Medical apps are turning our phones and tablets into exercise aides, blood pressure monitors and devices that transmit an EKG. But the proliferation of apps is way ahead of tests to determine which ones work.

Christine Porter is hooked on the My Fitness Pal app.

In October, after deciding to lose 50 pounds, Porter started recording everything she eats or drinks and any type of exercise she does.

“It’s telling me I have about 1,200 calories remaining for the day,” Porter said. She took a long walk at lunch and built up some calorie credits so she wouldn’t have to skimp so much at dinner.

Porter heard about the app from her health coach at the Ambulatory Practice of the Future, a primary care clinic for Massachusetts General Hospital employees.

“I usually give patients a choice of several apps that might help them,” said health coach Ryan Sherman. “Some patients won’t even look at them and then others might say, ‘Oh, yeah, this could work for me.’ ”

Increasingly, Sherman says, patients are coming in, pulling out their phones and asking, “Hey, have you seen this one?” The options are both exciting and hard to manage.

“There’s a new one every day so it’s trying to keep up with that,” Sherman said. “And if there’s not one place to look that can be hard.”

Which is one reason doctors at this Mass General clinic are suggesting — but not prescribing — apps. It’s hard to know which of the roughly 40,000 choices work.

Experts who are trying to figure out which apps are safe and effective generally separate them into two categories: those that actually turn your phone into a medical device and everything else.

The FDA is revising regulations that would apply to medical device apps. For all the other ones, Happtique, a company based in New York, has just created a certification process. Co-founder Ben Chodor says Happtique will review apps and give the ones that perform as advertised a seal of approval .

For example, Chodor said, “If you’re looking at glucose monitoring apps and there’s 150 of them, but 20 have a seal on them, then you can make an educated decision about which of those 20 you want to use.”

Some patients prefer game-type apps, Chodor added. Others like apps with big icons or great graphics.

But right now apps are largely untested despite the claims of some direct marketing ads. So if you’re using one instead of going to the doctor, think twice.

“It does make sense that people who download these apps and use them really understand that they are doing so at their own risk,” said Dr. Laura Ferris, a dermatology professor at the University of Pittsburgh.

Ferris ran a study of apps that claim to detect cancer based on a picture of a mole. Only one of the apps sends the picture to a dermatologist. It was right in 98 percent percent of cases. Three others could be dangerously wrong.

“The best of them missed melanoma 30 percent of the time,” Ferris said. “The worst of them missed melanoma over 90 percent of the time.”

Still, some doctors say apps that work are transforming medicine. Dr. Eric Topol, chief academic officer at Scripps Health in San Diego, prescribes apps that monitor blood pressure and heart rates so that both he and his patients know when and why things aren’t going well.

“And that’s a whole lot better than giving them medicine that we don’t even know if it works, has side effects, has costs,” Topol said. “So I have a higher regard for ads [devices connected to a phone or tablet] and apps than I do for medication.”

Topol says apps that control blood pressure will help prevent strokes and heart attacks, and may mean doctors should prescribe phones and tablets in addition to apps.

Few doctors in Massachusetts are prescribing apps, but many are paying close attention and thinking about ways that apps could improve care.

“If a diabetic patient can use an app and help organize their individual blood sugar regime and improve their self-care, then they can spend less time in the doctor’s office, which is a win-win for both sides,” said Dr. Richard Parker, chief medical officer for Beth Israel Deaconess Care Organization.

Count Porter in the “win” category. The fitness app devotee has lost 35 pounds in seven months. “It’s crazy, I never thought I could do that and I feel great. I feel like a different person,” she said.

Still, there are many unresolved questions about health care apps:

• Should all the information Porter uploads become part of her medical record, and if so, how?
• Who analyzes all her numbers?
• Will insurers cover the cost of apps?

Dr. Ben Crocker, who is with the MGH clinic that recommended Porter’s app, says those are questions doctors will have to answer because “this is what’s engaging patients. Patients are coming to their doctor for the first time saying, ‘I’ve been collecting some information,’ or, ‘I’ve been using this application.’ And that, I think, we can’t ignore, no matter where this is taking us, no matter how Wild West it feels.”

