Maheu & Armstrong - 2023 - Using Apps for Clinical Care 5 Steps to Legal, Ethical, Evidence Based Mental Health Apps.pptx
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The document provides an overview of 5 steps for using mental health apps in clinical care legally, ethically, and with evidence-based practices. Step 1 discusses the differences between self-help apps and clinical apps. Step 2 covers understanding client needs when selecting apps. Step 3 reviews clinical and ethical issues. Step 4 discusses legal issues. Step 5 identifies free, evidence-based resources for finding appropriate apps. The document provides guidance on app selection, implementation, privacy, security, and ongoing evaluation for clinical use.
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Maheu & Armstrong - 2023 - Using Apps for Clinical Care 5 Steps to Legal, Ethical, Evidence Based Mental Health Apps.pptx
- 1. Using Apps for Clinical Care? 5 Steps to Legal, Ethical, Evidence-Based Mental Health Apps
- 2. Step #1: Understand the Apps That You Use
- 3. © 1994-2023 Telehealth.org, LLC All rights reserved. • Anybody can create a self-help app. • Clinical apps are loosely defined, but should refer to clinical tools • Furthermore, some apps reside on a smartphone while others communicate with the cloud. If transmitting information to you, they are considered telehealth What is the difference between a self-help and a clinical app? 3
- 4. © 1994-2023 Telehealth.org, LLC All rights reserved. • Native apps reside on a smart device and do not connect to the Internet or cloud. • A web-app is an icon that has an underlying link that goes to a website upon clicking. • A hybrid app is a mix of native and a web app. What is the difference between a native app, a web-app or a hybrid? 4
- 5. Step #2: Understand the Needs of the Clients You Select When Using Apps
- 6. © 1994-2023 Telehealth.org, LLC All rights reserved. • Limited research • Does app integrate into tx plan? • How do I introduce it in session? • Client/patient preferences? • Please provide names of apps you have found successful in the chat box as we discuss this and the next slide. • The course’s discussion forum will remain accessible if you’d please paste them there with links for your colleagues. How do I think about evidence-based apps for an individual/group? 6
- 7. Step #3: Understand the Clinical & Ethical Issues Involved in Using Apps for Clinical Care
- 8. © 1994-2023 Telehealth.org, LLC All rights reserved. • Scientific literature • Peer review vs evidence-based • Skewed information • Developer • Other available clinical education & resources How do I practice and educate with evidence- based and/or peer-reviewed apps? 8
- 9. © 1994-2023 Telehealth.org, LLC All rights reserved. • Physical/emotional capacities • Rationale(s) • Treatment model/theoretical orientation • Needed features/options • Evidence-base What should I consider when assessing someone’s ability to use a clinical app? 9
- 10. © 1994-2023 Telehealth.org, LLC All rights reserved. • https://connectedcare.va. gov/sites/default/files/202 1-10/va-mobile-health- practice-guide.pdf A Mobile Health Practice Guide 10
- 11. © 1994-2023 Telehealth.org, LLC All rights reserved. • https://www.researchgate. net/publication/32684255 8_DoD_Mobile_Health_Pr actice_Guide_4th_Edition DoD Mobile Health Practice Guide, 4th edition 11
- 12. Step #4: Understand the Legal Issues Around Using Apps in Clinical Care
- 13. © 1994-2023 Telehealth.org, LLC All rights reserved. • Identify treatment goal(s) • Consider privacy limitations • Discuss with client/patient (educate re: privacy, fears, features/limitations of app) • Assist w/ installation of app on device How do I introduce a clinical app to an individual/group? 13
- 14. © 1994-2023 Telehealth.org, LLC All rights reserved. • Documentation • Privacy policies • Dynamic informed consent • Follow-up processes • Telehealth involvement? • Security issues What are the relevant legal, regulatory and ethical issues to consider when using clinical apps? 14
- 15. © 1994-2023 Telehealth.org, LLC All rights reserved. 15 • Prevent security leaks - only use the latest versions of apps. Encourage your clients to do updates, too. • Apps must have special FDA clearance to to be sued for rendering diagnosis or treatment. • Set aside time to review the apps you use in your practice https://blog.telehealth.org/therapy-apps- need-to-know-issues-for-clinicians/
- 16. © 1994-2023 Telehealth.org, LLC All rights reserved. 16 https://blog.telehealth.org/are-you-keeping- user-data-safe-in-mental-health-apps/ • Spend time reminding clients to delete personal mental health data from apps. • Avoid adding nonessential information when registering for apps (or anything else online.)0 • Use passwords everywhere, change them frequently, and add double authentication if possible to prevent phishing
- 17. 17 https://blog.telehealth.org/hipaa-compliant-app/ We no longer can trust websites that tell us their products are HIPAA-compliant. Many companies use the term “HIPAA complaint” for sales only, and sell patient data to data brokers.
