Made with FlowPaper - Flipbook Maker
3 6 0 IMPROVING MENTAL HEALTH WITH DIGITAL TECHNOLOGY A 360º VIEW OF THE MENTAL HEALTH INFORMATION THAT MATTERS TO YOU 2020 2020 01 01 December 2019 MRC2.CORP.X.04113Visit www.psychu.org/events/virtual-forums to view all upcoming webinars and register today! PsychU is supported by Otsuka Pharmaceutical Development & Commercialization, Inc. (OPDC), Otsuka America Pharmaceutical, Inc. (OAPI), and Lundbeck, LLC – committed supporters of the mental health treatment community. The opinions expressed by PsychU’s contributors are their own and are not endorsed or recommended by PsychU or its sponsors. The information provided through PsychU is intended for the educational benefit of mental health care professionals and others who support mental health care. It is not intended as, nor is it a substitute for, medical care, advice, or professional diagnosis. Health care professionals should use their independent medical judgement when reviewing PsychU’s educational resources. Users seeking medical advice should consult with a health care professional. No CME or CEU credits are available through any of the resources provided by PsychU. Some of the contributors may be paid consultants for OPDC, OAPI, and / or Lundbeck, LLC. © 2019 Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD PsychU webinars are designed to be interactive conversations between mental health professionals and the PsychU community. During these online presentations, experts in the field of mental health share their knowledge and experiences and answer questions from the live online audience. Can't attend live? Register anyway! We'll send you a copy of the slide deck and video presentation to view on-demand. WEBINARSTABLE OF CONTENTS 04 12 22 28 INTRODUCTION 04. Leveraging Digital Technology for Better Mental Health Care ENGAGEMENT & DIAGNOSIS 12. Consumer Engagement Tech--No Reward Without Risk 14. PsychU Live Events 16. Virtual Visits in Primary Care: Who Uses Them & Why? 17. 'Virtual Psychiatrist’ Telemedicine Decision Support System Effective in Diagnosing Mental Disorders 19. Data & Decision Support for Suicide Assessment TREATMENT 22. A Web-Based Self-Help Intervention may Prevent or Delay Major Depressive Disorder in Adults with Subthreshold Depression 24. Electronic Self-Monitoring of Mood for Bipolar Disorder: Full Speed Ahead or Proceed with Caution? 26. Telepsychiatry Improves Access to Mental Health Care in Rural Areas 27. Virtual Physical Rehabilitation Is as Effective as In-Person Services FOR MANAGEMENT 28. Crossing the Digital Health Chasm 30. Your Data Integration Checklist 31. Bot Anyone? The Question--What Services Can You Automate? 33. FDA Finalizes That Fitness Apps, EHRs Are Outside Regulatory Scope for Medical Devices 35. Ready or Not, Cognitive Computing Will Change Your Organization 36. Yes, There Are Organizations Using Augmented Intelligence 38. PsychU's National Forum 42. Becoming a Member of PsychU 03 December 2019 MRC2.CORP.X.04113D espite vast improvements in diagnosis and treatment over the last half-century, mental illness is underdiagnosed and undertreated. The reasons are many and varied. Among them: a lack of access for individuals amid a shortage of care providers, the interference of social determinants of health such as transportation problems, and social stigma. All play a role. But technology offers a route to improvement that skirts these and other barriers. Consider just a few of its more recent contributions. As a McKinsey & Company paper points out, technology applied in health care settings has helped prevent adverse drug events, including medication errors, allergic reactions, and overdoses. Technology has been deployed successfully to increase individuals’ compliance with care recommendations, such as preventive checkups and medication refill information, improving their health. And it has served to streamline diagnostic testing and other processes, saving significant cost. 1 LEVERAGING DIGITAL TECHNOLOGY FOR BETTER MENTAL HEALTH CAREToday’s advanced technology aids mental health care via disparate approaches and tools that have the capacity to: • Aid clinical decisions. • Streamline processes, both on the back end and consumer facing. Examples include blood utilization and appointment scheduling. • Expand access to care and increase its timeliness. • Enhance transparency and communication between physician and patient. • Collect and interpret health data in real time, complementing that recorded in the doctor’s office. • Reduce costs. • Improve outcomes. In short, technology—from telepsychiatry to wearable health devices to artificial intelligence– aided clinical decision support—may accelerate the drive toward the Triple Aim: a better care experience, improved population health, and reduced costs. And the benefits of better mental health care accrue to individuals who are suffering, to care providers who want to alleviate that suffering, and to health systems and insurers that seek to improve care quality while decreasing costs. All that translates to increased reach and enhanced value. One in five American adults lives with mental illness. That prevalence is more concerning when one considers that fewer than half of individuals with mental illness—only 43%—received any treatment for their illness in the previous year, according to a 2018 Substance Abuse and Mental Health Services Administration (SAMHSA) study. And about one in 25 U.S. adults has a serious mental illness (SMI), such as schizophrenia, bipolar disorder, or major depressive disorder. Among individuals aged 18–25 years with an SMI, nearly half—46%—received no treatment in the previous 12 months. 