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Technological innovations in mental healthcare: harnessing the digital revolution

  • Chris Hollis (a1), Richard Morriss (a1), Jennifer Martin (a1), Sarah Amani (a2), Rebecca Cotton (a3), Mike Denis (a4) and Shôn Lewis (a5)...
Summary

Digital technology has the potential to transform mental healthcare by connecting patients, services and health data in new ways. Digital online and mobile applications can offer patients greater access to information and services and enhance clinical management and early intervention through access to real-time patient data. However, substantial gaps exist in the evidence base underlying these technologies. Greater patient and clinician involvement is needed to evaluate digital technologies and ensure they target unmet needs, maintain public trust and improve clinical outcomes.

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Copyright
Corresponding author
Chris Hollis, NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Jubilee Campus, University of Nottingham Innovaton Park, Triumph Road, Nottingham NG7 2TU, UK. Email: chris.hollis@nottingham.ac.uk
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C.H. receives research funding from the National Institute of Health Research (NIHR) and European Union paid to his employing institution. R.M. receives research funding from the NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands paid to his employing institution. R.C. is employed by the Mental Health Network, which receives funding from providers of NHS-funded mental health services in England by way of membership fees. S.L. is chief investigator on the Medical Research Council-funded Clintouch project. This editorial is based on research conducted by the NIHR MindTech Healthcare Technology Co-operative, which is funded by the National Institute for Health Research. The views represented are the views of the authors alone and do not necessarily represent the views of the Department of Health in England or the National Institute for Health Research.

Declaration of interest

C.H. receives research funding from Shire Pharmaceuticals paid to his employing institution. R.C. reports that Janssen Cilag Ltd have provided a grant to support an upcoming Mental Health Network event on the subject of technology and mental health services. S.L. is chief investigator on the Clintouch project. C.H., R.M. and J.M. are all involved in the National Institute of Health Research (NIHR) MindTech Healthcare Technology Co-operative.

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References
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1 Ofcom. Communications Market Report 2013. Ofcom, 2013.
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3 Kroenke, K Spitzer, RL Williams, JB The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606–13.
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7 Vallance, C. NHS Care.data information scheme 'mishandled'. BBC News 2014; April 18.
8 Craven, MP Selvarajah, K Miles, R Schnädelbach, H Massey, A Vedhara, K et al. User requirements for the development of smartphone self-reporting applications in healthcare. In Human-Computer Interaction Applications and Services (ed. M, Kurosu). Springer, 2013.
9 Medicines and Healthcare Regulatory Authority. Guidance on Medical Device Stand-Alone Software (Including Apps). MHRA, 2014 (http://www.mhra.gov.uk/Howweregulate/Devices/Software/index.htm).
10 Stewart, R Soremekun, M Perera, G Broadbent, M Callard, F Denis, M, et al. The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry 2009; 9: 51.
11 Chang, CK Hayes, RD Perera, G Broadbent, MT Fernandes, AC Lee, WE, et al. Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS One 2011; 6: e19590.
12 World Health Organization. Glossary of Health Terms. WHO, no date (http://www.who.int/trade/glossary/story021/en/).
13 World Health Organization. mHealth New Horizons for Health through Mobile Technologies. Global Observatory for eHealth Series – Volume 3. WHO, 2013.
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  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Technological innovations in mental healthcare: harnessing the digital revolution

  • Chris Hollis (a1), Richard Morriss (a1), Jennifer Martin (a1), Sarah Amani (a2), Rebecca Cotton (a3), Mike Denis (a4) and Shôn Lewis (a5)...
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eLetters

Has mental health in fact harnessed the digital revolution?

Alastair Forrest, Head of School of Psychiatry, HE Kent Surrey and Sussex
27 July 2015

In their Editorial, Hollis et al (1) focus on the third of three digital revolutions, access to real-time patient data (‘connected health’) but also highlight the benefits of the first two revolutions: unlocking value in electronic medical records, and new forms of access that allow patients direct control.

How far have the first two digital revolutions imbedded benefits for patient care in mental health?



The first revolution (word-processing, from the 1960s) allows people with little training to prepare, edit and duplicate high quality documents. The second comes with the internet ability to access, transmit, share and edit these.

From these two revolutions, what can patients (and carers and professionals) expect as the outputs of the mental health IT system?

A basic expectation is that before every-face to-face clinical encounter, the IT system can easily deliver an accurate background history, an account of recent treatment, and an up-to-date Care Plan. (This list could extend to include both a summary history and a complete history, and a non-stigmatising Vulnerability and Risk History.)

The safety of these documents is assured by accessibility (so that they are used and reviewed often) and accuracy (confirmed by patients and carers.) They must be easily readable, to be safely understood, and actually used (as unread documents do not convey information.)

