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    Apps to manage chronic conditions come with risk

    Kyle Laudadio

    The long and short term consequences of failing to manage diabetes effectively can be devastating.  Mobile apps can often help but, according to new research, the information that many of these apps provide may be dangerously vague.  Caveat medicus …

    The treatment of chronic conditions imposes a huge financial burden, accounting for approximately three quarters of total US healthcare spending. When it comes to public health insurance, chronic conditions weigh even more heavily, accounting for 83 cents per dollar for Medicaid and 96 cents per dollar spent on Medicare.

    According to the Centers for Disease Control and Prevention, six out of 10 adults in the US have a chronic disease while four out of 10 have two or more. Worryingly, the number of Americans with chronic conditions is increasing.  Advances in healthcare mean that those with chronic conditions are living longer, but this too increases pressure on already stretched resources.

    To reduce these financial pressures, healthcare regulators have adopted a carrot and stick approach.  Incentives are provided for healthcare providers to monitor and manage patients with chronic conditions away from acute care facilities, while at the same time penalties are imposed on those that rely too heavily on hospitalization. For example, hospital readmission penalties under Medicare are focused principally on the treatment of chronically ill patients.

    Many in the healthcare world are consequently turning to technology to help. Mobile apps in particular hold out the prospect of relieving pressure on healthcare resources while giving those with chronic conditions more control over their health and a better quality of life.

    The number of healthcare apps has proliferated in recent years with some 300,000 now available. Many focus on diabetes management, offering diabetics tools to assist with self-care. Medical advice to those with diabetes emphasizes active management of their condition. Those who actively engage in their own care between healthcare visits are more successful in avoiding complications associated with the disease.

    However, a study of these apps, published in the Journal of the American Medical Association (JAMA), revealed many lack crucial functionality, potentially putting patients at risk. This poses questions for the developers of health apps as well as for clinicians who recommend their use to patients.

    The JAMA study found that, despite purporting to assist with type 2 diabetes management, many apps lacked the maturity to permit a user to safely self-manage their condition. The majority of apps did not provide real time decision support or situation-specific education for self-care - crucial elements for those living with type 2 diabetes.

    Only 58% of the apps studied alerted users when they had dangerously high or low blood sugar levels. Moreover only a fifth of the apps that did provide such alerts then offered advice on what to do about dangerously low blood sugar. Without clear information being passed to the patient, there is a real risk of the app causing patient harm.

    Even where the app possesses the functionality to help, reliance on technology can increase risk. Technical issues can cause an app to malfunction, prompting the user to take a course of action detrimental to their health or providing false assurances regarding blood sugar levels.    

    The long term health risks of failing to manage diabetes effectively include devastating complications such as blindness and heart disease. However there are also significant short term risks. Severely low blood sugar - hypoglycaemia - requires a sufferer to take immediate corrective action. If not addressed, it can result in seizures and the loss of consciousness requiring immediate medical attention.

    In scenarios where bodily injury does occur, the developer of the app could be sued for damages alongside the medical professional who recommended the use of the app. The plaintiffs’ bar is already aware of the potential for bodily injury arising from technology failures in such scenarios.

    Developers of apps, and medical professionals who recommend their use, should discuss their existing insurance coverages with their insurance agent to ensure they are adequately covered – including ensuring they have affirmative cover for bodily injury resulting from technology failure. By working with trusted partners to evaluate the risks posed by the technology they are employing, they can mitigate those risks where possible.



    Why Public Health Is Necessary to Improve Healthcare; National Association of Chronic Disease Directors; 

    Examining Diabetes Management Apps Recommended From a Google Search: Content Analysis; JMIR Mhealth Uhealth (Jan 2019)

    Decision Support and Alerts of Apps for Self-management of Blood Glucose for Type 2 Diabetes; Lum E, Jimenez G, Huang Z, et al.; JAMA (April 2019)

    Chronic Disease in America; Centers for Disease Control and Prevention;

    About the author:

    Kyle joined Beazley in January 2017 as an underwriter on our Private Enterprise team, specializing in Miscellaneous Medical risks. Prior to working with Beazley, he previously underwrote small non-profit business at United States Liability Insurance and mid-market/large healthcare accounts at AIG. Kyle received his bachelor’s degree in Finance from Saint Joseph’s University in Philadelphia where he was also a member of their Division 1 Track & Field Team.

    Kyle Laudadio
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