has developed such an application calledmyFitnessCompanion® [5]. It uses wireless sensors(Bluetooth, Wifi), or manual entry, to collect physiologicaldata. It works on Android phones & tablets and offerspersonalized exercise tracking and monitoring of weight,food intake, blood pressure, asthma, blood glucose,HbA1c (glycated hemoglobin), cholesterol, temperature,

P. Leijdekkers (*) :V. GayFaculty of Engineering and Information Technology,University of Technology, PO Box 123, Broadway 2007,Sydney, NSW, Australiae-mail: [email protected]

V. Gaye-mail: [email protected]

Health Technol. (2013) 3:111–118DOI 10.1007/s12553-013-0044-9

Page 2: Mobile apps for chronic disease management: lessons learned from myFitnessCompanion®

respiration, oxygen, intraocular pressure, bowel movementand heart rate. The therapy fields include fitness, diabetes,asthma, obesity and hypertension.

The first mHealth app developed by the team was relatedto continuous heart rhythm monitoring to detect certainarrhythmia. Trials were conducted to obtain feedback fromusers and health professionals regarding functionality andusability of a mobile phone app [6].

Ease of use and a clear interface was adopted bymyFitnessCompanion as a result from these trials. It hasbecome evident that chronic disease management is whatpeople are looking for in a mobile mHealth app.

Figure 1 shows several screenshots of myFitnessCompanionon a smart phone.

myFitnessCompanion® is available from Google Playand can be downloaded on an Android device for free or asmall fee. The sensors can be purchased separately if re-quired. Users can tailor the app to their needs and sensorsthey want to use. They can enter measurements manually(e.g. bowel movement, food intake), or if they don’t have awireless sensor.

myFitnessCompanion® allows users to keep track oftheir progress on easy to read graphs or upload theirdata to a Personal Health Record (PHR) system such asMicrosoft HealthVault® [7]. Thresholds and targets foreach physiological data monitor can be set to suit theuser’s particular condition. Personalized feedback is given intext or voice after each measurement (See [5] for moredetails).

The objective of this paper is to share the experiencedeveloping and rolling out a health and fitness app. It isorganized as follows:

Section 2 analyses myFitnessCompanion®‘s demo-graphics and focuses on languages used and countryof origin. It investigates the type of physiological datatracked and how data is entered into the application. Itdiscusses how users prefer to store their data and providesa summary on user acceptance. Section 3 discusses theacceptance by health professionals based on trials con-ducted with an Australian hospital and on feedback re-ceived from organizations interested in integratingmyFitnessCompanion® into their chronic disease man-agement systems. Section 4 discusses the potential im-pact of regulations such as the Food and DrugAdministration (FDA) on the future of mHealth apps.Section 5 presents the developer’s point of view whereassection 6 highlights the role of App stores and discussesthe future of mHealth app distribution. Section 7 con-cludes with a brief SWOT analysis on the use of mobileapps for chronic disease management, and highlights thechallenges and opportunities for app developers.

2 myFitnessCompanion®–user perspective

myFitnessCompanion® was launched worldwide viaGoogle Play in February 2011. The application supports

Fig. 1 myFitnessCompanion® data and exercise tracking examples

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14 different languages (e.g. English, Mandarin, French,Spanish) and no marketing campaign has been conductedfor a particular country. The application uses GoogleAnalytics [8] to collect anonymously usage data. GoogleAnalytics is a very effective tool and offers detailed insightin the features used by myFitnessCompanion users. Theresults presented are based on Google Play statistics andGoogle Analytics data from 5500+ users collected betweenJune 2011 and January 2012. It provides insight into thematurity level of the health and fitness App market forchronic disease management from a user’s perspective.The objective is to find out whether users are willing touse health and fitness apps such as myFitnessCompanion,and to investigate what conditions are being monitored,and which functionalities of myFitnessCompanion areused.

myFitnessCompanion® offers 3 different versions of theapp (Free, Silver and Gold). For the free version, the numberof concurrent physiological data monitoring is limited to 3and 10 measurements can be stored before the user is askedto upgrade to the paid version (Silver or Gold) or to deleteold measurements.

The Silver version allows unlimited collection ofmeasurements for three physiological data monitors. TheGold version is the premium version with no restrictionsand allows also the upload of measurements to PHR systemssuch as Microsoft HealthVault®. The vast majority ofpaying users use the Gold version.

Due to the different versions some results presented inthis section are limited to users using the paid version of theapp. The results are further limited to data collected fromusers that own an Android phone device and voluntarilywant to monitor their health.

