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Currently submitted to: JMIR mHealth and uHealth

Date Submitted: Nov 16, 2019
Open Peer Review Period: Nov 16, 2019 - Jan 11, 2020
(currently open for review)

Analysis of secure apps for daily clinical use as a German orthopaedic surgeon - searching for the "needle in a haystack"

  • Florian Dittrich; 
  • Sascha Beck; 
  • Anna Katharina Harren; 
  • Felix Reinecke; 
  • Sebastian Serong; 
  • Jochen Jung; 
  • David Alexander Back; 
  • Milan Wolf; 
  • Stefan Landgraeber; 



Benefits of adequate smartphone and app implementation in the fields of orthopaedic surgery are undeniable and offer enormous opportunities for future challenges in public health. But the number of available apps in the two major app stores remains unclear for use in daily clinical routine as a German orthopaedic surgeon.


The objective was to gain evidence regarding quantity and quality of available apps in the two major app stores for the intended use.


We conducted a systematic, keyword-based app store screening to gain evidence concerning quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the “app-synopsis – checklist for users” and the German Mobile App Rating Scale with regard to secure use, trustworthiness and quality.


The investigation revealed serious shortcomings regarding legal and medical aspects in the majority of apps. Most apps turned out useless and unsuitable for the clinical field of application (99.84%, 4242/4249). Finally, seven trustworthy and high-quality apps (0.16%, 7/4249) were identified offering secure usage in orthopaedic daily clinical routine. These apps mainly focused on education (5/7). None of these was CE certified. Moreover, all apps lack evidence of a beneficial effect demonstrated in studies.


Gained data suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic and rudimentarily controlled app stores is most challenging. Promising approaches, e.g. systematic app store screenings, app rating developments, reviews or app-libraries and the creation of consistent standards have been established. But future efforts are required not only to transfer knowledge but also to ensure safety of these innovative Mobile Health applications in daily clinical practice.


Please cite as:

Dittrich F, Beck S, Harren AK, Reinecke F, Serong S, Jung J, Back DA, Wolf M, Landgraeber S

Analysis of secure apps for daily clinical use as a German orthopaedic surgeon - searching for the "needle in a haystack"

JMIR Preprints. 16/11/2019:17085

DOI: 10.2196/preprints.17085


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