- 18. © 1994-2023 Telehealth.org, LLC All rights reserved. 1. Check the company website for HIPAA compliance statements 2. Check the website for a badge from a HIPAA auditing company 3. Check the HIPAA Wall of Shame for mention of the app development company 4. Other ideas? How can you evaluate an app for HIPAA compliance? 18
- 19. What is the HIPAA Wall of Shame? • 19 https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf
- 20. PHI Guidance for Clinicians When Clients Request Data Sharing w/Apps • Patients have the right to access their own PHI, telehealth providers may send that PHI to third-party apps at the patient’s request. should still adhere to their patients’ requests. • Telehealth providers will not be held liable under HIPAA if an app misuses patient data, so long as the data was transmitted at the patient’s request. This does not extent to any apps that are provided or used by the providers themselves. 20
- 21. PHI Guidance for Clinicians When Clients Request Data Sharing w/Apps • Telehealth providers will not be held liable under HIPAA if they transmit PHI over an unsecured medium, so long as the data was transmitted at the patient’s request. • However, the HIPAA guidance does state that providers should educate patients about the potential risks of sending PHI over unsecured mediums, such as unencrypted email. 21 https://blog.telehealth.org/hipaa-compliant-app/
- 23. © 1994-2023 Telehealth.org, LLC All rights reserved. • Fundamentals of research • Interprofessional issues • Practical, legal and ethical considerations for identifying appropriate apps What do I need to know regarding researching, teaching, supervising and/or consulting about clinical apps? 23
- 24. © 1994-2023 Telehealth.org, LLC All rights reserved. • PubMed • Google scholar • Journal for Technology in Behavioral Science (JTiBS) • Telehealth.org/bibliography • PsyberGuide.org Where is more scientific research available about clinical apps? 24
- 27. © 1994-2023 Telehealth.org, LLC All rights reserved. 27 https://blog.telehealth.org/smartphone-apps/ Standalone smartphone apps are designed to work without a professional. However, research has repeatedly shown that they are the most effective when using with the guidance and support of a trained clinician.
- 30. Step #5: Understand Where You Can Get Free, Evidence-Based Information for Apps
- 32. © 1994-2023 Telehealth.org, LLC All rights reserved. Other Free Resources SAMHSA PSYBERGUIDE Telehealth.org News (weekly email newsletter) store.samhsa.gov/apps psyberguide.org telehealth.org/signup 32
- 33. © 1994-2023 Telehealth.org, LLC All rights reserved. 33 App-Related Resources Hilty, D. M., Chan, S., Hwang, T., Wong, A., & Bauer, A. M. (2017). Advances in mobile mental health: opportunities and implications for the spectrum of e-mental health services. Mhealth, 3. Hilty, D. M., Chan, S., Torous, J., Luo, J., & Boland, R. J. (2019). A competency-based framework for psych/behavioral health apps for trainees, faculty, programs and health systems. Psychiatric Clinics of North America.