2.1 User demographics

The statistics presented in Fig. 2 suggest that the typical userowns a mainstream mobile phone that is approx. 1 year oldwith not necessarily the latest OS installed. Initially, the appwas only available for mobile phones but, due to the

increasing popularity of tablets, a trend is visible that usersinstall myFitnessCompanion on tablets as well.

Users can set instructions and feedback in their ownlanguage. Currently, myFitnessCompanion supports English,Mandarin, Spanish, French, Portuguese, Russian, Dutch,German, Korean, Japanese, Brazilian, Hindi, Swedish andItalian. Figure 3 shows that English is the most widelyused language followed by German and Spanish. It issurprising that Mandarin speaking countries seem not touse myFitnessCompanion. This is in stark contrast with astudy conducted by MiniWatts Marketing Group [9] thatputs Mandarin/Cantonese just behind English as the mostused language on the Internet. The most likely explanationis that the Google Play is not available in China andtherefore the exposure of myFitnessCompanion is verylimited.

When looking at the distribution of users per country(Fig. 4), the data shows that 4 of the top 10 most App savvycountries [4] use myFitnessCompanion: South Korea, theUnited States, Israel and the Netherlands. Surprisingly, 25 %of myFitnessCompanion users live in Germany. However,this is in line with literature: A Deloitte’s study [10] men-tions that the German fitness market has reached a newrecord high in 2011 and Germany has 7,100 fitness facilitieswith more than 7 million registered members, which is8.9 % of the total population. The report concluded thatGermans put increased value on physical fitness, and arewilling to spend money on it. Another article about the75th anniversary of a German sporting medal designation[11] phrases it as follows: “Hardly a nation gets so giddy(literally: drunk) on its own fitness like the Germans.”

2.2 What are users monitoring and how?

myFitnessCompanion can collect and interpret physiologi-cal data based on user preferences and personal thresholds.It enables users to adjust thresholds and targets to suit theirparticular condition and fitness level. Users can also receivereminders to take their measurement and choose to receivetext and voice feedback. During the study period, 40 %

Android 2.3.3+, 51.0Android

2.2, 30.5

Android 2.1, 10.8

Other, 7.7

Fig. 2 Android OS breakdown (%, source: Google Play statistics)

English, 56.9

German, 9.9

Spanish, 8.6

Dutch, 4.5

French, 4.0

Portuguese, 3.8

Korean, 2.5 Other , 9.8

Fig. 3 Language breakdown (%, source: Google Play statistics)

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of the total events recorded by Google Analytics formyFitnessCompanion where related to physiological datamonitoring.

Physiological data monitoring Figure 5 shows that usersmainly monitor their blood pressure (28.5 %), blood glucose(28.1 %), weight (27 %) and heart rate (5.5 %). Only a smallproportion of users monitor other physiological datasuch as oxygen, asthma, respiration, HbA1c, cholesterolor temperature.

This is inline with feedback received from myFitness-Companion users, which indicate that they also use comple-mentary apps to monitor their diabetes, blood pressure andweight loss. Comments from users illustrate this observationas well:

“The app is serving me well, by allowing me to trackmy weight and heart rate which was very important tome.”“Awesome! Works great with my Droid X. I use thismainly for getting body composition readings byBluetooth connection to my scale (…)”.

The main reason for using complementary apps is relatedto the fact that users do not want to loose existing data norwant to change their subscription with a service provider.myFitnessCompanion continues to add new features such asfood intake management and improve interoperability withother apps (e.g. FatSecret, iBody) so that existing data canbe downloaded into myFitnessCompanion.

Exercise monitoring 5.7 % of the monitoring is related toexercise tracking. myFitnessCompanion can track differenttypes of exercises using real-time data such as heart rate,calories burnt, body temperature and respiration rate. It usesbuilt-in GPS for accurate outdoor distance tracking. Mostexercise entries consist of a mix of manual and sensor data.The vast majority of users use the exercise functionality tomonitor their walking activities (70.2 %). Other exercisesinclude cycling (5.6 %), weight training (4.7 %), runni-ng/jogging (4.2 %) and treadmill (3.3 %). The followinguser feedback shows the use of the exercise feature:

“Excellent app for use with my heart rate Zephyr HxMmonitor. App records monitor readings for my work-outs and then I export the data for analysis of mytraining. I like the fact I can change the frequencythe data is recorded for the different workouts. Theconnection with Google Health saves time by upload-ing data. Built in graph gives a quick glance at theoverall data from a workout. The ability to get voiceoutput of data during workout is helpful when I can’tmonitor the screen. Having a Bluetooth earpiece tolisten makes it even more convenient. Great App!”