2 In addition to the human cost of untreated mental illness, there is an economic one as well: lost earnings due to SMI cost the economy around $193 billion yearly. 3 Why is mental illness, despite its undeniable human and societal burden, so undertreated? Many factors come into play, such as underdiagnosis, stigma, a worrisome shortage of psychiatrists and other mental health care providers, and individuals’ personal logistical challenges. Among these barriers, one of the most significant is wide geographical variation in the availability of mental health care providers. Countrywide there is an average of one mental health provider for every 536 individuals. But that average disguises a dramatic difference in access: the ratio in Massachusetts is 1:200, whereas in Alabama, it is 1:1260. More than 4,000 areas across the U.S., mostly rural and low-income locales, are designated mental health care professional shortage areas. 4 Why is mental illness, despite its undeniable human and societal burden, so undertreated? 05 PREVALENCE OF MENTAL ILLNESS BARRIERS TO CARE INTRODUCTION 1 in 5 American adults lives with a mental illness.Technology facilitates mental health care in multiple ways: • Mobile health (mHealth) sensors that collect health data. • Digital interventions and assessments. • Clinical-decision support systems. • Mobile apps for mental health. • Medication adherence technology. • Telepsychiatry and teletherapy. According to a 2019 Pew study, 96% of U.S. adults have a smartphone. 5 The prevalence of internet usage and the ubiquity of smartphones offer individuals an abundance of mental health care sites, functions, and apps. Estimates vary widely as to number, but internet sites and mobile apps number well into the thousands. Their advantages are plain to see. Most are low- cost or free. They overcome access barriers, both spatial and temporal. Given societal stigma, some consumers with mental illness wish for anonymity; apps can provide that. They are convenient to access and use. Some even offer games and other fun ways to manage mental health. Some examples of the types of apps available for use in managing mental wellness: Self-management apps: The user inputs personal data manually, and the app provides feedback of some kind. Apps in this category can prompt consumers to practice deep breathing when their anxiety climbs or take medication on schedule. Indeed, apps that support medication adherence can be very helpful, as it is well established that poor compliance with pharmacological therapy compromises treatment and results in poorer outcomes. Apps for improving thinking skills: Cognitive behavioral therapy, or CBT, relies on the recognition that thoughts, feelings, and behaviors are intertwined; change thoughts, and feelings and behaviors will follow suit. Apps that seek to alter thought patterns and improve thinking skills, using CBT principles, tend to be targeted at people with more serious mental illness. Attention-Controlling Games: According to the National Institute of Mental Health, apps in this category are being tested as a treatment for post- traumatic stress disorder (PTSD). Video Games: One example of a video game accessible via app features a protagonist who confronts anxiety and depression. The user can identify with the game’s central character as that person confronts challenges complicated by mental illness. Experimental: A major research university is currently studying how facial recognition technology can be used to predict schizophrenia. Apps that seek to alter thought patterns and improve thinking skills, using CBT principles, tend to be targeted at people with more serious mental illness. OPENING ACCESS, INCREASING TIMELY CARE07 electronic health records, or EHRs, the majority of provider practices do now have patient records in digital form. Along with those digitized records is the capacity to automate messages to the individuals treated by a practice, such as reminders to set up appointments for preventive or specialist care. Polypharmacy review is more easily accomplished when all an individual’s medical data from different providers is collected in the same place, thereby allowing analysis. EHRs facilitate efforts to improve population health by allowing providers to identify all individuals with a particular condition, such as diabetes type 2, and target interventions at them. One success story with health information technology is UCLA Health, which leveraged IT across the organization to improve processes and outcomes. For example, UCLA Health increased depression screenings