Call for NICE to assess medical apps for GP prescribing 'menu'

NICE should assess the safety and effectiveness of medical apps for smartphones and tablets to give GPs a 'menu' from which they can prescribe, it has been proposed.

The move could allow GPs to prescribe apps as treatment, such as CBT for depression (photo: Jason Heath Lancy)
The move could allow GPs to prescribe apps as treatment, such as CBT for depression (photo: Jason Heath Lancy)

The move would help GPs decide which apps could be safely prescribed to patients as clinically and cost effective, and could form part of their care alongside 'traditional' interventions such as medicines and face-to-face therapy.

Approved apps could also be used in the surgery to assist work such as diagnosis and dosage calculation. This 'menu' may help prevent clinical errors resulting from doctors using or prescribing apps whose accuracy has not been assessed.

It follows concerns that some medical apps for smartphones and tablets are not being fully appraised to determine whether they are safe and effective medical interventions.

The growth of apps in recent years as prompted the creation of around 100,000 medical and health-related apps for smartphones and tablets.

These range from simple step counters to expert clinical tools such as the free Mersey Burns app, which helps doctors calculate treatment for burns victims and was the first app to be approved by the MHRA in 2012.

'Uncertainty and doubt'

The MHRA sets out when it would consider an app to be a medical device requiring regulation. Typically, this may involve an app that 'applies some sort of automated reasoning', such as decision-support algorithms or analyses data for a clinician.

Charles Lowe, director of the Digital Health and Care Alliance, a project set up following work by the government's Technology Strategy Board (TSB), told GP that these apps should be assessed to give GPs confidence to prescribe them to patients and use them in the surgery.

He said there was 'a lack of faith in the cost effectiveness of apps, and also there was a terrific amount of fear, uncertainty and doubt as to what was necessary for an app to be considered safe and acceptable'.

Mr Lowe believes NICE's remit should be extended to cover medical apps, to be assessed in the same manner as other medical devices under its Medical Technologies Evaluation Programme.

He said: 'My vision is that in three years' time, I can sit in front of my doctor and my doctor can say: "You and I agree that you are depressed. The NICE guidance on this particular drug that will treat your depression is this; the NICE guidance on this particular app that will treat your depression is that; and we can also consider a combination of an app and a drug".

'Then you can have a rational discussion with your doctor about which is the most effective.'

'Strong business case'

It would represent a huge investment in resources, in light of the large number of potential apps for consideration. Mr Lowe believes NICE should target apps which assist a medical intervention. 'An inability to count my steps in a day is not going to kill me. However, an inability to calculate correctly the amount of warfarin I should take might well kill me,' he said.

But he is adamant the effort would be worthwhile. 'I would argue there's a very strong business case, in that if you can get doctors recommending apps, it would reduce drug prescriptions.'

The proposal would likely extend beyond the NHS Apps Library, which publishes a list of health apps that have been approved as clinically safe for patient use, but which tend to concentrate on symptom tracking and healthy living advice.

Mr Lowe spoke to GP at a King's Fund event, Self Care in the Digital Age, organised by the TSB and its 'dallas' assisted living programme.

At the event, delegates including GPs and CCG leads voted overwhelmingly in favour of the statement, 'Investing in technology and digital services to enable self care is essential for the future of health and social care in the UK'.

A DH spokesman told GP that NICE's current remit allowed it to consider apps as part of guidance on particular conditions. NICE had yet to respond at the time of publication.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in