About the author: Liz Ashall-Payne founded ORCHA, the Organisation for the Review of Care and Health Application, which is focused on providing guidance to app developers, as well as helping the public and professionals to find and apply apps that could improve public, patient and organisational outcomes. Initially a Speech and Language Therapist, Ashall-Payne has almost 20 years NHS experience.
Since the start of the COVID-19 pandemic, there has been a rise in the number of people dying at home compared to previous years. Clinicians are concerned that this is due to people staying away from NHS services and as a result of the deprioritisation of non-coronavirus services. To address this problem, especially as we move from being focused on crisis management, into also providing longer-term help for the vulnerable, apps will be pivotal in offering accessible support and resources.
Indeed, in the past two days alone, ORCHA has seen a 600% increase in usage of ORCHA App Libraries, used in 50% of NHS regions. Two weeks ago, the most popular search term was "COVID," whereas, now, the most searched for terms are "fitness," "mental health" and then "sleep." This shift indicates that people are actively looking for ways to better manage their health and wellbeing during lockdown.
'Empowering citizens to make informed choices'
In all situations, it is important that users understand the app they are using – its strengths, but also its weaknesses – so that they know when and how to use it best. A large part of mitigating the risks of misinformation and hesitancy to adopt digital health lies in offering full transparency to the public about how an app works. We should not make the mistake of claiming that an app is a perfect solution. Rather, being open about the rewards and corresponding risks means that people will be empowered to make an informed choice as to whether to use an app, how they will manage it and when they will stop using an app.
In an effort to offer this transparency, ORCHA, as an independent assessor of health and care apps, has reviewed 6,000 apps to date. Eighty-five percent of these apps do not meet the requirements of ORCHA’s Baseline Review (OBR). ORCHA provides a publicly available scorecard for each app that it reviews, offering a breakdown of why an app scored highly, alongside the areas in which improvement is required. If the digital health industry is to arm professionals and consumers with the facts that they desire in order to make informed choices, it is necessary to juxtapose the good with the bad.
By being open about the risks and rewards of apps, such as with the upcoming contact tracing app, the UK can avoid making the same mistakes as countries such as China and India, whose mistakes may deter people from using health apps again. China’s "health code" service, used to allow some movement after lockdown, has caused “complaints by Chinese social media users about a lack of transparency over how the app works and what data it is storing,” as reported in The Guardian. Similarly, the Indian government has faced claims that its mandatory coronavirus tracking app, Aarogya Setu, could put “the ‘privacy of 90 million Indians […] at stake’.”
The UK’s COVID-19 contact tracing app continues to be refined, meaning that future revisions of the app will bring lower risks, alongside potentially bigger benefits. Adopting an iterated approach to learning about an app’s effectiveness and adapting it accordingly is vitally important for ensuring that digital health continues to meet the needs of a changing society. Any such revisions to the contact tracing app will be reflected in ORCHA’s future evaluation scores and reports. By being open about the developments in the app’s strengths and weaknesses, the public will then also understand the importance of updating to the next version of the app, or will be empowered to choose to download it for the first time.
Evolving the digital health industry
The tendency to appraise and position digital health solutions according to a binary rule – that they are either "good" or "bad" – seems almost unique to the digital healthcare industry. For example, all medicines come with warnings and side effects are clearly listed, chemotherapy patients receive life-saving treatment but are informed of the risk of bad side effects, and IVF can help people to conceive, whilst carrying the risk of the treatment not working. For each of these healthcare circumstances, transparency is given about the reward, and the corresponding risk. Why should digital health be any different?
In order for the digital health industry to turn this explosion in demand for and provision of digital resources into a long-term behaviour, it needs to mature in both how the review of digital solutions is managed, and how information about these solutions is communicated to the public. As COVID-19 forces the world to adapt how it interacts, so too must the digital health industry evolve to balance risk with reward.