Have you had any positive or negative experiences with medical apps? Share your story in the comments.

Related:

• When Does An App Need FDA’s Blessing?
• Skin Doctors Question Accuracy Of Apps For Cancer Risk
• Calorie Tracking Apps May Help Boost Weight Loss
• Yes, There’s Probably A Medical App For That

Let me stipulate: What happened yesterday — the official opening of a state Healthcare Information Exchange that’s being likened to the golden spike that launched the intercontinental railroad — is surely a wonderful thing. It should become far easier for hospitals and doctors to share medical information. Dr. John Halamka blogs on his Life As A Healthcare CIO that state history was made:

“At 11:35 am Governor Deval [Patrick] and his physician sent the Governor’s healthcare record from Massachusetts General Hospital to Baystate Medical Center. It arrived and was integrated into Baystate’s Cerner medical record. The Massachusetts HIE [Healthcare Information Exchange] is now open for business.”

Read the full post for his description of the appalling health information disconnects that his wife encountered in her breast cancer care. He concludes ringingly:

“Just as the original golden spike in 1869 issued in a new era of connectness, so does today’s HIT [Health Information Technology] golden spike change business as usual in Massachusetts. Over the next year, we’ll be building new “bridges”, ensuring that every payer, provider, and payer can join the ecosystem. Here’s to innovation!”

I’m all for innovation. But in a world where a billion people are connected on Facebook, how do I get excited about a medical record crossing a state? Instead, I just get depressed at the tremendous obstacles that have tended to keep health information technology from keeping pace with the rest of this brave new technological world. A June “Perspective” article in The New England Journal of Medicine points out that doctors are “increasingly bound to documentation and communication products that are functionally decades behind those they use in their ‘civilian’ life.”

Dan Munro, a contributor to Forbes magazine, expresses the disturbing contrast here better than I ever could. He compares the inspiring technological feat of Felix Baumgartner‘s 24-mile fall to earth Sunday — including YouTube’s ability to stream the event live over 8 million concurrent streams — with the ‘Golden Spike’ press release he received. He writes:

The juxtaposition here is truly embarrassing and reflective of just how far adrift our Governmental healthcare IT thinking seems to have become. Felix Baumgartner is pushing the boundaries of human achievement from quite literally the edge of space – with some breathtaking technology (both aloft and here on terra firma) and the State of Massachusetts is looking for National recognition and applause for “Sending [the] First Electronic Health Record from Boston to Springfield.” The Federal Government has already spent billions – with billions more in the pipeline – to transition to Electronic Health Records – and the leading State in many of our healthcare IT efforts wants to announce with National fanfare the equivalent of a point-to-point telegraph transmission?

His full piece is worth a read, and if you want to correct him — and me — about the state of health information technology, we welcome comments below.

For the last two years, Dr. David Blumenthal was the czar of Health Information Technology for the Obama administration, overseeing its monumental efforts to push the country toward electronic medical records. This is his first week back at his Harvard home. In case you missed it yesterday, CommonHealth featured him in the above brief video, on what we should all be asking of our doctors, electronically speaking. Today, we continue our debriefing, lightly edited:

Q: You’re just back from two years in Washington, DC. What will you do now?

To be absolutely frank, I’m exploring lots of different options. It’s virtually impossible to plan your next step while you’re in government, because of all the potential conflicts of interest. I’m back as a professor at Harvard and I’m sure I’ll be doing some writing, and probably some academic work, and a lot of speaking and guest-lecturing. I also have acquired something of a taste for having an impact on the real world — I spent two years trying to do that in Washington — so I’m looking for opportunities to affect health care delivery, and I’m not sure what form that will take.

I’ve become a convert to the idea that information really is power, in health care just as in everything else. The information platforms that systems work with are vital to their success, and getting those better-integrated into the day-to-day delivery of care is important for patients, doctors, nurses, hospitals — everybody. I don’t see a pathway to accomplishing everything we want to accomplish, in the commonwealth or nationally, until we have much more powerful information systems.

You can make big changes in the delivery of health care just by giving people better information. Most health care professionals go to work every day wanting to do a good job, and when they fall short, it’s often because they don’t have the information they need.

