Millenson Michael L, Baldwin Jessica L, Zipperer Lorri, Singh Hardeep
Health Quality Advisors LLC, Highland Park, IL 60035, USA.
Northwestern University Feinberg School of Medicine, Department of General Internal Medicine and Geriatrics, Chicago, IL, USA.
Diagnosis (Berl). 2018 Sep 25;5(3):95-105. doi: 10.1515/dx-2018-0009.
Over a third of adults go online to diagnose their health condition. Direct-to-consumer (DTC), interactive, diagnostic apps with information personalization capabilities beyond those of static search engines are rapidly proliferating. While these apps promise faster, more convenient and more accurate information to improve diagnosis, little is known about the state of the evidence on their performance or the methods used to evaluate them. We conducted a scoping review of the peer-reviewed and gray literature for the period January 1, 2014–June 30, 2017. We found that the largest category of evaluations involved symptom checkers that applied algorithms to user-answered questions, followed by sensor-driven apps that applied algorithms to smartphone photos, with a handful of evaluations examining crowdsourcing. The most common clinical areas evaluated were dermatology and general diagnostic and triage advice for a range of conditions. Evaluations were highly variable in methodology and conclusions, with about half describing app characteristics and half examining actual performance. Apps were found to vary widely in functionality, accuracy, safety and effectiveness, although the usefulness of this evidence was limited by a frequent failure to provide results by named individual app. Overall, the current evidence base on DTC, interactive diagnostic apps is sparse in scope, uneven in the information provided and inconclusive with respect to safety and effectiveness, with no studies of clinical risks and benefits involving real-world consumer use. Given that DTC diagnostic apps are rapidly evolving, rigorous and standardized evaluations are essential to inform decisions by clinicians, patients, policymakers and other stakeholders.
超过三分之一的成年人会上网诊断自己的健康状况。直接面向消费者（DTC）的交互式诊断应用程序迅速普及，这些应用程序具有超越静态搜索引擎的信息个性化功能。虽然这些应用程序承诺能提供更快、更便捷、更准确的信息以改善诊断，但对于其性能证据的现状或评估它们所使用的方法却知之甚少。我们对2014年1月1日至2017年6月30日期间的同行评审文献和灰色文献进行了范围综述。我们发现，评估的最大类别涉及将算法应用于用户回答问题的症状检查器，其次是将算法应用于智能手机照片的传感器驱动应用程序，还有少数评估涉及众包。评估的最常见临床领域是皮肤病学以及针对一系列病症的一般诊断和分诊建议。评估在方法和结论上差异很大，约一半描述应用程序特征，一半检查实际性能。尽管由于经常未能按具体应用程序提供结果而限制了该证据的有用性，但发现应用程序在功能、准确性、安全性和有效性方面差异很大。总体而言，目前关于DTC交互式诊断应用程序的证据基础在范围上很稀疏，提供的信息不均衡，在安全性和有效性方面尚无定论，且没有涉及现实世界消费者使用的临床风险和益处的研究。鉴于DTC诊断应用程序正在迅速发展，严格和标准化的评估对于为临床医生、患者、政策制定者和其他利益相关者的决策提供信息至关重要。