2.3 How are users monitoring themselves?

Manua l d a t a e n t r y v e r s u s w i re l e s s s e n s o r smyFitnessCompanion works seamlessly with 15 differentwireless sensors. The current list of hardware sensors sup-ported can be found in [5]. The app also allows users toenter data manually. To date most users (88.6 %) enter thedata manually and only a small percentage uses one of thewireless sensors supported. A possible reason could be thecomplexity of pairing the Bluetooth sensor with the mobiledevice. However, the app includes step-by-step videosshowing how to pair a specific Bluetooth device [12] andthis overcomes many potential difficulties based on userfeedback received. Once set up, the sensors seamlesslyintegrate with the App, and how the sensor connects to theApp is transparent to the user. There can be different reasonswhy a particular sensor is more popular than others (e.g.price, well known brand). However, manual entry is mostused because of the substantially higher price of theseBluetooth devices compared to a non-Bluetooth deviceand also the fact that most users prefer to keep using theirown medical devices.

On-demand versus continuous monitoring The majority ofmeasurements are recorded on demand (94.5 %) and only asmall percentage monitor continuously their heart rate, res-piration or oxygen level for a longer period of time. This isin line with the observation that myFitnessCompanion usersmainly monitor their blood pressure, blood glucose and

USA, 36.8

Germany, 25.1

Australia, 3.8

Brazil, 3.6

Austria, 3.5

Israel, 3.0

Spain, 2.8

France, 2.7 Netherlands, 2.6

South Korea,

2.3

Fig. 4 Country breakdown (%, source: Google Analytics)

Blood pressure

28.5

Heart rate5.5Other

10.9

Blood glucose

28.1

Weight27.0

Fig. 5 Data monitoring (%, source: Google Analytics)

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weight, which do not require continuous monitoring.Continuous monitoring is mainly used in conjunction withexercise tracking where users monitor their performanceover a longer period of time.

2.4 What are users preferences for storing and sharing healthdata?

myFitnessCompanion® stores measurements locally on thephone but also allows the user to upload the data to aPersonal Health Record (PHR) system such as GoogleHealth or Microsoft HealthVault®. The health records maythen be shared with health professionals, doctors, andresearch institutes. Data collected, show that many userstake their measurements every day and upload these to aPHR. myFitnessCompanion® interfaced with GoogleHealth until Google decided to close down the service inDecember 2011. It became apparent that users were inter-ested in PHR systems when they asked for an alternative.From January 2012, myFitnessCompanion® connects toMicrosoft HealthVault® and it is one of the first Androidapplications formally approved to upload and downloadphysiological data to and from Microsoft HealthVault® inthe USA and the rest of the world. A formal reviewprocess was conducted by Microsoft to ensure that the datauploaded and downloaded complies with the standards asset by Microsoft.

However, the vast majority of users keep the datastored on their phone (91,7 %) and use the built-in graphfunctionality to view their progress. Only 5.3 % usemyFitnessCompanion server and 3.1 % uploads the datato Google Health. These low percentages are most likelyrelated to the fact that users need to have the premium(paid) version of myFitnessCompanion to be able toupload data to PHR servers. With the recent addition ofMicrosoft HealthVault®, these numbers will go up in thenear future.

Data export myFitnessCompanion allows the export (viaemail) of physiological data in Excel format and graphs.Blood pressure (40 %) is most exported which can beexplained, since many users want to share their blood pres-sure history with their GP. Furthermore, blood pressure andblood glucose are the most popular physiological data beingmonitored by myFitnessCompanion users. The export ofexercise tracking data (11.7 %) is relatively high due tothe fact that these users want to monitor and compare theirperformance over time.

Export to social networking sites myFitnessCompanionallows users to post their measurement results to Facebookor Google+, which can improve their motivation. Anexample Facebook wall posting is shown below (Fig. 6).

However, sharing health related data with social net-works is not very popular. Most people affected by chronicdisease are not willing to share this type of data with friends.

3 Summary of user acceptance

Overall, the data analysis shows that myFitnessCompanion isparticularly suitable for chronic disease patients since theyneed to collect and monitor their health regularly, and for along period. Blood pressure, weight and blood glucose mon-itoring are most used which is not surprising since they relateto cardiovascular, diabetes and obesity diseases, which are themost prevalent in developed and developing countries [13].

Each user has different needs so it is important to be able topersonalize and configure the application to the user require-ments. Some patients want to receive immediate feedbackregarding their physiological readings, whereas others preferno feedback and wait for their health professional to validatethe data. Active people want the application to be as unobtru-sive as possible. myFitnessCompanion® has been designedwith this in mind and allows full personalisation of the app.

