Can smartphone apps diagnose illnesses? No, say experts

With a barrage of smartphone health apps being launched globally claiming to go beyond fitness or calorie checkers and spot mental illnesses or respiratory diseases health experts stress that such digital applications can never be a replacement for a qualified, well-trained health service provider.

An Australia-based digital health solution provider recently launched an app called ResApp that claims to diagnose respiratory diseases like pneumonia, croup and asthma with high accuracy through a cough into a smartphone.

Go to Apple App Store and you will find a plethora of apps claiming to diagnose depression, anxiety, schizophrenia and post-traumatic stress disorder (PTSD). There are nearly 1,500 depression-checking apps out there but according to experts, apps can at best give information or help monitor diet and health parameters but if these claim to diagnose an illness, there are serious medico-legal issues in making such a claim.

"Apps may guide a patient to consult an appropriate doctor. However, an app by itself is not adequate to make a diagnosis. Diagnosis of a medical condition is made by detailed history and examination followed by investigations. This expertise is gained after several years of training and a digital app is not a replacement at all," emphasises Dr Vipul Gupta, head, (neurovascular intervention centre) at Medanta-The Medicity.

Gupta is soon going to launch an app called "Stroke and Neurointervention" being developed with the non-profit Stroke and Neurovascular Intervention Foundation where he is one of the founder members.

The app will provide information to people about stroke awareness, prevention and treatment options. "The app will also have an emergency number to call. It will regularly update doctors about current treatments, latest advances and protocols and provide expert opinion on medical cases," Dr Gupta said.

When it comes to health apps, experts say that trust in health care cannot be created by answering merely a set of questions and getting an instant diagnosis as the variables are too high to be included in a single app.

The key questions are: Is the app accredited by an agency or has the process been standardised by any council? Have double-blind clinical trials been performed on these apps for approval and do these prepare users for emergency situations? Are the people behind the apps are health care providers or mere IT geeks who wish to monetise their efforts?

"There is not enough evidence that such queries have been addressed when it comes to health apps. On the contrary, there is always an agreement clause which the user is made to click prior to use, absolving the app creator of any medical mishaps," Dr Amitabh Parti, unit head (internal medicine) at Fortis Medical research Institute in Gurgaon, said.

Dr Parti has come across many such tall claiming apps and found those misleading. "The efficacy of an app need to be subjected to multi-centric clinical trials and need to be assessed in varying clinical settings including individuals with many co-morbidities (more than one disease). We must realise there is no room for a redo in healthcare when it is a human life we are interfering with," emphasises Dr Parti.

Dr Rajeev Rathi, cardiologist at Max Super Specialty Hospital in the capital, recently devised and launched an app to help a person find if he or she is suffering from a heart disease or not. "Heart App" seeks answers to a set of seven basic questions which a physician will ask in case of chest discomfort. An analysis of answers indicates the possibility of a heart attack via app which is available in Google Play Store and Apple App Store.

But the app limits itself to this and does not claim to go into deeper clinical diagnosis like a doctor will do. Diagnosis in the field of mental health is largely clinical and questionnaires and apps at best can help with screening to help provide suggestions but not diagnosis.

"It is important that applications are used for education and screening purpose and not for more and should aid in reaching experts to a larger population and make accessibility easier," elaborates Dr Samir Parikh, director, department of mental health and behavioural sciences, at Fortis Healthcare.

According to Dr Aditya Ingle, consultant pathologist at tele-health venture LiveHealth, an app which is associated with a healthcare provider such as pathology labs can store and provide past results to you and your doctor with just a click of a button.

"If it can remind to perform certain tests depending on your clinical condition, then such apps will be of great help to the people," Dr Ingle said.
According to experts, health startups must get their apps accredited by a certified healthcare agency.

"The health ministry must include these and other guidelines prior to permitting such apps to be launched for fear of an adverse event. Remember that the doctor learns by experience and apps earns by experience," stresses Dr Parti.

In a recent report in the scientific journal Nature, psychiatrist John Torous who chairs the American Psychiatric Association's Smartphone App Evaluation Task Force, said: "Right now, it [apps] almost feels like the Wild West of health care."