With the explosion of health apps came the explosion of health app stores. This relatively new phenomenon sees a number of efforts with the mission to build professional app stores for health care. The demand for app curation in healthcare led to the development of a number of app stores/repositories/platforms, and I was intrigued to see how these work. Although my primary focus was to see whether usability is included (and if so how it is measured), I was quite intrigued to explore the recommended app review process.
So here we go:
Happtique (short for ‘Healthcare App Boutique’) describe themselves as a virtual marketplace and distribution platform that allows for the discovery, display and delivery of health apps. Certification program for app developers that will allow their apps to get displayed in Happtique’s certified registry (and as a result ‘stand out’ from competitors). Their requirements for certification are broken down to : operability, privacy, security and content.
Under the operability requirements, criterion 6, specifies that:
‘the app shall be designed to operate in a manner that supports a usable and useful end-user experience.’
In a note, they specify that this criterion is derived from the mHIMSS report ‘Selecting A Mobile App: Evaluating the Usability of Mobile Applications. This document(which I will be reviewing on this blog soon) is aimed at supporting ‘the healthcare provider and IT staff member who is engaged in the selection of mobile apps for his/her practice‘ and also mentions that :
‘While formal, professionally conducted, usability evaluations can provide in-depth product comparisons- they may not be a practical consideration for small- to medium-sized practices’
A blog post by the CEO of a company that develops health software solutions, raised concerns over how data was protected by two apps certified by Happtique (where various security issues were identified, including lack of data encryption for user authentication). As a result of this, Happtique had suspended their certification program and they are re-evaluating their testing methodologies
NHS Choices app store
The Health Apps Library is a similar effort that allows the users to find ‘safe and trusted’ apps that have been reviewed by the NHS to ensure they are clinically safe and relevant to people living in the UK. App submitted to the NHS app library are primarily checked to assess their compliance to data protection laws and trustes sources of information (i.e NHS Choices). The second phase of checks includes a safety assessment- i.e the potential harm the app usage can cause to a person’s health or condition. The reviewing team is made up of doctors, nurses and safety specialists.
As shown from the review process, this is very much focused on the clinical review of the content of the app, and there is no mention on usability (or accessibility.). NHS choices do have an accessibility statement discussing how they ensure that NHS Choices is usable and accessible to all users, but there is no specific information on the app library on adherence to accessibility standards.
This store allows the user to search the app repository by platform, condition and language (but not by rating or recommendation body). The process of submitting an app to the store includes questions about the nature of the app, its health benefits and any potential recommendations by patient groups or empowered consumers (such as the FDA, the MHRA, NHS Choices, Vodafone Foundation Heart-rating system, where each app is recommended by healthcare communities from around the world, including patients, carers, patient groups, charities and ‘empowered consumers’.
The ranking system and each rating adds up to a maximum of 5 hearts.
There is no additional information on the metrics or attributes they use to assess these criteria. For example, how do you assess (or even measure) whether an app helps you control your condition?
iMedical apps provides app reviews and commentary by medical professionals.
Unlike other platforms, they have a list of names of all the editors and reviewers with a short bio and also make a point of being unbiased as their editors are not involved in medical apps and institute conflict of interest policies.
Their review process includes ratings (1 to 5 stars) for user interface, multimedia usage, price and real world applicability. They don’t provide with any additional information on the criteria the use to assess the user interface. The examples below are taken from existing app reviews and show three different ratings for UI (2, 3 and 4-I couldn’t find an app with a 5/5 rating).
Working in the field of mhealth app design, I can certainly say that the abundance of health apps that have been developed recent years has left me questioning the usability and quality, credibility and legitimacy of many of those apps. I do see the merits of having health specific app stores (even though I am not convinced ‘stores’ is the right word for these efforts), but I think there is considerable scope for improvement in their review process, especially in terms of usability and accessibility.
- Even though happtique does mention usability as a criterion in their review process, providing a usability principle attribute checklist including simplicity, naturalness, consistency, forgiveness and feedback, effective use of language, efficient interactions, effective information presentation.
- Usability and accessibility go hand in hand, and one without the other is not much use, which is disappointing to say that none of these mhealth app stores I had a look at make any mention of adherence to accessibility standards. The change in population demographics and associated health conditions was originally one of the original drives of change in healthcare delivery that pushed for remote healthcare, so we need to make sure that inclusive design is part of the reserach agenda that informs app reviews.
- All these store provide information tailored to app developers, but I didn’t find anything specifically for designers. In my opinion, this re-inforces the misconception that a ‘all you need for a health app is a clinican and a developer’. Designing mobile applications to support health interventions requires a multi-disciplinary approach that brings together disciplines of HCI, public health, and engineering. This multi disciplinary approach should also be reflected in the app review process. Usability experts should also be included in reviewing teams
- Happtique does mention usability as a criterion in their review process, providing a usability principle attribute checklist including simplicity, naturalness, consistency, forgiveness and feedback, effective use of language, efficient interactions, effective information presentation.
- However, I am not entirely sure what this means- do for the example the app developers that submit an application to Happtique need to demostrate the results of their user testing? Do they need to show how they measured the effectiveness of their app and how they measured user’s satisfaction? Or does happtique carry out their own user testing of prospective apps? Or is this information available as a ‘best practice’ guidance?
Finally, the recent hurdle that Happtique have experienced is a disappointing start to an effort that was originally designed to alleviate trust issues with health apps.
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