Practicing in a Connected World: Tech Use Guidelines aka A Mobile Health Guide for Clinicians


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Practicing in a Connected World: Tech Use Guidelines aka A Mobile Health Guide for Clinicians

  1. 1. Practicing in a Connected World:Tech-Use Guidelines Robert Ciulla, Ph.D. Joint Base Lewis-McChord/ Tacoma, WA 10 April 2013
  2. 2. Technology to Make People Healthy Aligned with USAMRMC: DCoE Component Located at JBLM Lead the innovation of health technology solutions. Deliver MISSION tested, valued health solutions that improve the lives of our Nation‟s Warriors, Veterans, and their families. • Telehealth • Emerging Technology FOCUS AREAS • Mobile Health • Suicide Surveillance Services, Academia, Federal (VA and others) PARTNERSHIPS and civilian agencies2
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  4. 4. Scope of Behavioral Health ChallengeINSTITUTE OF MEDICINE IOM RECOMMENDATIONS• 13-20% of 2.6 million • "...the DoD and the VA also service members deployed should support research to Iraq or Afghanistan since that investigates 2001 may suffer from PTSD emerging techniques and• Only slightly more than half technology, including of those diagnosed with telemedicine, Internet- PTSD actually received based approaches, and treatment virtual reality, that may• “Treatment gap”: stigma; help to overcome barriers difficulty accessing care; to awareness, accessibility, health care workers not availability, and adherence suitably trained to treat to evidence-based PTSD treatments.”
  5. 5. Mobile Health• A mobile app is a type of application software designed to run on a mobile device, such as a smartphone or tablet computer.• A mobile device is a portable computing device such as a phone or tablet, typically having a display screen with touch interface and/or a miniature keyboard.• The MHS Mobile Application Framework defines mobile health as the use of mobile devices to deliver health care services wirelessly.
  6. 6. Mobile Operating Systems • iPhone (iOS) system (Apple‟s AppStore) • Android (Google Play; Amazon appstore) • Windows Mobile (Windows Phone market) • Symbian operating system (Ovi) • Blackberry (BlackBerry World)6
  7. 7. Mobile Applications • In 2009, the University of Pennsylvania‟s Wharton School named the biggest “life changers” of the past 30 years. They cited, in rank order, the Internet, broadband; PC and laptop; mobile phones; email; and DNA testing and sequencing. Today, approximately 40 years after Dr. Martin Cooper conceived the first portable cellular phone, a typical smart phone can do all the above, with (at this writing) DNA sequencing being the possible exception. Eric Topol, MD. The Creative Destruction of Medicine: How the Digital Revolution will Create Better Health Care, 2012, p.77
  8. 8. Perspective • 2007: the iPhone • 2008: Apple‟s AppStore • MAR 2012: 25 billionth AppStore download • Mobile apps are the single-biggest digital channel since the ’90s and the Web. Industry Analyst Frost & Sullivan8
  9. 9. Health-Related Apps • MobiHealthNews (July 2012): 13,600 health-related apps. Top Five Categories: – Cardio Fitness; Diet; Stress; Strength Training; Women‟s Health – Over 1,400 stress apps • 700+ mental health apps; overall represent about 5% of health apps • 8.7% mood tracking • 500 sleep apps (3.6% of health apps) • Affirmation apps are particularly prevalent • Number of substance abuse apps is increasing • Chronic condition apps9
  10. 10. Mobile Technology in Behavioral Healthcare • Various disorders (developmental, cognitive, substances, mood, eating, sleep) • Informational, assessment, track/graph, interactive tools, self-monitoring prompts • Mobile apps‟ many other capabilities: – Contact Lists – Phone, email, and texting – Videoconferencing – Calendars, file-sharing, therapist audio-recordings, date-stamp homework assignments – Real-time audio/ video coaches (telehealth) – Global positioning system (GPS) – Wearable sensors (biofeedback) Luxton et al. – mHealth for Mental Health: Integrating Smartphone Technology in Behavioral Healthcare. Professional Psychology: Research and Practice. 2011, Vol.42, No. 6, 505-512.10
  11. 11. Technology Adoption: Some Challenges • “I can‟t do my job unless the patient is in the same room.” • “If this is anything like programming my DVD player, forget about it.” • “I don‟t own a smartphone.” • “I‟m not a supporter of technology – it‟s making us more isolated.” • “This will involve more work on top of my already busy schedule.” • “Is there any evidence that these „apps‟ work?” • “Do these devices „talk‟ to other systems?” • “The IT department says they have to do system upgrades first.” • “Does this mean that patients can email me 24/7?” • “I don‟t know how to „chart‟ electronic communications.” • “How do I establish a therapeutic alliance using a mobile app?” • “What about: security; privacy; FDA; HIPAA?”11
  12. 12. Early Adopters “I’m ready, willing and able – Where do I start?”12
  13. 13. Mobile Application Development 13
  14. 14. PTSD PTSD Coach T2 collaborated with the VAs National Center for PTSD to develop this app to assist veterans and active duty personnel (and civilians) who are experiencing symptoms of PTSD. It is intended to be used as an adjunct to psychological treatment but can also serve as a stand-alone education tool. Features: • Self-assessment of PTSD Symptoms • Tracking of changes in symptoms • Manage symptoms with coping tools • Assistance in finding immediate support • Customized support information14
  15. 15. PTSD (2)PTSD Family CoachT2 collaborated with the VAs NationalCenter for PTSD to create the PTSDFamily Coach. This app providessupport to families of Veterans andActive Duty personnel (and civilians)who are experiencing symptoms ofPTSD.Features:• Education about PTSD• Coping tools to help manage stress• Guided deep breathing and progressive muscle relaxation• Assistance in finding immediate support and resources• Customized support information15