Q: Could you share a telling example of the power of information in health care?

I’ve often told the story of myself as a doctor using a radiology software program they have here at Partners. What it does is two things:

When you write an order for a high-cost imaging request — MRI or CAT scan, or an ultrasound, or a stress test with complicated imaging — it asks you to put in the indications and then it compares your test order to the American College of Radiology’s guidelines, in real time. It gives you a red, yellow or green signal.

If it’s red — which does happen, it happened to me many times — it’s often because you’re getting an MRI when a CAT scan would be better, or you’ve ordered an MRI without contrast when you should have added contrast, or you’re ordering a stress test with imaging of the heart when you need to order it without.

So people change, and it prevents waste. And you can override it. I suspect if you’re an outlier on overriding, you might hear from the chief medical officer or something like that, but there’s no penalty. I did override it; most commonly when I had a patient insisting. I’d say, ‘Your back hasn’t been hurting long enough, the guidelines don’t suggest you need an MRI for your back pain,’ and they’d say, ‘If you don’t do it I’ll find someone else who will.’

The other thing it did was in some ways even more powerful: It would scan through the record and find out if something similar had been ordered in the previous three months.

One woman came in with what I thought might be kidney disease, and I wanted to image her kidneys. I put in the order and up came the feedback that something similar had been ordered in the last three months. So I went looking for the test, and found another physician had ordered a lung CAT scan, but it so happens that when people do CAT scans of the lung, they often go below the diaphragm. Her kidneys had been imaged on that test and they had been normal.

So it avoided the money and it avoided her inconvenience, it was a total win. To me, that symbolizes the way forward. The doctor is a better doctor, the patient is less inconvenienced, and we’ve saved a whole bunch of money. I thought to myself, if that could happen tens of thousands of times a day all through our health care system, it would be a dramatic change, and without any controversy.

One of the reasons I think the work we were doing in Washington is so potentially important is that we were creating incentives for people to put in place this kind of software and the capability to use it.

Q: So you actually think this kind of change can come without controversy? Hasn’t there been a great deal of pushback against electronic medical records?

It’s a constant theme. We understood that this was about winning hearts and minds, of mostly the small practices and small hospitals. Among the large practices and hospitals, it’s absolutely unquestioned. That’s been a big psychological change.

It’s hard to adopt electronic health records, that’s very clear. It takes a lot of extra time and effort. The cost question is less clear. When I got to Washington, I was pretty much convinced that there was not much of a return on investment for small practices, but that you could get to break-even.

But there’s been increasing information demonstrating that in fact, there are pretty dramatic cost savings possible, and revenue gains — even in small practices — from electronic medical records. They have to do with elimination of personnel from filing, easier systems to make appointments, less requirements for nurse follow-up of lab testing, all those kinds of things — and needing less space as you get rid of all those paper files. And also more thorough, accurate billing. The Medical Group Management Association, which represents groups of five physicians or larger, did a study that showed that among their members, groups with electronic health records — compared to groups without — netted over $40,000 more per physician per year.

I think this will be especially true as the systems improve, and one of the elements of improvement is cloud-based software.

Q: You’d said initially your commitment was only for two years, but still, why did you decide to leave Washington?

I think that at the margin, my contribution was diminishing. There are still some big problems to solve but the task was much more an implementation task than a policy development task now, so I thought there were other people who could do that just as well as I could.

Q: Some people say you’re leaving just as the really hard part starts…

The first two years weren’t without their controversy but I think we have a good grounding. And if Information Technology were my lifelong passion it might also have made a difference, but I’m much more about delivering health care services more efficiently.

Q: What surprised you there?

A number of things, both positively and negatively.

One of the positive things was the enormous outpouring of support and time commitment that we got from volunteers on our advisory committee. I calculated that we had probably had 15 or 20,000 volunteer uncompensated hours from experts, the best people in the country who either sat on the phone or met in meetings open to the public and discussed the key issues.