performed by primary care physicians via automated notices to case management. Another project UCLA Health tackled was blood utilization. Concerted national efforts and careful research have demonstrated that blood has been routinely overused in hospitals, compromising patient outcomes. What’s more, blood is high in cost, so overuse of blood translates not only to patients receiving suboptimal care but also to increases in the cost of care without a concomitant increase in quality. Guided by clinical decision support that aided clinicians in real time, UCLA Health optimized blood utilization across its organization. Much has been written about how health information technology has impacted medical care for the better. In the wake of the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 and the Patient Protection and Affordable Care Act (PPACA) in 2010, both of which incentivized the adoption of HEALTH INFORMATION TECHNOLOGY INTRODUCTION Among individuals with a serious mental illness, nearly half --46%-- received no treatment in the past year. So far-reaching were its accomplishments that UCLA Health was awarded the 2018 HIMSS Davies Enterprise Award for leveraging HIT to improve outcomes, a McKinsey paper reports. 6 Whether treatment occurs via smartphone or computer, telepsychiatry and other mental health services performed online open access to mental health care in resource-poor regions by offering consumers a way to videoconference with a psychiatrist or other mental health care professional in real time. This synchronous therapy can be augmented by asynchronous communication between consumer and care professional. Certainly, televisits for mental health are now in wide use. Consider this graphic showing the degree to which different payers reimburse for them: 7 But some question whether those with SMIs can use mHealth apps and other technologies appropriately. Does the Pew research that found widespread ownership of computers and smartphones and use of the internet mean that these individuals are comfortable with technology? The answer would seem to be yes. One study of individuals with SMI found broad acceptance of technology-aided treatment. Key characteristics associated with successful use of digital health tools as identified by the authors’ research: • Interest in using state-of-the-art technology. • Resources, such as a smartphone or WiFi, that facilitate access to treatment. • Positive expectations about using a digital health tool. • Supportive social network. • Good occupational functioning. Substance use and chaotic living situations were two factors that worked against successful use of digital technology in this population. 8 Gathered here are articles about digital health care featured on PsychU, grouped into these three categories: 1. Engagement and Diagnosis 2. Treatment 3. For Management Getting things started is “Consumer Engagement Tech—No Reward Without Risk,” which homes in on a key issue in health care today: how to engage consumers in managing their health. THERAPY VIA MOBILE OR COMPUTER WHAT’S TO FOLLOW ENGAGEMENT & DIAGNOSIS 85% 68% 98% 99% 0% 20% 40% 60% 80% 100% 120% Telehealth All Plans (n=1,273)Commercial (n=541) Medicaid (n=159)Medicare (n=557) REIMBURSEMENT FOR TELEHEALTH 59% 63% 40%40% 82% 84% 0%0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Mobile AppsOnline Engagement Tools Planned Use of Engagement Strategies All PlansCommercialMedicaidMedicare ENGAGING THE CONSUMER09 The fact is, investing in consumer-engagement technology is a must today. This article argues that the potential upside makes investment worth it, despite the short-term risk. Next in line is a look at a research study about virtual visits: who used them and under what conditions. One notable finding was that those individuals who used virtual visits to receive health care were significantly more likely than the general population to be seeking care for a mental disorder. Another salient fact: The vast majority (93.2%) of those using virtual visits said the care they received was of high quality. The age of digital health care offers hope for enhanced diagnosis, with artificial intelligence deployed to aid clinicians in identifying disease. In an Indian study, a telemedicine clinical decision support system was used successfully by non- psychiatrists to diagnose 18 mental health disorders. Read “‘Virtual Psychiatrist’ Telemedicine Decision Support System Effective In Diagnosing Mental Disorders” for more. Suicide rates have increased notably in the last 15 years, by 33% from 1993 to 2017. Assessing suicide risk is a crucial aspect of mental health care. Identifying individuals most at risk for suicide is the aim of several programs highlighted in “Data and Decision Support for Suicide Assessment,” among them efforts by Kaiser Permanente in different locations and the Department of Veterans Affairs’ Recovery Engagement and Coordination for Health-- Veterans Enhanced Treatment (REACH VET). In an Indian study, a telemedicine clinical decision support system was used successfully by non- psychiatrists to diagnose 18 mental health disorders. INTRODUCTIONNext >