  16. 16. PTSD (3) PE Coach The first mobile application that supports the elements of an evidence-based psychotherapy for PTSD Features: • Session homework • Confidential and convenient • Therapist guide • Session audio recording • Assessment result tracking • Disabled veteran accessible16
  17. 17. Stress Management Breathe2Relax A portable stress management tool utilizing hands-on diaphragmatic breathing exercise. Breathe2Relax uses state-of-the-art graphics, animation, narration, and videos to deliver a sophisticated, immersive experience for the user. Features: • Setup guide to assist with tailoring app • Customizable backgrounds and music • Immersive tutorial videos • Body scanner to display effects of stress • Graphing to track effectiveness17 • Audio narration
  18. 18. Mobile Version Life Armor A multi-topic application derived from to provide the user with knowledge and tools to cope with the many challenges faced by today‟s service members. Features: • 17 Self-assessments • Multi-topic resource guide • Ease to manage, customizable views and favorites • Manage symptoms with coping tools • Video resources on topics18
  19. 19. Behavioral ActivationPositive Activities JackpotProvides suggestions for daily positiveactivities. Based on positive eventscheduling, the active component ofBehavior Activation. Helps withdepression, self-harming behaviors, andindividuals without any mental healthdifficulties.Features:• “Jackpot” suggests random activities• Users select from 376+ possible activities• Augmented reality technology to identify activities in immediate surroundings• Ability to invite friends or post chosen activity to social media19
  20. 20. Mood Enhancement Virtual Hope Box Self-care tool for patients. Helps the user cope with suicidal ideation and other symptoms of depression by providing a customizable, virtual “hope box” containing reminders for living, distraction tools, relaxation tools, coping cards, and other symptom management tools. Features: • Customizable pictures, video, and music to remind user of reasons for living • Word games, photo puzzles, and other distraction tools • Guides user in controlled breathing and progressive muscle relaxation • Inspiring quotes • Crisis lines and customizable contact information for immediate support20
  21. 21. “Wearable” Sensors BioZen Monitor, track and view biometric data from Bluetooth enabled devices to assist with biofeedback therapies. Features • Real-time tracking • User tutorials for setup and learning • Customizable graphical feedback • Supports broad range of signal data including: EEG, EMG, GSR, EKG, respiratory rate, and temp21
  22. 22. Provider Support Provider Resilience Self-care tool for healthcare providers who work with service members and who may need support in coping with burnout or compassion fatigue Features: • Quick dashboard view • Graphing to track resilience progress • Tools to assist increasing resilience • Inspirational value cards • User sets reminders22
  23. 23. Practice Guidelines (1) mTBI Pocket Guide Clinical Practice Guidelines for treatment of mTBI Features: • Quick results with coding guidance • Symptom management lists • Summary of clinical recommendations • Patient education resources • Clinical tools and resources23
  24. 24. Practice Guidelines (2)mTBI Co-Occurring ConditionsToolkitCo-occurring Conditions Toolkit:Mild Traumatic Brain Injury andPsychological Health(Co-occurring Conditions Toolkit)Features:• Guidance to primary care providers on the assessment and management of patients• Synthesizes information from the following VA/DoD CPGS: mTBI,• PTSD, depression, chronic opioid therapy and substance use disorder24
  25. 25. Early Adopters “O.k. Now I have an idea what’s out there. So how do I bring mobile health into my practice? Is there a Technology Clinical Practice Guideline?”25
  26. 26. Mobile Health Guide for Clinicians26
  27. 27. Early Adopters “A how-to manual! What will it teach me?”27
  28. 28. The First Mobile Health Session: What You Need to Know • The benefits of mobile health. • Basic information/ how-to‟s. • Anticipate frequently asked questions. • Know the range of available apps. • A treatment plan that includes mobility.28
  29. 29. The First Mobile Health Session: What You Need to Ask • “Do you own a smartphone or a tablet?” • “Are you familiar with smartphone “apps” and how to download an app?” • “Have you ever used a health-related app to help with (nutrition, sleep problems, exercise tracking, depression, etc.)”29
  30. 30. Customizable Self-Rating Tool T2 Mood Tracker Self-monitor, track and reference emotional experiences over a period of days, weeks and months. Features: • Self-rating on pre-populated categories • Full note adding • Graphed results • Fully customizable categories • User-set reminders for self-rating • Send results to providers Advantages: • Smart phones are always with us • Minimizes stigma • Fills the white space between visits31
  31. 31. Health Technologies: Paradigm Shift • Educated/ integrated consumer • Social networks/ crowdsourcing • Wearable sensors/ the “measured life” • Patient-centered/ participatory model • Advancements in user interface • Files uploaded directly to health records • Barriers overcome by „virtual‟ clinics • Clinical practice in „the age of connectivity‟32
  32. 32. 21st Century Healthcare: “Anywhere, Anytime, Any Device” • Making Connections • Enabling Access • Working in the “White Spaces”33
  33. 33. Communication Opportunities LinkedIn • For behavioral health providers • Community of who treat Service members and Veterans Practice • Share ideas and best practices • Next meeting July 10 • Psychological-Health-Providers- POC: Military-Community- 4135318/about • T2 moderators screen group applicants to ensure they hold the necessary credentials34
  34. 34. Technology to Make People Healthy “I want us to ask ourselves every day, how are we using technology to make a real difference in people’s lives.” - President Barack Obama36
  35. 35. Contact Information Robert Ciulla, Ph.D. Director, Mobile Health Program National Center for Telehealth and Technology |T2| Joint Base Lewis-McChord, Tacoma, WA robert.p.ciulla.civ@mail.mil37