Simplicity and motivation, not age, seem to be the keyfactors for accepting and using fitness and health Apps. Atrial with an earlier version [6] of myFitnessCompanion®,

which focussed only on arrhythmia detection, confirms thatfor user acceptance the application had to be easy to use andcustomizable. The majority of users were over 60 years old,with some in their 80’s. No problems were recorded regard-ing the use of the mobile app and wireless sensors. This wasdue to highly motivated patients that wanted to know fromwhich arrhythmia they were suffering.

The users find it important to be in charge of their healthand keep track of their progress (e.g. they can work out whattriggers changes in blood sugar levels or blood pressure).However, self-motivation to record data over a longer periodcan be a challenge without the involvement of a healthprofessional. As mentioned in [14], ‘Self-managementeducation for chronic illness may soon become an integralpart of high-quality primary care’.

4 Healthcare professionals

A feasibility trial conducted in collaboration with a hospital[6] showed that for health professionals an app has to add

Fig. 6 Facebook wall posting example

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value to the overall healthcare chain. The health professionalidentified the app useful for a certain category of patientswhere symptoms (arrhythmias in this case) did not show upduring a visit to the specialist.

Collecting physiological data in a home setting couldalso help avoiding the white coat hypertension (i.e. ‘thepresence of a defined hypertensive average blood pressurein an office setting but not at home’ [15]).

However, usage analysis of myFitnessCompanion®shows that measurements are mainly entered manually andthat the use of Bluetooth physiological sensors is limited.This may allow for inaccurate data entry, which couldcompromise reliability. Health professionals might thereforetreat personally recorded data as suspicious and reject it. Thequestion arises what will persuade healthcare professionalsto recommend mHealth apps? Reliability and accuracy areessential for acceptance by health professionals.

The use of devices certified by the FDA or the EuropeanCommunity (CE) such as blood glucose monitors and bloodpressure monitors are essential. It is also important to offerthe possibility to record physiological data regularly as itimproves the quality of the diagnosis. Chronic diseasepatients find that data collected by myFitnessCompanion®helps their GP providing a better diagnosis of their chroniccondition. In our trials, the cardiologist confirmed that thedata collected from a mobile app and wireless heart monitorwas of sufficient quality to identify the main arrhythmias.Using mHealth apps allow specialists to make better-informed decisions. Instead of saying that they cannot con-firm a diagnosis without evidence, they can recommend amHealth App, and a particular sensor, to monitor certainphysiological data over a longer period of time.

5 FDA: showstopper for mHealth apps in the USA?

In its latest proposal [16] the FDA considers that it will notregulate mobile apps that promote wellness and good health.However, apps that are involved in the diagnosis, treatment,cure, or mitigation of a disease will need to be FDA approved.If the FDA definition is applied to myFitnessCompanion®, itdoes not need approval for logging, recording or tracking ofweight and exercises and it can perform the function of anelectronic health record. However, the guidelines suggestFDA approval for “mobile medical apps that allow the userto input patient-specific information and–using formulae or aprocessing algorithm–output a patient-specific result, diagno-sis, or treatment recommendation that is used in clinicalpractice or to assist in making clinical decisions”. AlsoFDA approval is needed if the mobile app retrieves data fromsensors that are classified as medical devices by the FDA. Ifthe FDA proposal is approved, myFitnessCompanion®would either need to create a US version, which is far less

personalized, with a minimum of user feedback and only nonmedical sensors, or obtain FDA approval.

A major problem with the current FDA proposal is that itwill slow down the innovation of mHealth apps since it isalmost impossible to obtain FDA approval fast enough tokeep up with the continuous release of new smartphones,tablets or operating system updates. On the positive side,FDA involvement would mean credibility and wouldimprove the trust by patients and health professionalsin mobile apps.

6 Mobile app developers viewpoint

There are many challenges and opportunities for health andfitness app developers. Currently, there is a huge gap be-tween what users are willing to pay, versus what it costs todevelop and maintain an mHealth app. Users should notneed to pay a fortune to monitor their health using amobile device. However, the looming FDA regulationmight stall the use of mHealth apps in the USA or forcedevelopers to charge a lot in order to recoup the FDAcertification costs.

There is also a strong interest from healthcare providerswith a web based solution to add myFitnessCompanion® astheir mobile component. Mobile apps can collect and trans-mit data in a reliable and secure manner to a PHR system(e.g. Microsoft HealthVault®). Adding a mobile version totheir solutions portfolio increases their market share andimproves personalization and customer empowerment.Health sensor manufacturers are also very interested inmHealth apps as it offers them the opportunity to sell morehardware devices. Mobile apps with wireless connectivityoffer a perfect means to interact seamlessly and comfortablywith these wireless devices.

