Simulated therapy training. Apps that monitor behavior and stand-in therapy. Vast streams of data shaped into undeniable patterns. According to a report by psychologists on the cutting edge of technology development, these could be familiar practice adds in the not-distant future.
Jason Satterfield, PhD, director of behavioral medicine UCSF Medical Center spoke of how hi-tech training could help equip clinicians to help meet the demands of truly integrated behavioral health care, otherwise known as the patient-centered medical home.
“The average primary care physician has a panel of 2,500 patients … [and] would need to work 21.7 hours per day just to do [treatments], and 7.4 hours per day for prevention, to deliver best standards of care,” he said. Meanwhile, 70 percent of of health care expenditures are due to chronic illness, and one in four of those patients will have diagnosable mental illness.
Newer tools may help clinicians to treat more people more efficiently and effectively. These include social networking using podcasts and online discussion panels, MOOCs (massive open online courses), and e-mentoring and supervision. “Smart care” tools might remind clinicians when it’s time to do a test or when a patient’s record indicates an intervention. Actors could play patients in simulated online scenarios.
To further help access, “extender and augmenter” apps can that help boost the lessons of cognitive behavioral therapy between sessions. For example, one mobile phone app called Addiction CHESS, currently in development, helps people in recovery for substance abuse, buzzing if they’re approaching a behavioral trigger and delivering appropriate messages. There’s also a “panic button” to call for help and therapists after hours.
That said, “There are lots of studies on digital health and ehealth tools, but if you build it, it doesn’t mean people will use it. Folks are too overwhelmed; there are too many choices and too many things to do. As psychologists we need to think about motivation,” Satterfield said.
One way may be through gamification of virtual therapy. People get drawn into games because they’re tapping into the psychology of motivation and rewards, like badges and scores, limiting play time and setting challenges just above your level of ability to add just enough fun.
“What if we had our training programs set up that way? Not to make light of them, but if they were fun and easy to use, and where people were bored and could take out a pad and do their CBT exercises — how awesome would that be?” he said.
Assessment is critical to helping clinicians and supervisors of care managers make decisions, but can take up much of the time they have with patients, said Patricia Areán, PhD, of the University of Washington.
“We don’t know how our patient is doing until they walk into our office, and [sometimes] don’t even see patients once a week. We also have to rely on self report, which is guided by how person feels that day,” she said. “What if we could capture all of this information before you see your patient? Data collected in real time and presented in a really efficient way gives us the time to do treatments we need to do to make our patients feel better.”
Mobile phones and wearables may be the vehicles. Smartphone apps can give clinicians clues as to how patients are faring by collecting activity and social data, listening for voice data and changes, looking for typing errors and giving quick mood surveys or memory tests, and being on the lookout for texts and emails that get no response. Plus, they could help reach groups that currently lack access; minorities use mobile health apps more than Caucasians, according to Pew surveys, she said. Wearable sensors have grown 110 percent since 2011, and older adults are more likely to use these devices than any other demographic.
“It’s a combination of data points that will really come up with a signal for people on whether they are really doing better or worse,” Areán said.
All of this personal and public health data and electronic health records are generating enormous amounts of useful information, said Kari Stephens, PhD, who teaches biomedical informatics at the University of Washington, but the challenge lies in ” getting this data wrangled and unburying ourselves,” she said.
Government and other groups are spending millions of dollars to create information-sharing networks that have great value for behavioral scientists, she said, including the National Institutes of Health BD2K (big-data-to-knowledge) project, the Patient-Centered Outcomes Research Institute’s clinical data repository network, the research-focused NIH Collaboratory, and the FDA’s Mini-Sentinel, which monitors the safety of medical products.
“Big data is correlational, not causal. … and messy and that’s OK, as long it’s mediated by human interpretation,” she said. “Lots of reporting pieces can help us figure out how behavioral health specialists are supporting evidence-based care. Imaging mapping a patient to providers to see how well each provider consults across a team. We also need to be thinking out of the box when we pioneer new ways to do research” with data.
Other big data boons on the horizon: cloud services, actigraphy, consumer data clouds, genomic profiling, and discovering new neurocognitive measures. Psychologists are integral to designing and implementing these tools, and supervising real world change in practice and policy, she said.