That was the upside. The downside: I was surprised at the level of skepticism about the whole premise. I expected people to say, ‘It’s going to be hard.’ I expected people to say, ‘I don’t trust the software.’ I expected people to say, ‘It’s going to reduce my productivity.’ I was a little more suprised by a theme that was kind of a conspiracy theory, that this was an industry project, that in the IT industry there were some big donors, big democratic donors, big information technology companies that had basically captured the process.

The fortunate thing about it is that there was absolutely no truth to the story so it went away. I was the poster person for this initiative, and I’ve been on the masthead of the New England Journal of Medicine, and the New England Journal has very, very tight conflict rules: I couldn’t accept honoraria for speaking, I did no consulting for industry, no speaking. I was really completely clean. And not only that, I had no involvement in information technology before I got there. I didn’t know these people. Evenutally, they just couldn’t make the case.

Then it took another shape. The Huffington Post had a couple of investigative reporters who were tackling us for quite a while and their argument explicitly was that electronic health records were unsafe for patients, because they made errors — software bugs and failures and unusable equipment could lead to errors.

Q: And are there errors?

The response we made was that net-net, people are safer with electronic health records, but any technology, no matter how beneficial, creates potential errors, that’s why we regulate vaccines, drugs and devices. We need to look carefully at information technology from the same perspective. So we actually asked the Insitute of Medicine to do a study of how to improve the safety of electronic health records, and they’re in the process of doing it. They’re going to report in the fall, and there are a number of options we were actively looking at, including that they could be considered devices under FDA regulation. We also have a certification process that didn’t exist before, that could involve some safety assessment.

Q: Was the president supportive enough?

Yes, I felt we got support from the president. I had fewer surprises than there might otherwise have been. This is a bipartisan issue. The administration was strongly committed to it; it was a priority for them to get it launched successfully. When we really needed them to help us meet our deadlines for getting regulations out the door and meeting legislative deadlines, they got the job done for us. Nothing ever is completely as you expect, or completely uncontroversial, but on the whole I got the support I needed. Even the Ryan proposal does not take aim at electronic health records. I think it’s because people like Newt Gingrich have been big supporters of health information technology. One of the early bills on health information technology was jointly sponsored by Hillary Clinton and Newt Gingrich.

Q: You say we can’t proceed with health reform without better technology...

You can’t be accountable for care if you don’t know what care you’re delivering. You can’t be accountable for cost if you don’t know cost. You can’t be accountable for quality you can’t measure. We don’t have a way for doing things better absent better information

For the last two years, Dr. David Blumenthal was the czar of Health Information Technology for the Obama administration, overseeing its monumental efforts to push the country toward electronic medical records. This is his first week back at his Harvard home, in a Massachusetts General Hospital office about the size of a walk-in closet, bookshelves still waiting to be filled. Rachel and I spoke with him today about his experiences in Washington, his current plans and the state of Health IT in the country and the state.

We’ll share more of that debriefing tomorrow. But first, the news you can use: in the video above and the text below, he answers the practical question: What’s the least we should expect from our doctors, at this point, in terms of using computers?

I think you should expect your doctor, nurse, and pharmacist to have your personal health information in electronic form. That means they should be entering it pretty much at the time you see them. You should be able to find your medicines, your problems, your X-ray and lab results, in their computers.

It’s a little too soon to expect them to be in electronic communication with other doctors and hospitals. Our systems in many parts of the country are not yet capable of that. We should be capable of doing this soon in this market, in the Eastern Massachusetts market. And I think the obstacles are more a matter of will and effort and money than they are of technology.

Tomorrow: Dr. Blumenthal went to Washington. What surprised him there? How can technology help cut health care costs? And what is the current state of play in terms of federal incentives to go electronic?

“The tech spending is set to go on,” said Lynne Dunbrack, an analyst in the Health Industry Insights unit for IDC, a technology research company. “The better use of health care technology to reduce costs and improve care has bipartisan support.”

Some new evidence of industry’s confidence in the future of health IT: AT&T has just announced a new division called AT&T ForHealth, the Times reports in its Bits blog.

AT&T will offer data-center and hosting technology for [EMR] exchanges. It also plans to provide telehealth services for remote diagnosis and treatment, and a wide range of support for preventive and disease management applications on smartphones.