Across nearly every industry, the COVID-19 pandemic ushered in a period of immediate digital disruption. With lives at risk, the healthcare industry quickly innovated to provide fitness, wellness, and medical care on familiar devices. Now, two years after the pandemic’s start, medical apps face compounding pressures to match the speed and quality of consumer demands. 

Despite a shared commitment to healthcare software QA, data shows that digital-first health and fitness applications have higher ratings across the board than medical apps. Why? The different approaches and unique user/regulatory requirements allow health & fitness apps to release new versions of their apps more frequently and cover more languages. Medical app makers have to be exceptionally thorough, which slows release cadence.

For incumbent medical apps to match the speed, release cadence, and interoperability that digital-first health platforms have laid out, they need to take a unique approach to QA.

Incumbents vs. digital native healthcare apps

As we may use the words interchangeably, let me explain. 

On Google Play and Apple App Store, medical, fitness, and wellness apps are categorized into two genres, Health & Fitness and Medical. Their innovations cover electronic health records, telehealth, digital therapeutics, medical wearables, fitness tech, wellness tech, and more.

Data from our Health & Wellness Industry Report shows that in Q1 of 2022, legacy healthcare organizations developed approximately 45% of the top 30 Medical applications, including companies like Abbott, Anthem, and Allergan. Whereas digital-first companies develop nearly 90% of the Health & Fitness apps and include companies like AllTrails and Headspace. 

Our State of App testing 2022 comprehensive report identifies trends and benchmarks in medical and health app software testing.

Download the free report here.

Digital-first organizations build their products from the ground up as digital offerings; this gives them greater agility to adapt their products and user experiences as new features are required.  Although a sea change is underway, many medical application providers have not fully transformed into digital incumbents. These structural differences plus greater regulatory pressure for medical applications mean these two approach healthcare software QA very differently, as shown below.

Digital-first health and fitness apps:

  • Earn higher ratings than similar top medical applications.
  • Ship new updates more frequently than medical (usually with fewer testers and O/S combinations).
  • Are more likely to leverage continuous testing and development as part of their DNA.
  • Cover more languages (9.6 on average) than medical (3.6).

In contrast, medical apps:

  • Test on more device/OS combinations.
  • Use a larger pool of software testers.
  • May require devs to interface with older or outdated systems
  • Are subject to more rigorous testing due to FDA regulations for Software as Medical Device products or digital therapeutics offerings, which impacts the ability to release as often (more on this later).

Despite a balanced set of advantages and disadvantages between medical incumbents and digital-first apps, health & fitness apps have higher ratings across the board. Why? Well, more releases catch more issues before they reach the hands of users. Many health and fitness apps are digitally native, giving them a leg up on QA, automation, CI/CD, and UX. We also hypothesize that medical applications require more rigorous testing due to FDA regulations for Software as Medical Device (SaMD) products and medical wearables with sensors, which impacts the ability to release as often.

Medical apps face a complex regulatory environment

If we explained above that higher frequency releases = better ratings, you might ask, “why don’t medical apps just… release more?” Well, it’s not that simple. Incumbent medical apps exist within a strict regulatory environment: HIPAA, PHI, data compliance, and patient regulations.

With regulatory considerations, incumbents face a more complex path to iterating quickly than other industries. Patient data is highly regulated and highly sensitive. Medical app companies must ensure complete coverage to provide a bug-free, safe, private, and high-performing user experience. 

Also, as explained above, medical apps are less likely to be digitally dextrous with an in-house QA team, automated testing, software development lifecycle pipeline, etc. Outsourcing your QA and automated testing to a healthcare app testing service offers a strategic and cost-saving advantage. But, with responsibility for 3rd-party compliance, medical apps must identify software testing partners that understand HIPAA/PHI standards formalized through a Business Associate Agreement (BAA).

To put it plainly: despite a shared commitment to healthcare software QA, the different approaches and unique user/regulatory requirements have created a chasm in ratings between medical applications and their health & wellness contemporaries.

A unique QA strategy for medical apps

How to solve that chasm? Highly regulated medical apps need a different QA strategy than others in the space. Fewer releases with more testers, O/S combinations, and runs.

Achieving that level of quality doesn’t have to (and would be nearly impossible) to do alone. Instead, increase per run coverage by augmenting your in-house QA team with expert on-demand testers, QE, and software testing partners. This enables you to expand location, language, and device coverage with global freelancers aligned to your testing windows and code downtime.

To improve user ratings and compete with digitally native apps, medical apps should take a different approach to QA that focuses on:

  • Full device coverage: Cover as many real device/OS combinations per run as possible.
  • Fusing automation with manual: maximize testing coverage by mixing and matching automated and manual testing in different ways with a fused testing methodology.
  • Increase testers per run: Specifically for mHealth apps and test setup costs, increasing coverage per run is more cost-effective.
  • Shift Left and right: Optimize your testing strategy to ensure developers own a level of accountability for their code (e.g., unit and integration testing). At the same time, test in real-world conditions to fail fast, learn, and feed back into the continuous integration cycle. 

Testlio health and wellness clients outperform industry averages in release frequency and ratings — regardless of whether the app is oriented to wellness or medical treatment and use.

Kassidy Kelley serves as the Managing Editor for Testlio and works from her home base in Boston, MA.