"Challenges and potential: health apps in Germany".

The introduction of "Digital Health Apps" (DiGA) in Germany aimed to improve access to health services, especially for people with mental illnesses such as depression and anxiety disorders. A main advantage of DiGA is that they offer a flexible and easily accessible complement to conventional health care. Yet despite rising mental illness in Germany, health app prescriptions have been disappointingly low so far - only 164,000 apps had been prescribed by September 2022. Yet these figures mask profound challenges, as outlined in the underlying Handelsblatt article, these highlight that despite high expectations and efforts to promote digital healthcare, significant hurdles remain.

The main reasons for this lack of acceptance are:

• Complexity of illnesses: Some doctors classify the treatment of mental illness as too complex for an app. They believe that an app is not sufficient to treat patients with profound problems.

• Unrealistic promises: Some health app providers advertise their products with very optimistic promises, which some doctors consider unrealistic and exaggerated. The statements of some providers suggest that the diseases are sufficiently treated by the apps and suddenly disappear, which is not medically realistic.
  Lack of information among doctors: Many doctors have never heard of the concept of digital health apps or are insufficiently informed about what such apps can do. A large proportion of outpatient doctors stated at the DiGA launch in 2021 that they were not aware of the prescription apps.

• Costs and study quality: The costs of the apps and the quality of the clinical studies that are supposed to prove their effectiveness are controversial. Some doctors doubt the quality of the studies, which often have too few participants and can only vaguely prove effectiveness. In addition, the prices are too high for some health insurance companies or too low for the manufacturers to finance the necessary clinical trials.

• Limited role of physicians: DiGA regulation generally allows apps to function without the intervention of a doctor. The dovetailing of doctors and technologies, referred to as "blended care", is seen as promising by some, but the DiGA prescription is still limited in this respect so far.

The issues behind health app prescribing are succinctly summarised by Peter Kuhn, DiGA consultant at 5-HT Digital Hub: "It is disappointing but not surprising that DiGA success in Germany has so far fallen short of expectations. Doctors need to be involved and educated at an early stage, but this is hardly possible due to the already constantly increasing workload of service providers and the effort required to develop a DiGA.

Especially in the case of mental illnesses, a long-term relationship of trust between the practitioner and the patient is important, which is why blended care approaches, such as those of Elona Health, in which the practitioner and the patient work together with a DiGA, could be more accepted by the service providers.

Only the active involvement and good information of doctors can lead to the acceptance of DiGA and ultimately improve the well-being of the patient."

Click here for the entire Handelsblatt article in German.