This week the Psychiatric Times released an article titled, Challenges with mHealth Apps for Depression and Suicide Prevention, to “learn what potential challenges come with mHealth apps and how to overcome them to best fit patient needs.” We love to see articles like this highlighting many of the same challenges we encounter when it comes to standalone mobile apps attempting to solve complex mental health issues.
The authors, both with extensive clinical and academic backgrounds, help underscore the critical belief we have at NeuroFlow that the thoughtful combination of high-tech and high-touch will help to properly scale and augment clinically proven integrated care models. One without the other won’t be enough, these two have to work in tandem to make a real impact on the health crisis facing our nation.
Far too often, behavioral health gets treated in a silo despite the overwhelming research around the clinical impacts of integrated care. Clearly, an opportunity exists for technology and care coordination to help bridge this divide leading to better, holistic care for patients. When people ask me “what makes NeuroFlow different” from the growing number of mental health technology companies, apps, and digital tools, I point out these four drivers:
- We integrate behavioral health into physical health care settings to maximize clinical outcomes. This effort helps providers in all settings get the behavioral health data of patients they need to deliver the best care.
- We get people to the right level of care, by proactively identifying and triaging BH needs population-wide.
- We pair technology with clinical services and care coordination, creating a feedback loop that is high tech and high touch, enabling both scale and human intervention in key moments
- We enable longitudinal monitoring of individuals during and after care, identifying changes over time, and measuring the effectiveness of interventions.
As a result of our differentiated approach, we have avoided many of the challenges often associated with mHealth apps, but not all. With that in mind, let’s walk through the four potential challenges the article highlights and I’ll offer our perspective on them.
Unintended Consequences: Inaccurate Information and Self-Diagnosis
The Psychiatric Times raises two very good points here: 1) app reviews and ratings don’t correlate with validity or effectiveness, and 2) individuals may self-diagnose themselves with depression rather than connecting with their doctor to get proper treatment.
Consumer ratings are highly valuable when applications rely primarily on direct-to-consumer adoption and as a consequence consumer ratings are often not a measure of the app’s effectiveness and end up driving what the app builds towards. However, there are other models of gaining consumer adoption that involve offering digital health solutions through trusted care organizations, this is a more relationship-focused approach. In this case, organizations are incentivized to offer only digital health applications with verified outcomes for their population. NeuroFlow believes that an integrated approach, like described, is the most effective which often means driving adoption through existing relationships with a consumer’s payor or provider rather than on app store ratings.
It’s not that reviews are bad, we always appreciate our 5-star reviews, like this recent one on the Google Play store. It’s when mHealth apps are disconnected from traditional care organizations, adoption often becomes overly reliant on reviews that are not necessarily correlated to the outcomes being achieved.
Similarly, direct-to-consumer models often rely on self-diagnosis. In an integrated model, self-diagnosis is less of a problem because a care provider is included. For instance, NeuroFlow uses validated, clinical assessments like the PHQ-9 and GAD-7 that a care manager or PCP would use. These assessment outcomes can then be shared with an individual’s clinical care team. Clinical assessments alongside other validated metrics are combined to create a unique severity score (associated research), used to create a baseline of severity, and triage individuals to the right level of care determined by the organization and identified needs.
Clinical Validation and Efficacy
The article continues and notes how, “The existing medical research on apps is not very robust, and it is quite far behind relative to how widely mHealth apps are utilized.” We agree, for these reasons we’ve put multiple steps in place to ensure the clinical validity at NeuroFlow. Last year we established a Clinical Advisory Board that brings leaders with decades of experience across the healthcare landscape to inform and validate the clinical nature of our technology and processes. We now have a growing body of research to highlight clinical validation and efficacy. Further, we are encouraged by objective third-party reviews of digital health apps, like One Mind PsyberGuide. We welcome more efforts like these to help raise the standard for digital health technologies and solutions.
Privacy of Patient Information
This is another important topic mentioned in the article. There are too many examples of direct-to-consumer apps that play loose with patient information, due in part because they play outside of traditional healthcare regulation. Since day one of starting NeuroFlow, we’ve put a priority on patient privacy. This blog post helps to expand upon just some of the efforts we’ve taken as a company including risk assessments, maintaining HIPAA compliance, encrypting patient data, and more. We also recently put together a helpful one-pager documenting the efforts our product, security, and engineering teams take to protect the privacy and security of patient data. Additionally, efforts from these same teams are underway for NeuroFlow to earn HITRUST certification in 2022.
Patient Safety and Risk
As the piece noted, there is a significant concern related to patient safety, especially when one’s symptoms are severe and amidst the presence of suicidal thoughts or actions.” We couldn’t agree more; which is why we’ve sought out and established partnerships with organizations like CAMS (Collaborative Assessment and Management of Suicidality) in order to combine an evidence-based Suicide Prevention Training therapeutic framework with our industry-leading remote monitoring and behavioral health platform. Given that someone’s mental health evolves over time, we’ve made sure to build a solution that gets the right users to the right level of care. The combination of user-generated and passive data allows us to risk stratify populations, offering self-service tools and resources for those managing stress or benefiting from mindfulness exercises.
At the same time, we’ve put the pieces in place to proactively identify those at high risk for self-harm. For those instances, our clinical services team can conduct the proper outreach and telephonic support. The feedback from the incredible work of our clinical services team is a constant reminder of the life-saving impact of new digital health tools like NeuroFlow. Lisa Petersen, the Clinical Director of Stop Soldier Suicide summed it up well; “Through our partnership with NeuroFlow, we can empower our clients with real-time symptom tracking and help them practice better self-awareness. Now we understand the trends in our clients’ mental health symptoms, allowing us to create dynamic safety plans and provide better care. NeuroFlow also equips our clients with more knowledge and choices in regard to their care.”
Turning Challenges into Opportunities with Better Solutions
We believe an integrated approach to digital healthcare helps organizations overcome many of the challenges with scaling behavioral health support and resources. As our Head of Clinical Operations noted in an op-ed last year, proper procedures, documentation, and support can and should help quell the fears of malpractice and liability noted in the Psychiatric Times article. We remain steadfast in our belief that there isn’t a “one size fits” all approach to mental health. While many self-service tools and resources might suffice for those living with anxiety and depression, complex, life-threatening conditions require more coordinated solutions combining personalized support with proactive outreach.
Despite the challenges, which are worth our attention, digital health has the potential to scale and empower the relationship of us as individuals with our providers, as well as help to prevent suicide. Dr. Caroline Carney, Chief Medical Officer Magellan Health and President, Magellan Behavioral Health summarizes it well, “Integrating behavioral and physical health and understanding the social context in which health occurs remains a critical healthcare need. I believe digital solutions can help achieve this by encountering and assessing across health domains. Unfortunately, many digital solutions are siloed and disconnected from traditional care, creating a need for digital health platforms that can meet the needs for both high-tech and integrated high-touch care. NeuroFlow stands out in this regard. The NeuroFlow platform spans consumer digital engagement linked to care management through an actionable data platform. Our high-touch in-house team responds proactively to members who trigger urgent alerts, assessing for suicide. Our partnership with NeuroFlow has advanced our ability to reach people where they are and engage in active harm reduction.”
Technology should not replace the expertise and guidance of a therapist or mental health professional, rather work in concert with care providers and organizations to help improve access, remove barriers to care, and harness the appropriate, thoughtful applications of technology to achieve our mission of creating a happier, healthier world.