eHealth applications are getting increasingly popular. A representative survey carried out by Bitkom Research in early February 2016 on 1,236 people showed that 31% of Germans over 14 use so-called fitness trackers for recording their health values. These trackers include fitness bracelets, smartphone fitness apps and smartwatches. Large numbers of people appear to take an active interest in their health and collect information to help them improve their health. Little is yet known about the influence of these eHealth applications. The Bertelsmann Foundation therefore commissioned a report on digital health applications used by the general public, specifically focusing on context, typology and relevance from a public health perspective.

“A cooperative and/or interactive application of modern information and communication technologies for improving the health and healthcare of the population,” is how the authors of the report define digital health, which they equate with the terms eHealth and Health 2.0. The report found that the digitalisation of healthcare is driven by technological innovations developed independently from the healthcare system. Some applications have already established themselves in parts of the healthcare market, including, inter alia, telemedicine, which is the medical application of information and communication technologies. However, the growth of apps is also driven by a cultural change. Human individuals, whether sick or healthy, have changed their health behaviour, which according to the report, is the “goal to maintain, promote or improve personal health in an everyday social context”. Another issue that needs to be taken into account is the health policy framework as eHealth applications may be medical products and as such subject to special regulatory provisions.

Based on this knowledge, the authors of the report developed a classification system that was then applied to 106 eHealth applications selected by health experts. However, experts believe that the value of the report is limited due to the small number of samples. The digital health application market is rather non-transparent, so the selected samples cover a broad range of different applications, including mobile, web and system applications. The researchers selected five main areas – particular application, target group, application context, technology and business model – and carried out a descriptive analysis. They came up with some interesting core statements: eHealth applications support mainly information & orientation in health issues. These particular apps provide the users mainly with information on diseases or with information on how they can eat healthily. Mobile applications also target control & monitoring, for example apps that record an individual’s level of fitness.

It came as no surprise that the report found that 71% of all health applications investigated were targeted mainly at healthy people. Healthy people tend to use such applications to improve their health or avoid becoming ill (application context). About 50 percent of the applications are free of charge.

In the area business model, the researchers also studied approval and financing, and found that most apps are not subject to regulatory approval. 10% of all apps are subject to regulatory approval. 7% have obtained the authorisation to be placed on the European market (CE marking) and 2% are approved for use in the USA (FDA approval). One percent of all apps that are subject to regulatory approval have in fact not received marketing authorisation. Those surveyed could give multiple responses. To date, only very few applications are covered by a health insurance scheme.

The researchers drew up a list of application types based on their descriptive analyses. Decision makers in the healthcare sector will be able to use these application types as a basis for action and orientation. The types were named after their main usage:

• Enhancing health literacy (e.g. portals providing information about diseases, such as www.gesundheitsinformation.de)
• Analysis and knowledge (e.g. applications for diagnosis and evaluation, such as the Mimi hearing test)
• Indirect intervention: promotion of self-efficacy, adherence & security (e.g. continuous monitoring of personal health data, such as the Baby Tracker Pro does)
• Direct intervention: changing capacity, behaviour & states (e.g. therapy support such as provided by the Tinnitracks app)
• Documentation of health and medical history (e.g. establishment of a dashboard of health and fitness data such as the Apple Health app)
• Organisation and administration (e.g. health insurance applications, such as that of www.tk.de)
• Purchase and supply (e.g. support in drug purchase as provided by www.docmorris.de)

Can these applications contribute to improving public health? The authors of the report say they do. If national health objectives are taken as a basis, then relevant success can be achieved as the apps help raise public health literacy in particular. The apps can also help reduce tobacco and alcohol consumption by detecting health behaviour, and thus causing compliance through the ability to monitor success in giving up smoking.