Mobile and web-based apps, accessed via smartphones, electronic tablets, or desktops, have recently emerged as another method to increase patient engagement. Apps designed to monitor symptoms and self-management of chronic conditions have shown promise in improving health outcomes in patients with diabetes and chronic lung disease.31-37 ED patients who track and trend important symptoms or key variables (blood sugar, weight, etc.) via an app may be able to provide a more reliable history and better participate in the diagnostic process.
Recent studies have reported on the use of apps as a tool for ED clinicians to directly engage patients in diagnosis and decision making at the point of care.38,39 One study described the development and testing of a novel app developed to engage caregivers of young febrile infants in shared decision making related to diagnostic testing (particularly lumbar puncture).38 Both clinicians and caregivers perceived the app to be useful in augmenting communication. Caregivers provided high ratings of the app’s usability and expressed preference for an internet-based app over paper-based materials.
Another study investigated the use of an app to facilitate communication about diagnostic testing in adult patients presenting to an ED with minor head injuries.39 The app integrated a patient decision aid with an established clinical decision rule to communicate an individualized risk assessment and guidance related to head computed tomography (CT). Use of the app resulted in increased patient knowledge and was associated with high trust in the physician, low CT use, and no adverse patient events. Both patients and clinicians found the app to be helpful and easy to use.39
Importantly, both applications were based on robust scientific evidence and codesigned iteratively by teams of clinicians and patients. With over 100,000 health-related applications available for general public use, better guidance is needed when selecting and implementing these tools due to the significant variability in quality and the degree to which different applications rely on or render evidence-based recommendations.40-44
Currently, the Food and Drug Administration only regulates health-related apps that function as medical devices (glucose monitoring, electrocardiograms, etc.). The Agency has little oversight of the many other apps focusing on patient education, self-management of chronic conditions, and patient data collection.45 Further review, development, implementation, and study of health-related apps for use in ED settings represents a significant opportunity to affect health behaviors and facilitate shared decision making and patient engagement.
