A study found just five apps account for 15 per cent of all downloads in the healthcare category of the US Apple iTunes app store, an example – say the authors – of a significant imbalance in how the market works.

Moreover, 50 per cent of apps achieve fewer than 500 downloads, said the IMS Institute for Healthcare Informatics, which analysed the 40,000-plus healthcare apps in the store.

Most apps fall in the overall wellness category, with diet and exercise apps accounting for the majority.

However, the study says “patients currently face a dizzying array of healthcare apps to choose from, with little guidance on quality or support from their doctors”.

There are efforts underway in the US and UK to provide professional healthcare guidance but these are “limited in scope and impact to date”.

Furthermore, the typical app profile does not address the major crisis in healthcare which is patients dealing with chronic diseases, who typically are aged over 65. They are the patients on which most resources are invested, but among whom smartphone penetration is lowest – only 18 per cent in the US against 55 per cent of those aged 45-54.

Physicians appreciate the benefit of apps but remain cautious about recommending apps to patients without strong evidence of their benefits, as well as professional guidelines for their usage and confidence in the security of personal health data.

Payers and employers also want positive evidence of benefits before backing reimbursement or promoting app adoption.

More optimistically, the study says: “Over time, the app maturity model will see apps progress from being recommended on an ad hoc basis by individual physicians, to systematic use in healthcare, and ultimately to an end goal of being a fully integrated component of healthcare management.”

To reach that goal, four steps are necessary: 1) recognition by payers and providers of the role that apps can play in healthcare.

2) Security and privacy guidelines and assurances being put in place between providers, patients and app developers.

3) Systematic curation and evaluation of apps that can provide both physicians and patients with useful summarised content about apps that can aid decision-making regarding their appropriate use.

4) Integration of apps with other aspects of patient care.