The quality of these “output” documents must convey respect for patients, carers and professionals, and the interactions between them. For patients and carers, documents summarising core parts of their present or past lives must carry “real world” acceptability in appearance and structure.

Clinical staff able to take pride in their documentation (being clear, respectful, accurate and useful) will welcome sharing them with patients, carers and other professionals.

Finally (as in the ordinary world) the IT system should save time for professionals (and patients and carers) to free up treatment time.

Simple IT technology can deliver this for professionals, patients and carers. (Hollis et al note that mental health patients’ use of technology is similar to the general UK population, with three-quarters of adults accessing the internet daily, and half with a smartphone.)

I have only anecdotal knowledge of how far Mental Health IT is delivering the benefits of the first two revolutions.

The conclusion of Hollis et al summarises key challenges for the third revolution, in connected health: “first, ensuring that patients and their needs remain at the centre of technology development and implementation; second, rapidly increasing the evidence base for the clinical effectiveness of digital technology; third, ensuring that the opportunity provided by data sharing between patients, carers and clinicians does not threaten privacy and undermine public trust. Finally, patients, clinicians and NHS commissioners require an agreed framework to evaluate the core features of new technologies including usability, content, safety, clinical- and cost-effectiveness.”

These still apply with equal force to the first two digital revolutions.

1) Chris Hollis Richard Morriss, Jennifer Martin, Sarah Amani, Rebecca Cotton, Mike Denis, Shon Lewis. Technological innovations in mental healthcare: harnessing the digital revolution.Br J. Psychiatry April 2015 205: 263-265.

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Conflict of interest: None Declared

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RE: Technological innovations in mental healthcare: harnessing the digital revolution

Other Contributors:

Roger C M Ho, Assistant Professor and Consultant Psychiatrist, National University of Singapore

Chris C S Cheok, Senior Consultant Psychiatrist, IMH

This existing article on “Technological innovations in mental healthcare: harnessing the digital revolution” offers readers an excellent overview of E Health in healthcare, and enables readers to be cognisant of its inherent benefits; but also the current gaps in service provision and knowledge. The authors of this editorial reply concur with the concerns raised, especially with regards to M-Health applications. One of the major concern raised about M-Health applications is that there has been rapid development and an avalanche of applications in the application store. However, there are seemingly very minimal evidence based publications based on these applications, and there are also no regulatory guidance in place, until recently. Apart from there being a need for regulatory procedures to be in place as a safe-guard, the other methodologies include either getting medical experts to guide or self-program the medical applications themselves; or have patients and clinicians rate applications using a validated toolkit. Previous research done by Subhi Y et al. [1] have highlighted that it is relatively easy for clinicians to develop web-based application themselves just by using a text editor. Zhang MW [2,3] has further illustrated in their papers 2 alternative methodologies used for the creation of applications for education [4], research [5] and also for clinical utility [6]. The rationale for having clinicians involved and as app developers is that it will help to overcome the barriers pertaining to applications lacking evidence base and would also drive down the cost associated with development of the application. The developmental process could be faster given that they already have the necessary expertise in a particular field. Apart from getting the involvement of clinicians, the other methodology is to have patients and clinicians to rate application based on validated scales of online health information quality such as the silberg scale as well as the newly developed Mobile App Rating Scale (MARS) [7].

References:

1. Subhi Y, Todsen T, Ringsted C, Konge L. Designing web-apps for smartphones can be easy as making slideshow presentations. BMC Res Notes. 2014;7:94. doi: 10.1186/1756-0500-7-94.

2. Zhang MW, Tsang T, Cheow E, Ho Csh, Yeong NB, Ho RC. Enabling Psychiatrist to be Mobile Phone App Developers: Insights into App Development Methodologies. JIMR Mhealth U Health 2014 Nov 11;2(4):e53

3. Zhang M, Cheow E, Ho Csh, Ng BY, Ho R, Cheok CC. Application of low-cost methodologies for mobile phone app development. JIMR Mhealth UHealth 2014 Dec 9;2(4):e55.

4. Zhang MW, Ho CS, Ho RC. Methodology of development and students’ perceptions of a psychiatry educational smartphone application. Technol Health Care. 2014;22(6):847-55.

5. Ho RC, Zhang MW, Ho CS, Pan F, Lu Y, Sharma VK. Impact of 2013 south asian haze crisis: study of physical and psychological symptoms and perceived dangerousness of pollution level. BMC Psychiatry. 2014 Mar 19;14:81.

6. Zhang MW, Ho RC, Sockalingam S. Methodology of development of a delirium clinical application and initial feasibility results. Technol Health Care 2015 Mar 3 [Epub ahead of print]

7. Stoyanov SR, Hides L, Kavanagh Dj, Zelenko O, Tjondronegoro D, Mani M. Mobile App Rating Scale: A New Tool for assessing the Quality of Health Mobile Apps. JIMR mHealth uHealth 2015;3(1):e27.
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