As mentioned in section 2.2, many users do use morethan one app to monitor their health. It is therefore desirable,from a user’s perspective, to achieve interoperability betweenthe various Apps. The use of Microsoft HealthVault® as acentral data repository is a great way to offer interoperabilityby allowing users to import/export data between differentapps. myFitnessCompanion® is fully integrated withMicrosoft HealthVault® and can seamlessly import existingphysiological data reducing the need to have several mHealthapps to collect physiological data.

There is a bright future for mobile app developers if theapp is integrated in a total end-to-end healthcare solution,and if the stakeholders (healthcare institutions, content cre-ators, governments, mobile operators, device manufacturers,non-governmental organizations, providers, insurers, manu-facturers, distributers) acknowledge the importance of themobile aspect in their business model, and are willing toshare a percentage of their profit with mHealth developers.

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7 Distribution of mHealth apps

Apple’s App Store, Google Play, and more recently theWindows Store, are currently the main distributors of healthand fitness apps. These stores offer an easy to use distribu-tion channel where, for a few dollars, high quality apps canbe downloaded.

At the time of writing, Apple’s operating system is thefavorite with health professionals since it supports higherquality healthcare apps. However, Android is catching upquickly and it can be expected that a particular mHealth appwill be available for multiple platforms in the near future.

However, this might all change! Research conducted byresearch2guidance [2] shows that traditional healthcarechannels such as hospitals and specialized healthcareproduct vendors will distribute the majority of mHealth appsby 2015. This makes sense for those apps that are used forhealth diagnosis and treatment since it will separate qualityhealth apps from emerging or faulty ones. App stores do nothave a proper quality control system in place and manyunreliable apps are currently available. However, theauthors believe that App stores will be widely used forfitness and well being apps that are not bound by FDAruling.

8 Discussion

This paper concludes with a short SWOT analysis of theuser adoption of mobile apps for chronic disease manage-ment based on literature research and experience withmyFitnessCompanion®.

Strengths Health related apps on mobile devices are ofteneasy to use and appeal to many users. It allows users to takemeasurements whenever they need to. The apps offer a lotof functionality for either free or a few dollars and healthprofessionals start using the physiological data collectedfrom these apps in their diagnosis. These apps are particu-larly suitable for chronic disease patients since they need tocollect and monitor their health for a longer period of timeindependent of a specific location.

Usage data collected from myFitnessCompanion® con-firms this and there is an increasing interest by consumers.Particularly, Americans and Germans are early adopters andare willing to pay for these apps. Blood pressure, weight andblood glucose monitoring are most popular which relate tocardiovascular, diabetes and obesity diseases, which are themost prevalent in developed and developing countries [13].

Weaknesses The study highlights that measurementsrecorded using mHealth apps are mainly entered manuallyby the user. This allows for inaccurate data entry, which

could compromise its reliability. Self-motivation to recorddata over a longer period can be a challenge without theinvolvement of a health professional. Also, with the prolifer-ation of mHealth apps, it is difficult for developers/companiesto make it commercially viable, and might result in poorersolutions or faulty apps if they are not integrated in atotal end-to-end healthcare solution.

Threats There are significant challenges ahead for mHealthapps due to proposed FDA regulations in the USA [16]. Amajor problem with the current FDA proposal is that it couldstall the innovation of mHealth apps since it is almostimpossible to obtain FDA approval fast enough to keep upwith the continuous release of new smart phones, tablets oroperating system updates. However, FDA involvementwould remove health apps that make unwarranted medicalclaims.

Security and privacy concerns may prohibit the wideadoption due to concerns about data breach and misuse.

Opportunities According to research from Frost & Sullivan[1] the mHealth application market will grow substantiallyof the next few years. The growing awareness of health andfitness apps in the medical community, as well as, thegrowing proportion of patients using mobile devices willencourage healthcare professionals to exploit the possibili-ties rendered by smartphone technology and incorporateapplications into their chronic disease patient managementplans.

Overall, the outlook is positive and the authors believemHealth applications will continue to grow as users andother healthcare stakeholders plan to adopt mobile technol-ogy. This is confirmed by a recent report from Ernst andYoung [17]. mHealth Apps are a natural complementationof health telematics and personal health records. Theyshould be part of a complete solution to address changesin healthcare delivery, and they are particularly suitable forchronic disease prevention and management.

Conflict of interest The authors declare that they have no conflict ofinterest.

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