Twinning solution

Guideline of safe practices for health app developers

Twinning type

Partial adoption

Main policy priority

Digital tools for citizen empowerment and for person-centred care


Fundación Pública Andaluza Progreso y Salud (Spain)


Serviços Partilhados do Ministério da Saúde (Portugal)

Short description

AppSaludable is a recommendations guide for health-related apps, devices and software, designed by the Andalucian Agency for Healthcare Quality (ACSA). It includes a quality seal granting the quality recognition of the authority and can be obtained by every app which covers the recommendation guidelines.
The aim of this twinning is to set the basis for the establishment of a quality seal for mHealth apps within the Portuguese healthcare system through SPMS, based on the existing model developed by ACSA. This will be done through the adoption of the 31 recommendations (divided into four big blocks of content) included in the Andalusian model, its methodology, strategy and working framework; all these elements will be analysed to evaluate their applicability to the reality and existing technologies in the Portuguese healthcare system.
Furthermore, as an added value and to enrich this collaboration, a cross-recognition model between the two territories and models is planned. A minimum set of common recommendations present in both instances will allow any app awarded in one of the systems to be automatically also acknowledged in the other one. Thus, the initiative could constitute the seed of an eventual common international framework on mHealth apps assessment.


Twinning activities

The AppSaludable twinning activities included an initial workshop for knowledge exchange, the mapping of MySNS Selecção and AppSaludable criteria and recommendations and the exploration of a cross-recognition model after a minimum set of common recommendations had been defined. Although the original schedule for the activities had to be revised due to the impact of the COVID-19 pandemic, regular online meetings took place throughout the project to ensure the progress of the DigitalHealthEurope twinning.


The DigitalHealthEurope twinning allowed the partial adopter (SPMS) to analyse its health apps quality seal model (MySNS Selecção) and improve it in order to ensure a more comprehensive and robust appraisal process. Their original model considered three assessment criteria in the following areas: Performance, Security and Public Utility. Based on the collaborative work between SPMS, ACSA and mHealthBelgium, SPMS decided to implement additional requirements into their model that address information security and contribute to an increase of the app’s user trust.

Added value and benefits

The main benefit of the AppSaludable twinning is the fact that the recommendations resulting from the models will be implemented in the Portuguese Model (MySNS Selecção) in its 2020 updated version with a higher value for citizens and health professionals that will use certified health apps. The twinning led to the possibility of complementing the Portuguese model with the strongest aspects of the Andalusian model. The prospects for a potential cross-recognition model open up new international possibilities for collaboration and for improving the quality of international health apps assessment.

Barriers and success factors

The main difficulties were related to carrying out the mapping of the recommendations in the two models. For example, barriers included: 1) Different assessment criteria classification: criteria evaluating the same aspects were assessed from different points of view. 2) Different assessment semantics: criteria evaluating the same aspects were assessed from different points of view. The lack of physical meetings during the COVID-19 pandemic was also considered a barrier. Moreover, the COVID-19 outbreak created a challenge in staying on schedule, as all partners had additional responsibilities and shifted focus. However, the teamwork, the know-how exchange and the synergies between the Andalusian and Portuguese teams exceeded the existing barriers. Specifically, the comprehensive project management by the originator with clear timing and deadlines ensured smooth execution of the DigitalHealthEurope twinning.


The adopter, SPMS, will implement the additional requirements into its model (MySNS Selecção) in order to contribute to an increase in the app’s user trust. Additionally, SPMS will review its assessment model, particularly the submission form, to segregate health apps from medical apps since the latter will have to comply with specific Medical Device Regulations and CE certifications. SPMS will also develop a health apps certification platform that will contribute to the certification process dematerialization. Both ACSA and SPMS are interested in continuing their collaboration around mobile health applications. Despite the Covid-19 pandemic arising during the twinning, the DigitalHealthEurope twinning partners are expected to continue their partnership in the future.