The digital clinic: Implementing technology and augmenting care for mental health

Rodriguez-Villa, Elena; Rauseo-Ricupero, Natali; Camacho, Erica; Wisniewski, Hannah; Keshavan, Matcheri S.; Torous, John

doi:10.1016/j.genhosppsych.2020.06.009

Cited by 71 publications

(40 citation statements)

References 32 publications

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“…Solving these issues is a high priority and significant challenge 216 . New workflow con siderations were critical to designing a digital psychiatry clinic in Boston in order to ensure that apps were a core part of treat ment 217 .…”

Section: Recipients Of Innovation: Clinical and Clinician Factorsmentioning

confidence: 99%

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

et al. 2021

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As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies -such as smartphone apps, virtual reality, chatbots, and social media -have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions -including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders -as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.

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Section: Recipients Of Innovation: Clinical and Clinician Factorsmentioning

confidence: 99%

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

et al. 2021

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“…We suggest that use of this data may be best utilised in the context of an entirely new clinical workflow and clinic designed to support the integration of digital data – the digital clinic. Our team has outlined our experiences and implementation of this new pilot clinic 38 and how we build trust and therapeutic alliance when using the mindLAMP app.…”

Section: Discussionmentioning

confidence: 99%

Deriving symptom networks from digital phenotyping data in serious mental illness

et al. 2020

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Background Symptoms of serious mental illness are multidimensional and often interact in complex ways. Generative models offer value in elucidating the underlying relationships that characterise these networks of symptoms. Aims In this paper we use generative models to find unique interactions of schizophrenia symptoms as experienced on a moment-by-moment basis. Method Self-reported mood, anxiety and psychosis symptoms, self-reported measurements of sleep quality and social function, cognitive assessment, and smartphone touch screen data from two assessments modelled after the Trail Making A and B tests were collected with a digital phenotyping app for 47 patients in active treatment for schizophrenia over a 90-day period. Patients were retrospectively divided up into various non-exclusive subgroups based on measurements of depression, anxiety, sleep duration, cognition and psychosis symptoms taken in the clinic. Associated transition probabilities for the patient cohort and for the clinical subgroups were calculated using state transitions between adjacent 3-day timesteps of pairwise survey domains. Results The three highest probabilities for associated transitions across all patients were anxiety-inducing mood (0.357, P < 0.001), psychosis-inducing mood (0.276, P < 0.001), and anxiety-inducing poor sleep (0.268, P < 0.001). These transition probabilities were compared against a validation set of 17 patients from a pilot study, and no significant differences were found. Unique symptom networks were found for clinical subgroups. Conclusions Using a generative model using digital phenotyping data, we show that certain symptoms of schizophrenia may play a role in elevating other schizophrenia symptoms in future timesteps. Symptom networks show that it is feasible to create clinically interpretable models that reflect the unique symptom interactions of psychosis-spectrum illness. These results offer a framework for researchers capturing temporal dynamics, for clinicians seeking to move towards preventative care, and for patients to better understand their lived experience.

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“…The remainder of this perspective outlines opportunities and cautions for the road ahead; pulling from the emergent growing literature regarding digital health use since the advent of COVID-19 to discuss how new trends may advance or hinder the functional and normative mechanisms that underpin integrated care. -Clinical level: An unprecedented increase in the use of virtual care across sectors [1][2][3][4] and the use of patient portals to access information [5]. -Professional level: Providers are using more tools to enable collaboration and teamwork through technology enabled referral, consultation, and care plan meetings/rounds [3,6].…”

Section: Enter Covid: Digital Health's Big Breakmentioning

confidence: 99%

“…-Clinical level: An unprecedented increase in the use of virtual care across sectors [1][2][3][4] and the use of patient portals to access information [5]. -Professional level: Providers are using more tools to enable collaboration and teamwork through technology enabled referral, consultation, and care plan meetings/rounds [3,6]. -Organizational level: Health information data sets are being integrated to meet public health reporting needs [7], however infrastructure barriers to interoperability remain a significant barrier [4,10].…”

Section: Enter Covid: Digital Health's Big Breakmentioning

confidence: 99%

Integrated Care’s New Protagonist: The Expanding Role of Digital Health

Gray

2021

International Journal of Integrated Care

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Digital health technologies hold significant promise to advance both functional and normative health and social care integration. The COVID-19 pandemic has created a window of opportunity to rapidly advance the adoption of digital solutions which can improve activities that support integration at clinical, professional, organizational and system levels. Global examples demonstrate how the pandemic has also created opportunities to use technology to address core values of integrated care like personcentredness and coordination. However, rapid and reactive changes could lead to increased fragmentation and exacerbate health inequity. This perspective paper outlines some of the opportunities and threats to advancing integrated care presented by the rapid adoption of digital health tools, suggesting we maintain a long view to ensure the stage we set today will mean greater integration tomorrow.

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The digital clinic: Implementing technology and augmenting care for mental health

Cited by 71 publications

References 32 publications

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

Deriving symptom networks from digital phenotyping data in serious mental illness

Integrated Care’s New Protagonist: The Expanding Role of Digital Health

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