Ravaud, Philippe

Objective Digital health applications (health apps) are increasingly integrated in clinical care. Yet the information describing these apps varies across curated app repositories supporting prescription. We aimed to identify the information items used to describe health apps in repositories; and to quantify the completeness of publicly displayed app-entry information across repositories. Methods We conducted a cross-sectional study of seven national or international curated health app repositories: mHealthBelgium, DiGA, AppThera, ORCHA, GGD AppStore, MIND, and AppGuide. In January 2025, we randomly selected 140 health apps, with 20 apps per repository. For each app, one reviewer extracted the publicly available information displayed in the repository entry and inductively identified the information items reported (i.e., atomic information elements used to describe apps). These information items were then grouped into categories by an expert committee. We calculated, for each repository, the median number of items reported across apps, overall and by category. Results Health apps were described by 32 information items grouped into 10 categories: general information, regulatory information, compatibility, costs, indication, functions, evidence, user experience, data governance and security, and change history. The median number of items reported in repositories ranged from a median of 9/32 items, IQR 9 to 11 in MIND to 27/32, IQR 26 to 28 in DiGA. Only, three repositories (AppThera, DiGA and AppGuide) systematically reported information on the evidence supporting the apps for all listed apps. Conclusions Curated health app repositories differed in the information items presented to clinicians and patients. Incomplete reporting of clinically relevant information, particularly evidence and data governance, may limit informed app selection and prescription. Minimum reporting standards are needed to enable safe prescription and reliable integration of health apps into clinical practice.

Importance Digital health technologies (DHTs) aiming to monitor, treat, and manage diseases can be prescribed for patients with multimorbidity; yet most DHTs are designed for individual conditions or problems, while approximately half of patients with chronic conditions have multiple chronic conditions. Objectives To identify DHTs approved by the US Food and Drug Administration (FDA) or listed in the Organisation for the Review of Care and Health Apps (ORCHA) library and prescribable for a hypothetical patient with 5 conditions and to model the number of DHTs this patient should be prescribed to receive benefits health professionals considered important. Evidence Review The FDA databases (Premarket Notification 510(k), Premarket Approval, and De Novo) and the ORCHA App Library from National Health Service Somerset were systematically searched for DHTs registered or updated between January 1, 2019, and December 31, 2022, that could be prescribed to a hypothetical woman with 5 chronic conditions (type 2 diabetes, hypertension, chronic obstructive pulmonary disease, osteoporosis, and osteoarthritis). After abstracting each DHT’s elementary functions (ie, simple and delineated features to monitor, treat, and/or manage conditions), an assessment was undertaken to determine the fewest DHTs this hypothetical patient should be prescribed to receive benefit from digital functions health professionals considered important. Findings A total of 148 DHTs were identified (68 [46%] from FDA databases), of which 96 (65%) involved devices and 52 (35%) were standalone health apps. Only 5 DHTs (3.4%) were intended for 2 or more conditions. DHTs offered 140 elementary functions, ranging from recording, tracking, or visualizing health parameters to providing information to digital therapeutics with just-in-time interventions. The hypothetical patient would need to be prescribed up to 13 apps and 7 devices (a blood pressure monitor, a smartwatch, a pulse oximeter, a connected weight scale, a sensor-attached inhaler to monitor adherence, a lung function monitor, and a blood glucose sensor) to receive benefits from 28 functions at least 3 of 5 health professionals considered important. Conclusions and Relevance This systematic review found that almost all prescribable DHTs were developed for a single condition or problem. Thus, patients with multiple chronic conditions would have to routinize many DHTs concurrently in daily life to benefit from digital functions health professionals considered important.

Abstract Background Remote digital monitoring (RDM, i.e., using digital devices to monitor patients' health and behavior) is a novel care model that can improve health outcomes for people with chronic conditions. However, it could be intrusive to patients' lives. We sought to understand which aspects of RDM make it intrusive to patients and why. Methods We performed content analysis of qualitative data collected by using open-ended questions in an international, online survey with a convenience sample of adults with type 1 or 2 diabetes (February-July 2019). Participants were first shown scenarios describing possible RDM features (i.e. different RDM tools [for glucose or food monitoring], feedback loops [receiving feedback in consultation, or remotely by a physician, or by artificial intelligence], and data handling options [by the public or private sector]). Results We analyzed data from 709 participants from 24 countries (38% men, median age 38, 54% type 1). Participants found RDM burdensome (n = 468). Burden arose from RDM features that caused disruption in daily life (e.g., alerts), features that may invite undesirable attention in public (e.g., visible wearable sensors may invite questions about one's health), or from having to adapt one's life to fit in RDM (e.g., adapt one's mealtime routine around food monitoring). Participants wanted control, particularly over sharing food-monitoring data with health care professionals in real-time to receive feedback (n = 440). They felt RDM could expose a delicate topic to 'surveillance' by authority figures (i.e., their data may 'reveal' poor dietary habits, leading to criticism by physicians). Intrusion could take the form of RDM eroding the patient-physician relationship (n = 34), or fear of data misuse (n = 206), which was associated with private-sector financial interests. Conclusions Our findings offer directions for minimally intrusive RDM design and show that digital health may cause concerns about stigma and treatment burden. Key messages Remote digital monitoring is intrusive when it increases treatment burden and limits patients’ control over their own health. “Minimally intrusive” digital health design could increase patient acceptability and, ultimately, foster scalability.