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Published on 30.12.13 in Vol 15, No 12 (2013): December

This paper is in the following e-collection/theme issue:

    Letter to the Editor

    Transparency of Health-Apps for Trust and Decision Making

    PL Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany

    Corresponding Author:

    Urs-Vito Albrecht, Dr med, MPH

    PL Reichertz Institute for Medical Informatics

    Hannover Medical School

    Carl-Neuberg-Str. 1

    Hannover, 30625


    Phone: 49 5115323508

    Fax:49 5115322517


    Smart devices such as smartphones and tablet PCs have become an integral part of everyday life as well as for professional applications. This is also true for medicine [1]. To enhance patient safety for medical apps or health apps that are to be used successfully in today’s medical settings, a good information policy should always be part of the marketing strategy. Patients and doctors that are well informed about the benefits, limits, and risks of an app are in a better position to give more reasoning to their decisions whether they want to use it in a medical context or not.

    To address the current shortcomings concerning the way information about apps is provided to potential users of apps, Lewis, in a recent letter to JMIR, proposed a set of standard criteria [2] analogous to those published by the Health on the Net foundation [3] to be used for assessing the utility of medical apps based on a systematic self-certification model. He suggested using a central platform for this purpose, for example, the United Kingdom National Health Service App Store, to allow registered developers of mobile medical apps to highlight the fact that they conform to these criteria. This would probably also give developers and distributors of such apps an advantage over their competitors.

    While this certainly is a promising approach, I would like to add a few points. For one, in an international setting with users coming from various (and in many cases non-professional) backgrounds, it may be difficult to lead them to a separate platform that is not the standard app distribution platform that users are accustomed to. This is especially the case for casual users who probably tend to use information that is readily available on the app stores or to simply read what other users have to say about an app.

    In my opinion, the users themselves should not be disregarded in the overall process since they play an important role by applying the information they have at hand to the product they are interested in and evaluating whether it meets their needs. In contrast to other medical products (eg, for clinical use), where many professional users are confronted with already chosen products that have been labeled as appropriate by experts, many professionals or laypersons have to decide on the appropriateness of the medical app themselves. Therefore, especially for apps, ensuring patient safety also has to include the identification of the right product, in this case an app, that matches the desired setting and indication. Every piece of information covering the necessary aspects helps decision makers and/or end users in professional settings as well as for private use to determine whether an app can be trusted and safe. Thus, to ensure high impact, it would probably make sense to provide users with the appropriate information at places where they expect it (ie, directly in an app’s description on the respective app store and/or on the manufacturer’s homepage and/or marketing material). This should be done following a standardized structure that includes criteria with a clear rationale (Table 1), for example, in the form of a clearly structured app synopsis (Table 2) [4]. A basis for this was proposed in [5], which also included the aspects mentioned in [2] with more detail.

    There are already a number of existing initiatives and projects that use almost identical criteria to those suggested by Lewis, for example, the “Apps Peer-Review” by the Journal of Medical Internet Research (JMIR) launched in 2013 [6]. The JMIR mHealth disclosure form [7] also covers many of the concerns mentioned in the proposed app synopsis. Mostly, these projects reach this goal by installing certification and/or (third party) review processes and publishing the corresponding evaluation results using specific channels (eg, their own webpage or scientific journals). The app synopsis could be seen as a “first level” approach according to criteria already specified by previous projects dealing with quality assurance for Web-based information sources [8], though its focus is slightly different. At first, it could serve to provide all interested parties with sufficient information that, in addition to providing customers with basic information about an app, can then also be used as a starting point for building tests (eg, to identify the appropriate reviewers and testing methods, independent of the business model or revenue strategy that is employed by each respective initiative). The current market players come from different backgrounds and thus also have different interests in mind. In Germany, for example, there are some initiatives focusing mainly on a single disease while others target health apps in general. Also, their funding strategies differ significantly, ranging from privately funded initiatives or publicly financed institutions to companies that are being paid on a case-by-case basis.

    If manufacturers were to publish the necessary information following this app synopsis, both they as well as the users would clearly benefit. Users would receive a complete and easily comprehensible set of information that would support them in their decision making process while manufacturers would be able to follow the simple structure of the synopsis to compile the necessary information without expending too much effort since they only have to compile information that should already be available to them. Although this is not equivalent to an officially sanctioned certification process, information published according to the synopsis could nevertheless serve as a reference if there are any disputes between both sides.


    Table 1. Criteria for assessing health apps and medical apps.
    View this table
    Table 2. Detailed description of items of the App-Synopsis for health apps and medical apps.
    View this table


    This article received no sources of funding or sponsorship and there is no financial disclosure. Since no human subjects were involved, ethical approval was not deemed necessary.

    Conflicts of Interest

    None declared.


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    2. Lewis TL. A systematic self-certification model for mobile medical apps. J Med Internet Res 2013;15(4):e89 [FREE Full text] [CrossRef] [Medline]
    3. HONcode Operational definition of the HONcode principles.   URL: [accessed 2012-11-21] [WebCite Cache]
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    5. Albrecht UV, von Jan U, Jungnickel T, Pramann O. App-synopsis - standard reporting for medical apps. Stud Health Technol Inform 2013;192:1154. [Medline]
    6. JMIR mhealth and uhealth - Apps Peer-Review Launched. 2013 Mar 12.   URL: [accessed 2013-10-28] [WebCite Cache]
    7. JMIR Publications: Submission Form for Health Apps Version 0.4. 2013 Mar 12.   URL: [accessed 2013-10-28] [WebCite Cache]
    8. Eysenbach G, Yihune G, Lampe K, Cross P, Brickley D. Quality management, certification and rating of health information on the Net with MedCERTAIN: using a medPICS/RDF/XML metadata structure for implementing eHealth ethics and creating trust globally. J Med Internet Res 2000;2(2 Suppl):2E1 [FREE Full text] [Medline]

    Edited by G Eysenbach; submitted 24.09.13; peer-reviewed by T Lewis; comments to author 26.10.13; revised version received 28.10.13; accepted 28.11.13; published 30.12.13

    ©Urs-Vito Albrecht. Originally published in the Journal of Medical Internet Research (, 30.12.2013.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.