- 34. © 1994-2023 Telehealth.org, LLC All rights reserved. 34 App-Related Resources Maheu, M. M., Pulier, M. L., & Roy, S. (2013). Finding, evaluating, and using smartphone applications. In G. P. Koocher, J. C. Norcross & B. A. Greene (Eds.), Psychologists’ desk reference. (3rd ed., pp. 704-708). New York: Oxford University Press. Maheu, M. M., Nicolucci, V., Pulier, M. L., Wall, K. M., Frye, T. J., & Hudlicka, E. (2017). The interactive mobile app review toolkit (IMART): a clinical practice-oriented system. Journal of Technology in Behavioral Science, 1(1-4), 3-15.
- 35. © 1994-2023 Telehealth.org, LLC All rights reserved. 35 App-Related Resources Luxton, D. D., June, J. D., & Chalker, S. A. (2015). Mobile health technologies for suicide prevention: feature review and recommendations for use in clinical care. Current Treatment Options in Psychiatry, 2(4), 349-362. Luxton, D. D., June, J. D., Sano, A., & Bickmore, T. (2016). Intelligent mobile, wearable, and ambient technologies for behavioral health care. In Artificial intelligence in behavioral and mental health care (pp. 137-162). Academic Press.
- 36. © 1994-2023 Telehealth.org, LLC All rights reserved. 36 App-Related Resources Neary, M., & Schueller, S. M. (2018). State of the field of mental health apps. Cognitive and Behavioral Practice, 25(4), 531-537. O'Loughlin, K., Neary, M., Adkins, E. C., & Schueller, S. M. (2019). Reviewing the data security and privacy policies of mobile apps for depression. Internet interventions, 15, 110-115.
- 37. © 1994-2023 Telehealth.org, LLC All rights reserved. 37 App-Related Resources Armstrong, C. M., Edwards-Stewart, A., Ciulla, R. P., Bush, N. E., Cooper, D. C., Kinn, J. T., & Hoyt, T. V. (2017). Department of Defense mobile health practice guide (3rd edition). Defense Health Agency Connected Health, Department of Defense. Armstrong, C. M., Ciulla, R. P., Edwards- Stewart, A., Hoyt, T., & Bush, N. (2018). Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program. Professional Psychology: Research and Practice, 49(5-6), 355.
- 38. © 1994-2023 Telehealth.org, LLC All rights reserved. 38 App-Related Resources Research and Development Examples of Mobile Apps For Which the FDA Will Exercise Enforcement Discretion: https://www.fda.gov/medical- devices/mobile-medical- applications/examples-mobile-apps-which- fda-will-exercise-enforcement-discretion Guidance on the Use of Mobile Applications: http://www.kumc.edu/Documents/hrpp/Topic al%20Guidance/Guidance%20on%20the%2 0Use%20of%20Mobile%20Applications.pdf Ramos, G., Ponting, C., Labao, J. P., & Sobowale, K. (2021). Considerations of diversity, equity, and inclusion in mental health apps: A scoping review of evaluation frameworks. Behaviour Research and Therapy, 147, 103990. https://doi.org/10.1016/j.brat.2 021.103990
- 39. © 1994-2023 Telehealth.org, LLC All rights reserved. 39 App-Related Resources Camacho E., Cohen A., & Torous J. (2022). Assessment of mental health services available through smartphone apps. JAMA Netw Open, 5(12). doi:10.1001/jamanetworkopen.202 2.48784 Guidance for Research Involving Mobile Apps or Mobile Medical Apps: https://irb.northwestern.edu/sites/irb/files/doc uments/Mobile%20Apps%20and%20Mobile %20Medical%20Apps%20Guidance.pdf Health App Use Scenarios & HIPAA: https://hipaaqsportal.hhs.gov/community- library/accounts/92/925889/Public/OCR- health-app-developer-scenarios-2-2016.pdf
- 40. © 1994-2023 Telehealth.org, LLC All rights reserved. 40 App-Related Resources Lewis, T. L., & Wyatt, J. C. (2014). mHealth and mobile medical apps: a framework to assess risk and promote safer use. Journal of medical Internet research, 16(9), e210.