title: Unaddressed privacy risks in accredited health and wellness apps: a cross-sectional systematic assessment.
abstract: BACKGROUND
  Poor information privacy practices have been identified in health apps. Medical app accreditation programs offer a mechanism for assuring the quality of apps; however, little is known about their ability to control information privacy risks. We aimed to assess the extent to which already-certified apps complied with data protection principles mandated by the largest national accreditation program.
  
  
  METHODS
  Cross-sectional, systematic, 6-month assessment of 79 apps certified as clinically safe and trustworthy by the UK NHS Health Apps Library. Protocol-based testing was used to characterize personal information collection, local-device storage and information transmission. Observed information handling practices were compared against privacy policy commitments.
  
  
  RESULTS
  The study revealed that 89% (n = 70/79) of apps transmitted information to online services. No app encrypted personal information stored locally. Furthermore, 66% (23/35) of apps sending identifying information over the Internet did not use encryption and 20% (7/35) did not have a privacy policy. Overall, 67% (53/79) of apps had some form of privacy policy. No app collected or transmitted information that a policy explicitly stated it would not; however, 78% (38/49) of information-transmitting apps with a policy did not describe the nature of personal information included in transmissions. Four apps sent both identifying and health information without encryption. Although the study was not designed to examine data handling after transmission to online services, security problems appeared to place users at risk of data theft in two cases.
  
  
  CONCLUSIONS
  Systematic gaps in compliance with data protection principles in accredited health apps question whether certification programs relying substantially on developer disclosures can provide a trusted resource for patients and clinicians. Accreditation programs should, as a minimum, provide consistent and reliable warnings about possible threats and, ideally, require publishers to rectify vulnerabilities before apps are released.
authors.affiliation: Global eHealth Unit, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK. c.huckvale@imperial.ac.uk.
authors.forename: Kit
authors.initials: K
authors.lastname: Huckvale
authors.affiliation: CRG, Ecole polytechnique CNRS, Bâtiment Ensta, 828 boulevard des Maréchaux, Palaiseau, Cedex, 91762, France. jose-tomas.prieto@polytechnique.edu.
authors.forename: José Tomás
authors.initials: JT
authors.lastname: Prieto
authors.affiliation: Global eHealth Unit, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK. m.tilney11@imperial.ac.uk.
authors.forename: Myra
authors.initials: M
authors.lastname: Tilney
authors.affiliation: CRG, Ecole polytechnique CNRS, Bâtiment Ensta, 828 boulevard des Maréchaux, Palaiseau, Cedex, 91762, France. pierre-jean.benghozi@arcep.fr.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Benghozi
authors.affiliation: Global eHealth Unit, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK. josip.car@imperial.ac.uk.|Health Services and Outcomes Research Programme, LKC Medicine, Imperial College, Nanyang Technological University, Singapore, Singapore. josip.car@imperial.ac.uk.
authors.forename: Josip
authors.initials: J
authors.lastname: Car
mesh_terms: D016494:Computer Security; D003219:Confidentiality; D003430:Cross-Sectional Studies; D006801:Humans; D020407:Internet; D009313:National Health Programs; D018570:Risk Assessment; D012984:Software; D006113:United Kingdom