One in five Americans experience a mental health condition in a given year, and one in 25 U.S. adults experiences a serious mental illness that substantially interferes with major life activities, according to the National Alliance on Mental Illness. Globally, the World Health Organization (WHO) reports that depression is the leading cause of disability worldwide.
These statistics indicate that mental health issues impact a significant number of patients in every health system and healthcare provider organization. With the evolution of digital health tools, can technology help healthcare providers solve these issues? And, if digital health can help with mild to moderate mental health issues, can these tools, such as cognitive behavioral therapy apps, help with severe mental health conditions?
Don Mordecai, M.D., National Leader for Mental Health and Wellness for the Oakland, Calif.-based Kaiser Permanente organization, addressed these issues and gave his perspective on the state of digital health innovation in mental health care while speaking at a health innovation conference Nov. 29 sponsored by the Massachusetts Institute of Technology (MIT). MIT’s Sloan School of Management’s Initiative for Health Systems Innovation (HSI) sponsored the “Innovating Health Systems: Digital Health Transformations” conference at the Cambridge, Mass.-based campus.
Kaiser Permanente, an integrated hospital and health plan organization based in Oakland, California, is a 39-hospital health system with 20,000 employed physicians serving 11.8 million members, with 4 million mental health visits a year, Mordecai said.
Citing statistics on mental health, Mordecai said individuals who enter treatment for a mental health disorder are two times as likely to also be living with a substance abuse disorder, and less than half of adults with mental health conditions received treatment in the past year.
At Kaiser, physicians and researchers are working to leverage data, digital tools and predictive analytics to better address mental health issues among the health system’s patients. “With our EMR (electronic medical record system), we are technologically advanced—we have labs, diagnoses, visit notes, progression of disease. We have incredibly rich data beyond just the claims database,” he said.
Mordecai pointed out that there are currently hundreds of mobile apps targeting mental health and behavioral health. “But, we find that the evidence base is pretty thin. And, where there is evidence that cognitive behavioral therapy through a computer works, the uptake is low. We’ve tested apps, but people don’t use them. That is the central problem—how do you design them so people use them?”
Mordecai said one key issue with designing behavioral health apps is to focus on facilitating human interaction rather than replicating it. “Texting facilitates human interaction. A standalone cognitive behavioral therapy app is trying to replicate it. And maybe that’s why it’s not working.”
He continued, “At this point, standalone digital solutions are not the answer for us yet. What is a winning solution? I think of a trifecta of digital health solutions in which you get uptake, which means people open it and are interested in checking it out, and then engagement, meaning they stay with it, and then, third, it affects their outcomes. From a large health care system perspective, I’m not particularly interested in an app without those three,” he said.
At Kaiser, physician leaders and researchers are focused on building an ecosystem of applications that meet those three standards. “With our EMR system, we have rich data, we can look at outcomes, such are the patients’ labs improving, and look at whether the patients are using the app. We’re working on that ecosystem now,” he said.
The process involves bringing together clinicians, patients and app developers to focus on the human-centered design process, Mordecai said. “How do we design this compelling human element into this product we want to create?” He added, “There is a sweet spot that combines the human element with the digital element to address mild to moderate mental health issues, and you have to grapple with the pitfalls and the challenges of big data, and bringing that to bear on these types of problems.”
Kaiser Permanente is currently an enterprise partner with a digital health company that developed a mobile application called Recovery Record, which is targeted to individuals with eating disorders. The app is an eating disorder management tool developed to empower patients and equip treatment teams with the complete clinical picture.
“The app connects people that have eating disorders with their treating provider, and takes episodic care and turns it into continuous care,” Mordecai said. “Patients love it, and, importantly, the clinicians really like it. One thing I’ve learned with app work, if the clinicians don’t support it, you’re not going anywhere.”
Mordecai said there are indications that the app is improving outcomes. “We’re seeing things like a decrease in missed appointments, and we’re looking at whether the patient’s weight stabilizes at a healthier level.”
Moving forward, as Kaiser physicians and researchers look to build that ecosystem of apps, they are looking at the layers of data that can be incorporated, Mordecai said, such as patient reported outcomes, EMR data, genetics and even passive monitoring, such as social media data.
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