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Office of Technology Assessment at the German Bundestag Office of Technology Assessment at the German Bundestag

Information on the project

Health Apps

Thematic area: Technology, society, innovation
Analytical approach: Innovation report
Topic initiative: Committee on Education, Research and Technology Assessment
Status: ongoing
Current project phase: Report completed. Approval by the Committee on Education, Research and Technology Assessment pending
Duration: 2016 till 2017

Background and central aspects of the topic

In recent years, the number of »apps« (applications) as well as the number of mobile terminals such as smartphones or tablets in private and professional everyday life has increased significantly. The app market covers almost all kinds of topics and areas of life. High growth rates can be observed for apps related to health issues. Besides medical apps which are primarily offered for expert personnel in medicine and health care or for chronically ill people, numerous health apps for the general public are available on the market now. At the beginning of the development of health apps, only very simple apps were available – regarding the utilization function and graphic design. Today's health apps allow the acquisition and analysis of more and more and increasingly qualified health data due to the improved performance of mobile terminals.

The fields of application of health apps cover a broad range from health promotion to primary and secondary prevention (preserving health and preventing diseases, early diagnosis and preventing an aggravation of a disease) to tertiary prevention (preventing an aggravation or complications in an already manifest disease). Today, it is possible to acquire and analyze data continuously, e. g. during leisure sport, to add calories of the food consumed and to compare it with individual specific calorie requirements. Moreover, it is possible to support chronically ill people in coping with their everyday life and in self-managing their disease. Health apps are assumed to provide a wide range of benefits: providing knowledge and raising awareness for possible health hazards, increasing well-being and health competence, strengthening prevention, effectively initiating and (ideally) consolidating behavioural changes, complementing diagnosis, monitoring the success of medical treatments, promoting compliance with therapy and much more. For all this, health-related data are collected continuously and location-independently and are analyzed almost in real time combining them with other stored data.

The European market for health apps has developed quite differently. The German market is one of the largest in Europe. However, the effort for health app developers and providers is comparatively low, because anyone can make self-made apps available on the Internet or on corresponding platforms so far. The market regulates itself. Exceptions apply to medical apps which have been classified as a medical device. They require control by government authorities and have to comply with corresponding standards, if the software – according to the manufacturer – is intended for the »diagnosis, prevention, monitoring, treatment or alleviation of diseases«. For consumers, the boundaries between health apps and medical apps are often blurred.

Very often – according to the results of recent studies – the security, protection and further use of personal data as well as the scientific basis of the outputs of health apps are not transparent. Moreover, there is a lack of binding standards supporting the assessment of the quality as well as the reliability and trustworthiness of health apps. At the same time, in Germany there is a large community of lifestyle-oriented Quantified-Self, Self-Tracking or Life-Logging activists who want their vital values and other health data of any sort to be continuously collected, stored and analyzed by means of apps and cloud services (Quantified Self = quantifying one's own bodily functions; Self Tracking = logging of body and fitness data; Life-Logging = logging of personal events). Hence, the collection of health data is progressing.

However, the use and dissemination of apps not only offers opportunities, but also has some risks – particularly with regard to data protection: The amount and variety of data gathered increase, they can be processed more rapidly (»big data in the healthcare sector«) and often personal and location data are integrated. This continuous collection of data by means of health apps can be very useful for preserving human health. On the other hand, due to the series of scandals which have occurred regarding the handling of sensitive data – such as the NSA surveillance scandal – a large part of the population has grown insecure and partly very critical towards the increase of data collection in all areas of life. Moreover, as the servers for data storage often are not located in Germany or Europe, they are not subject to German/European law or to the influence of the associated data protection authorities. The »Safe Harbor« decision of the European Court of Justice of October 2015 refers to a decision of the European Commission with regard to the transfer of personal data outside the EU. This decision has stimulated a new debate on fundamental issues of European data protection with high relevance for the issue of »health apps«.

Objectives and approach

The objective of this study is to analyze the dissemination and use of health apps and to discuss the societal opportunities and risks involved. The study focuses predominantly on the following aspects:

  • Overview of available health apps and their functionalities particularly taking into consideration the »grey area« of transition to medical apps;
  • Synopsis of the scientific status quo on the dissemination and use of health apps as well as of their potential benefits;
  • Identification of technological and socio-economic trends influencing the further development, use and application of health apps;
  • Legal classification of health apps, assessment of legal conditions and the framework for conception, use and dissemination of health apps in Germany, identification of pending legal questions and political options for action (taking into consideration data protection, data security, data privacy and location privacy);
  • Analysis of problem perceptions and value orientations (e. g. with regard to changes of the body image and of the relationship between physician and patient) of stakeholders (e. g. consumers and consumer organizations, health app providers, experts of the healthcare sector as well as health, life and occupational disability insurance companies). The analysis takes into consideration possible conflicts of interests as well as gaps in knowledge and perception of stakeholders;
  • Identification of options for action and for shaping the issue intended for the German Bundestag.

The methodological approach focuses on literature and document analyses taking into account all fields of expertise involved and scientific or TA-relevant perspectives as well as guideline-based expert interviews. In addition, a survey shall be conducted within the framework of the Stakeholder Panel TA (https://www.stakeholderpanel.de). Furthermore, within the framework of this study, an intensive exchange with the EPTA members TA-Swiss (particularly with regard to the planned project »Quantified Self – interface between lifestyle and medicine«) and the Rathenau Institute (particularly regarding the project »The electronic lifestyle coach«) shall take place.