title: Impact of consumer health informatics applications.
abstract: OBJECTIVE
  The objective of the report is to review the evidence on the impact of consumer health informatics (CHI) applications on health outcomes, to identify the knowledge gaps and to make recommendations for future research.
  
  
  METHODS
  We searched MEDLINE, EMBASE, The Cochrane Library, Scopus, and CINAHL databases, references in eligible articles and the table of contents of selected journals; and query of experts.
  
  
  METHODS
  Paired reviewers reviewed citations to identify randomized controlled trials (RCTs) of the impact of CHI applications, and all studies that addressed barriers to use of CHI applications. All studies were independently assessed for quality. All data was abstracted, graded, and reviewed by 2 different reviewers.
  
  
  RESULTS
  One hundred forty-six eligible articles were identified including 121 RCTs. Studies were very heterogeous and of variable quality. Four of five asthma care studies found significant positive impact of a CHI application on at least one healthcare process measure. In terms of the impact of CHI on intermediate health outcomes, significant positive impact was demonstrated in at least one intermediate health outcome of; all three identified breast cancer studies, 89 percent of 32 diet, exercise, physical activity, not obesity studies, all 7 alcohol abuse studies, 58 percent of 19 smoking cessation studies, 40 percent of 12 obesity studies, all 7 diabetes studies, 88 percent of 8 mental health studies, 25 percent of 4 asthma/COPD studies, and one of two menopause/HRT utilization studies. Thirteen additional single studies were identified and each found evidence of significant impact of a CHI application on one or more intermediate outcomes. Eight studies evaluated the effect of CHI on the doctor patient relationship. Five of these studies demonstrated significant positive impact of CHI on at least one aspect of the doctor patient relationship. In terms of the impact of CHI on clinical outcomes, significant positive impact was demonstrated in at least one clinical outcome of; one of three breast cancer studies, four of five diet, exercise, or physical activity studies, all seven mental health studies, all three identified diabetes studies. No studies included in this review found any evidence of consumer harm attributable to a CHI application. Evidence was insufficient to determine the economic impact of CHI applications.
  
  
  CONCLUSIONS
  Despite study heterogeneity, quality variability, and some data paucity, available literature suggests that select CHI applications may effectively engage consumers, enhance traditional clinical interventions, and improve both intermediate and clinical health outcomes.
authors.forename: M Christopher
authors.initials: MC
authors.lastname: Gibbons
authors.forename: Renee F
authors.initials: RF
authors.lastname: Wilson
authors.forename: Lipika
authors.initials: L
authors.lastname: Samal
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Lehman
authors.forename: Kay
authors.initials: K
authors.lastname: Dickersin
authors.forename: Harold P
authors.initials: HP
authors.lastname: Lehmann
authors.forename: Hanan
authors.initials: H
authors.lastname: Aboumatar
authors.forename: Joseph
authors.initials: J
authors.lastname: Finkelstein
authors.forename: Erica
authors.initials: E
authors.lastname: Shelton
authors.forename: Ritu
authors.initials: R
authors.lastname: Sharma
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
mesh_terms: D054626:Consumer Health Information; D006801:Humans; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome