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Information Technology & Psychiatry

1) The document discusses the adoption of electronic medical records (EMRs) and information technology in psychiatry. While EMRs provide benefits like accurate record keeping and data analysis, psychiatrists have been reluctant to adopt EMRs due to concerns about privacy of sensitive patient information and potential impacts on clinical practice and patient interactions. 2) Features of EMRs like patient portals that allow access to medical records can both help patient engagement but also raise issues for sensitive psychiatric diagnoses. Studies also show that while computers in exam rooms do not generally reduce patient satisfaction, they may disrupt non-verbal communication. 3) The document outlines strategies for psychiatrists to mitigate potential negative impacts of EMRs on patient interactions

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Information Technology & Psychiatry SEMINAR PRESENTER: DR JITHIN RAJ M FINAL YEAR RESIDENT IN PSYCHIATRY MODERATOR: DR KAUSHIK CHATTERJEE PROFESSOR OF PSYCHIATRY AFMC
Greetings from AFMC ! 2
“ मयाध्यक्षेण प्रकृ ति: सूयिे सचराचरम ्। हेिुनानेन कौन्िेय जगद्विपररिितिे ॥” Sloka 10, Chapter 9 (Raja vidya raja guhya yogam), Bhagavadgita 3
Humans have used tools all along to solve problems… 4
5 Evolution of Technology & Networking…
Evolution of Medicine… 6
Evolution of Medicine… 7
8 Available at: http://www.nasscom.in/. Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/
9 Available at: http://www.nasscom.in/. Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/
10 Available at: http://www.nasscom.in/. Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/ Number of Internet subscribers
11 Available at: http://www.nasscom.in/. Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/ Number of Internet subscribers
12 Available at: http://www.nasscom.in/. Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/ Number of Internet subscribers
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Has Psychiatry missed the ‘Technology bus ’ ? 15
16Outline
17 Electronic Medical Records
Clinical documentation  An internal record  To communicate with other professionals  Billing/insurance  An external record for in times of litigation 18
Clinical document section- Shankara Netralaya, Chennai 19 Scholl J et al. A case study of an EMR system at a large hospital in India: challenges and strategies for successful adoption. J Biomed Inform. 2011
Electronic Medical Record  Defined as "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization," 20 Demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information https://www.healthcare-informatics.com/news-item/nahit-releases-hit-definitions
EMR Adoption in Shankara Netralaya Scholl J, Syed-abdul S, Ahmed LA. A case study of an EMR system at a large hospital in India: challenges and strategies for successful adoption. J Biomed Inform. 21
Related terminologies EHR EMR PHR 22
ADVANTAGES OF EMR  Accurate storage of data  No need to track down data from stack of papers or files  Data replication is unlikely  Legible  Searchable  Trends across time  Population based data 23
Protocols and interoperability • ASC X12 • TC/251 • HL7 • FHIR • ISO – ISO TC 215 • xDT • openEHR • Virtual Medical Record • SMART 24
Adoption of EMR by Psychiatrist 25 Grinspan, Z. M. et al. “Physician Specialty and Variations in Adoption of Electronic Health Records.” Applied Clinical Informatics 4.2 (2013).
26 Grinspan, Z. M. et al. “Physician Specialty and Variations in Adoption of Electronic Health Records.” Applied Clinical Informatics 4.2 (2013).
27  Psychiatrist are least likely to adopt EMR Grinspan, Z. M. et al. “Physician Specialty and Variations in Adoption of Electronic Health Records.” Applied Clinical Informatics 4.2 (2013).
Reasons for the reluctance ? • Privacy of sensitive information detailed within mental health records • Amount of data needs to be entered • Subjective findings • Remotely accessible system-Security issues • Access of MHR to child/adolescent’s parents? • Blocking or sequestering extremely sensitive information  “Covered entities” 28
Concerns about altered clinical practice ? • Often unreal- researches from 1990 • Content and quality of patient interactions were preserved • Notes were more clearer and legible • Difficulty with documentation and maintaining confidential information Salomon RM et al. Openness of patients’ reporting with use of electronic records: psychiatric clinicians’ views. J Am Med Inform Assoc 2010;17(1) 29
Patient Portals 30 • A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection.
Facilities provided by Patient portals Patients can: Exchange secure e-mail with their health care teams Request prescription refills Schedule non-urgent appointments Check benefits and coverage Update contact information Make payments Download and complete forms View educational materials 31
Psychiatry and Patient Portals • Most behavioral health notes are now excluded • Many health portals and organizations are moving to full transparency • Driving factors: Research like “OpenNote” study 32
The ‘OpenNotes’ project https://www.opennotes.org/ 33
Studies on ‘OpenNotes’ • Most patients expressed “better control over their care” • More compliant with their medication regime • 30% had worries about privacy issues • No increase in SMS s sent to providers (in contrast to earlier concerns by doctors) • Providers-  Increase in the documentation time(21%)  Slight alteration to the content documented Leveille SG, Walker J, Ralston JD, et al. Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project. BMC Med Inform Decis Mak 2012;12:32. 34
Implementable in Psychiatry ? • Entering a minefield !  How will a patient respond if he/she reads about the personality disorder diagnosis?  What about F20 patient reading that her firm beliefs are ‘delusional’? Kahn MW, Bell SK, Walker J, et al. A piece of my mind. Let’s show patients their mental health records. JAMA 2014;311(13):1291–2. 35
Implementable in Psychiatry ? • TransparencyOpportunities More active participation by patients and may reduce the stigma they experience. Kahn MW, Bell SK, Walker J, et al. A piece of my mind. Let’s show patients their mental health records. JAMA 2014;311(13):1291–2. 36
Better notes are to be created if patients are freely accessing it… • Succinct formulation “medical tweet” • Preventing ‘note bloat’ • Not merely focusing on positive symptoms, but focus on strength and resilience points Patient should feel more ‘like people’ than patients 37
Clinical benefit of EMR and interdisciplinary collaboration in Psychiatry • SUD-delay in referral of more than 10 years • Better tracking of substance use across a multidisciplinary team • Similar pattern of delay in internalizing disorders, eating disorders and even depression 38 Peters TE. Transformational Impact of Health Information Technology on the Clinical Practice of Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2017;26(1):55-66.
CDS-Clinical decision Support 39
CDS-Clinical decision Support  Computerized alerts and reminders for providers and patients  Clinical guidelines  Condition-specific order sets  Focused patient data reports and summaries Documentation templates  Diagnostic support  Contextually relevant reference information 40
Electronic Clinical Decision support (CDS) 5 ‘Rights’ Right information To Right people Through Right channels In Right intervention format At the Right point 41
Example: Advantages of timely alerts in CDS • Suicide risk assessments were completed in only 38% people who later committed suicide1 • Screening questionnaires in the waiting room or via a secure email before patients appointment could have helped ? 1 Milton J, Ferguson B, Mills T. Risk assessment and suicide prevention in primary care. Crisis 1999;20(4):171–7. 42
Impact on doctor patient relationships 43
The clinical visit Dr 44
Computer in consultation room • Need active attention on the monitor and keyboard • Computer as a ‘third party’ in the room 45
Effect of EMR on patient interaction • Less data for psychiatry • Extrapolation from few studies in psychiatry and many studies in general medicine • Difference in population and their needs to be kept in mind while interpreting results 46
Evidence… • The General medical literature over the last 20 years Consistently shows that computers in the examining room do not have a negative effect on Patient perceptions of the encounter May even increase patient satisfaction Koide D, Asonuma M, Naito K, et al. Evaluation of electronic health records from viewpoint of patients. Stud Health Technol Inform 2006;122:304. 47
Evidence… • Physicians using an EHR produced more complete assessments1 • But they tend to have less focus on psychosocial issues or issues of how illness affects a patient’s life1 • Use of EHR can alter or disrupt nonverbal communication between physician and patient, which can alter rapport building, patient comfort, and disclosure patterns.2 1). Makoul G, Curry RH, Tang PC. The use of electronic medical records: communication patterns in outpatient encounters. J Am Med Inform Assoc 2001;8(6):610–5. 2). Mcgrath JM, Arar NH, Pugh JA. The influence of electronic medical record usage on nonverbal communication in the medical interview. Health Informatics J 2007; 13(2):105–18. 48
Important to note that… • What is important for psychiatry may be ancillary to general medical visit • So the impact may be more 49
How to manage these concerns 1. Review the patient’s chart before the visit allowing for immediate engagement 2. with the patient rather than an initial chart review. 3. Learn/practice touch typing 4. Defer extensive data entry until after the visit. 5. Set aside time during the visit to disengage from the computer and focus full attention to patient and family Krishna R. The Impact of Health Information Technology on the Doctor-Patient Relationship in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2017;26(1):67-75. 50
How to manage these concerns 6. Set aside time for completing work on the computer. 7. Talk to patients and families about what you are doing on the EHR to maintain engagement. 8. Computer can be operated while facing the patient/family to maximizes opportunities to monitor affect and nonverbal cues Krishna R. The Impact of Health Information Technology on the Doctor-Patient Relationship in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2017;26(1):67-75. 51
Evidence… • In contrary to their own hypothesis; no significant change in patient satisfaction with communication, education, confidentiality, anxiety and several other subscales Stewart RF, Kroth PJ, Schuyler M, et al. Do electronic health records affect the patient-psychiatrist relationship? A before & after study of psychiatric outpatients. BMC Psychiatry 2010;10(1):3. 52
Tele-mental health activities 53
Tele-mental health activities • Accessibility gap exist in Psychiatry care • ‘Tele-mental health’-Umbrella term • Definition:  Behavioral and mental health services that are provided via synchronous telecommunications technologies, including discipline-specific applications such as tele- psychiatry and tele-psychology1 1) Luxton D, Nelson E, Maheu M. A practitioner’s guide to telemental health: how to conduct legal, ethical, and evidence-based telepractice. Washington, DC: American Psychological Association Press; 2016 54
Tele-mental health • Providers and patients/families at different locations interact in real time • Relatively low-cost technology solution • Relies largely rely on verbal communication and observation 55 Luxton D, Nelson E, Maheu M. A practitioner’s guide to telemental health: how to conduct legal, ethical, and evidence-based telepractice. Washington, DC: American Psychological Association Press; 2016
Tele-mental health • May be a particularly good fit for younger age group. • Saves the time and expense of travel • Both rural and urban settings • Connecting systems of care and enhancing care coordination. 56 Supervised settings Unsupervised settings
ECHOTM Model • Project ECHO® (Extension for Community Healthcare Outcomes) • Movement to de-monopolize knowledge and amplify the capacity to provide best practice care for underserved people all over the world • A range of behavioural health topics also • Weekly brief didactic updates around best practices & Case presentations from participating sites Moto- “Move knowledge, not patients ! ” 57
ECHOTM Model 58 Video Sanjeev Arora MD, Director, Project ECHO
Evidence… 1.Arora, S. et al. Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers. New England Journal of Medicine 364, 2199–2207 (2011). 59 • Quality of hepatitis C care provided by Project ECHO-trained clinicians was equal to that of care provided by university-based specialists.
ECHOTM Model- NIMHANS 60
Evidence.. • Tele Psychiatry consultation resulted in- Change in diagnosis in 48 % Change in treatment in 81.6% Clinical improvement in 60. 1% 1.Marcin, J. P. et al. Changes in Diagnosis, Treatment, and Clinical Improvement Among Patients Receiving Telemedicine Consultations. Telemedicine and e-Health 11, 36–43 (2005). 61
e-Prescribing 62
e-Prescribing • e-Prescribing is defined as the process of electronically generating, transmission and filing a prescription order by a physician, instead of using paper or faxed prescriptions 63 • Physicians can transmit an electronic prescription to a pharmacy directly from the point of care. • e-Prescribing improves accuracy, enhances patient safety and quality of care since there is no handwriting for the pharmacist to interpret Virk P, Bates DW, Halamka J, Fournier GA, Rothschild JM. Analyzing Transaction Workflows in an ePrescribing System. AMIA Annual Symposium Proceedings. 2006;2006:1129.
e-Prescription at Asvini 64
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E prescribing Architecture 66
Benefits Reduce prescribing and dispensing errors Avoid more adverse drug interactions and reactions Able offer to substitute less expensive drug alternatives by checking the formulary Improve medication compliance Reduce the incidence of drug diversion (drug abuse) by alerting providers and pharmacists of duplicative prescriptions for controlled substances Troy Trenkle, Director, Office of E-Health Standards and Services The Benefits of E-prescribingU.S. Department of Health & Human Services (Dec2007) https://web.archive.org/web/20080916200221/http://www.hhs.gov/asl/testify/2007/12/t2007120 4c.html 67
Limitations • Financial Cost and Return on Investment (ROI) • Change management • Hardware and software selection • Accidental data input • Security and privacy • Verification of electronic signatures, in ensuring the medical integrity of the prescriptions received by pharmacists • Hacking • System downtimeAmerican Medical Association. (2011). A Clinician's Guide to Electronic Prescribing. Retrieved December 17, 2011, from: http://www.ama- assn.org/ama1/pub/upload/mm/472/electronic-e-prescribing.pdf 68
Online treatment and virtual psychotherapies 69
The need Only 20% of youth meeting cut-off points on mental health screening questionnaires receiving services1 1Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among US children: variation by ethnicity and insurance status. Am J Psychiatry 2002; 159(9):1548–55. 70
Reasons Insufficient workforce Concentration in urban areas Costs and resources required to regularly attend sessions that are necessary for proper care Lack of knowledge and stigma toward mental health services 1Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among US children: variation by ethnicity and insurance status. Am J Psychiatry 2002; 159(9):1548–55. 71
Solutions..?  Online and virtual therapies that could serve as alternatives and adjuncts to other services  Creating low cost, widely available resources  Several methods, majority focused on CBT principles 72
Online and virtual therapies Online and Virtual therapies Self Guided Supported Therapist Teacher Parent Higher efficacy and adherence Spek V, Cuijpers P, Nyklicek I, et al. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007; 37(3):319–28. 73
Online and virtual therapies  Completion rates-vary between 12% to 100% with a median rate of 56% 1  Higher in supported programs  For youth-A parent, caregiver, or teacher could play the role of supporter -More knowledge about the child’s behaviour and context 1. Waller R, Gilbody S. Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence. Psychol Med 2009;39(5):705–12. 74
Delivery platforms • CD-ROMs or Web sites • Several sessions or modules Interactive lessons Didactic materials Complete assignments to reinforce and practice the skills Moving on to the next lesson. 75
Cope-A-Lot The Coping Cat CD • 12-session interactive computer-assisted treatment for anxious youth • Each session 35 minutes each 76
Virtual therapy for Parents 77
Mood Gym https://moodgym.com.au/ 78
Meta-analysis Effectiveness of MoodGym 79
3 D Game Personal Investigator (PI) 80
• Increased therapeutic relationship, improved structure in session, and boosted child • Engagement Coyle D, Doherty G, Sharry J. An evaluation of a solution focused computer game in adolescent interventions. Clin Child Psychol Psychiatry 2009;14(3):345–60 81
Internet based interventions also useful in : • Depression and anxiety1 , Chronic pain 2, • Encopresis 3 , Smoking cessation 4 • 1 Richardson T, Stallard P, Velleman S. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review. Clin Child Fam Psychol Rev 2010;13(3): • 2 Palermo TM, Wilson AC, Peters M, et al. Randomized controlled trial of an Internet- delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain 2009;146(1–2):205–13. • 3Ritterband LM, Thorndike FP, Lord HR, et al. An RCTof an Internet Intervention for pediatric encopresis with one year follow-up. Clin Pract pediatr Psychol 2013 • 4Patten CA, Croghan IT, Meis TM, et al. Randomized clinical trial of an Internet based versus brief office intervention for adolescent smoking cessation. Patient Educ Couns 2006 82
Social networking platforms • Social networking and messaging apps are increasingly growing in popularity • Children and adolescent populations • New avenues for interventions and drive engaging platforms • Panoply 83
Machine-Learning to predict behavior using Social media 84
Beginning of Social Media Psychiatry? 85
Panoply 86
IT in psychiatric education 87
Films and Television • Dissolution of stigma associated with psychiatric disorders, such as schizophrenia 1 • Traversing through time and place Understanding chronic illnesses in a holistic way 2 88 1 Akram A, O’Brien A, O’Neill A, et al. Crossing the line–learning psychiatry at the movies. Int Rev Psychiatry 2009;21(3):267–8. 2 Hankir A, Holloway D, Zaman R, et al. Cinematherapy and film as an educational tool in undergraduate psychiatry teaching: a case report and review of the literature. Psychiatr Danub 2015;27(Suppl 1):136–42
Normal Development Video Series: A Longitudinal Stimulation Video Curriculum Resource for Educators 89
Normal Development Video Series: A Longitudinal Stimulation Video Curriculum Resource for Educators 90
The Up Series 91
Video feedback in treatment • In Treating personality disorder • Perinatal psychiatric illness • Improving Parent Child Interaction • SUD • Principle  Patient’s confused self image v/s real image on screen  Strong memory formation 92
Impact of Video feedback on an episode of DT and treatment outcome in patients of ADS PhD Thesis. Lt Col Sojan Baby, CAM NIMHANS Oct 2017 • 90 patients • Randomized to TAU and Video feedback arm • Result: Average quantity of drinking was reduced in intervention arm (narrowly missed statistical significance) • Denial was much less and motivation levels were high 93
Web based simulations-Virtual patients • Web-based simulations- Are already being used for medical training • Advantages-Opportunity to practice clinical skills and problem solving in settings that are less anxiety provoking 94
Web based simulations-Virtual patients 95 • Psychiatry case simulation-Challenging Difficulty in simulating affective and behavioural processes
Evidence 96 • Computer simulation assessment tool to teach psychiatric residents how to obtain consent for treatment with antipsychotics • Results: Data suggested that the simulation increased physician confidence in obtaining informed consent and that it was easy to use. Gorrindo T, Baer L, Sanders K, et al. Web-based simulation in psychiatry residency training: a pilot study. Acad Psychiatry 2011;35:232–7
MOOC • Typical MOOC- Course of few weekss, broken down into weekly modules • Each module-A single or few topics related to the subject • The format of teaching is through video lectures, demonstrations, essential readings and quizzes • Students can put forth their questions and opinions in discussion boards moderated by content providers • Courses typically require somewhere between 3 to 10 hours of participant involvement per week • Assessment of the participants is typically through multiple choice questions, extended matching questions and true-false type questions 97 S Sarkar et al. Adapting massive open online courses for medical education. International Journal of Advanced Medical and Health Research. 2015;2(1):68.
Web based learning/e-Learning • MOOC • Set of educational material hosted on an internet site, accessible to the learners through their devices • Thousands of students-hence acknowledged as massive 98
MOOC- Advantages  Ease of access  Attract students from all over the world, offering a chance of cross-fertilization of ideas from different parts of the globe  Globally renowned professors may reach out to a large number of students through these courses, which they might not be able to cater through regular classroom-based courses  Also, a course once made can be delivered a number of times, thus reducing the recurring efforts and costs.  Less administrative hassle and lower costs of delivery of the educational content. 99 S Sarkar et al. Adapting massive open online courses for medical education. International Journal of Advanced Medical and Health Research. 2015;2(1):68.
MOOC- Disadvantages • High dropout rates. • Assessments in MOOCs rely on self-reported fidelity to honour code • MOOCs are usually introductory short-duration courses which can hardly be substitutes of in- depth full-time courses. • How the employers and funders would appraise ? • There is limited financial incentive for course content developers 100 S Sarkar et al. Adapting massive open online courses for medical education. International Journal of Advanced Medical and Health Research. 2015;2(1):68.
Mobile App based Mental health interventions 10 1
102
103 Marley, Justin, and Saeed Farooq. “Mobile Telephone Apps in Mental Health Practice: Uses, Opportunities and Challenges.” BJPsych Bulletin 39.6 (2015): 288–290. PMC. Web. 27 July 2017.
Evidence 104 • To systematically compile and analyze the evidence on the acceptability, feasibility, safety and benefits of online and mobile-based interventions for psychosis • Systematic review of peer-reviewed studies examining the usability, acceptability, feasibility, safety or efficacy of user-led, Internet or mobile- based interventions, with at least 80% of participants diagnosed with schizophrenia- spectrum disorders Alvarez et al. Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. Schizophr Res. 2014;156(1):96-106.
Evidence 105 • 74-86% of patients used them efficiently • 75-92% perceived them as positive and useful • 70-86% completed or were engaged with the interventions over the follow-up • Preliminary evidence indicated that online and mobile-based interventions show promise in improving positive psychotic symptoms, hospital admissions, socialization, social connectedness, depression and medication adherence Alvarez et al. Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. Schizophr Res. 2014;156(1):96-106.
Context-awareness system 10 6
Mobile phone driven context-awareness systems 107
Research 108 • Mixed-effects linear modeling showed that sensor-derived geospatial activity , sleep duration , and variability in geospatial activity were associated with daily stress levels • Associations between changes in depression and sensor-derived speech duration, geospatial activity, and sleep duration • Changes in loneliness were associated with sensor-derived kinaesthetic activity (p<.01). Ben-Zeev, Dror et al. “Next-Generation Psychiatric Assessment: Using Smartphone Sensors to Monitor Behavior and Mental Health.” Psychiatric rehabilitation journal 38.3 (2015)
Providing context driven solutions in crisis situations 109
Wearable Devices and Mental Health • Ubiquitous fitness trackers Accelerometers Step counters • Smart watches Numerous sensors 110
Wearable Devices and Mental Health • Send and receive messages • Collect data on health indicators 111
Can a wearable device improve mental health outcomes? • Activity levels • Collecting real time physiological data-as biomarkers of illness- “digital phenotyping” • May help redefine how we diagnose, monitor, and treat mental illness 112
Can a wearable device improve mental health outcomes? • Medication reminders 113
Will patients with mental illness want to use wearable devices? • Early evidence 25% of activity trackers are owned by those aged 55 years or older. 77% of participants found activity trackers useful and 45% reported that they increased motivation for healthier living 114 AARP. Building a Better Tracker: Older Consumers Weigh in on Activity and Sleep Monitoring Devices. 2016
Will patients with mental illness want to use wearable devices? • Not a barrier • Small study (n=10)  All participants reported high satisfaction with the devices for help with motivation, goal setting, social connectivity, self-monitoring, and ease of use 115 Naslund JA, Aschbrenner KA, Barre LK, Bartels SJ. Feasibility of popular m-health technologies for activity tracking among individuals with serious mental illness. Telemed J E Health. 2015;21:213-216
Indian Scenario 11 6
11 7 http://www.india.himsschapter.org/. Date accessed: 24/07/2017
Levels of acceptance of EHR in India 118 1 3 5 7 Available at: http://www.himssasiapac.org/. Accessed July 28, 2017.
Levels of acceptance of EHR in India 119 1 3 5 7 Available at: http://www.himssasiapac.org/. Accessed July 28, 2017. • Stage 0 -Small or nil acceptance • Stage 7-complete implementation or acceptance. Paperless work will be there to deliver and manage patient care
Digital India Programs 120
Adoption by states 121 • “that every clinical establishment shall immediately after coming into force of this Act, implement e-Prescription, maintain Electronic Medical Records and provide a set of all medical records and treatment details along with the discharge summary at the time of discharge of the service recipient”
Summary and take home message 12 2
Summary and take home message • Information technology in the 21st century  Dramatic changes to psychiatric practice and psychotherapy • There are many new possibilities are:  EMR/HER  Patient portals  Tele-psychiatry  Virtual therapies  e-Prescribing  Mobile Mental Health Apps 123
Summary and take home message • An EMR/HER-Systematized collection of patient’s health information stored in a digital format • Psychiatrist are least likely to adopt EMR • Patient confidentiality issues are a major concern • Content and quality of patient interactions were preserved 124
Summary and take home message • Tele-psychiatry technologies- allows wide outreach into the underserved population • e-Prescriptions-reduced error and enhances adherence • Youth may adopt better to online and virtual therapies • MOOC allows wider access to educational content 125
Summary and take home message • Context awareness systems and wearable devices uses numerous sensors to pick up real- time ‘biometric’ data • Governments across the globe including India are promoting eMental Health in a big way 126
127
Thank You 12 8

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Information Technology & Psychiatry

  • 1.
    Information Technology & Psychiatry SEMINAR PRESENTER: DRJITHIN RAJ M FINAL YEAR RESIDENT IN PSYCHIATRY MODERATOR: DR KAUSHIK CHATTERJEE PROFESSOR OF PSYCHIATRY AFMC
  • 2.
  • 3.
    “ मयाध्यक्षेण प्रकृति: सूयिे सचराचरम ्। हेिुनानेन कौन्िेय जगद्विपररिितिे ॥” Sloka 10, Chapter 9 (Raja vidya raja guhya yogam), Bhagavadgita 3
  • 4.
    Humans have usedtools all along to solve problems… 4
  • 5.
  • 6.
  • 7.
  • 8.
    8 Available at: http://www.nasscom.in/.Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/
  • 9.
    9 Available at: http://www.nasscom.in/.Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/
  • 10.
    10 Available at: http://www.nasscom.in/.Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/ Number of Internet subscribers
  • 11.
    11 Available at: http://www.nasscom.in/.Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/ Number of Internet subscribers
  • 12.
    12 Available at: http://www.nasscom.in/.Accessed July 26, 2017. https://www.statista.com/statistics/255135/internet-penetration-in-india/ Number of Internet subscribers
  • 13.
  • 14.
  • 15.
    Has Psychiatry missedthe ‘Technology bus ’ ? 15
  • 16.
  • 17.
  • 18.
    Clinical documentation  Aninternal record  To communicate with other professionals  Billing/insurance  An external record for in times of litigation 18
  • 19.
    Clinical document section- ShankaraNetralaya, Chennai 19 Scholl J et al. A case study of an EMR system at a large hospital in India: challenges and strategies for successful adoption. J Biomed Inform. 2011
  • 20.
    Electronic Medical Record Defined as "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization," 20 Demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information https://www.healthcare-informatics.com/news-item/nahit-releases-hit-definitions
  • 21.
    EMR Adoption inShankara Netralaya Scholl J, Syed-abdul S, Ahmed LA. A case study of an EMR system at a large hospital in India: challenges and strategies for successful adoption. J Biomed Inform. 21
  • 22.
  • 23.
    ADVANTAGES OF EMR Accurate storage of data  No need to track down data from stack of papers or files  Data replication is unlikely  Legible  Searchable  Trends across time  Population based data 23
  • 24.
    Protocols and interoperability •ASC X12 • TC/251 • HL7 • FHIR • ISO – ISO TC 215 • xDT • openEHR • Virtual Medical Record • SMART 24
  • 25.
    Adoption of EMRby Psychiatrist 25 Grinspan, Z. M. et al. “Physician Specialty and Variations in Adoption of Electronic Health Records.” Applied Clinical Informatics 4.2 (2013).
  • 26.
    26 Grinspan, Z. M.et al. “Physician Specialty and Variations in Adoption of Electronic Health Records.” Applied Clinical Informatics 4.2 (2013).
  • 27.
    27  Psychiatrist areleast likely to adopt EMR Grinspan, Z. M. et al. “Physician Specialty and Variations in Adoption of Electronic Health Records.” Applied Clinical Informatics 4.2 (2013).
  • 28.
    Reasons for thereluctance ? • Privacy of sensitive information detailed within mental health records • Amount of data needs to be entered • Subjective findings • Remotely accessible system-Security issues • Access of MHR to child/adolescent’s parents? • Blocking or sequestering extremely sensitive information  “Covered entities” 28
  • 29.
    Concerns about alteredclinical practice ? • Often unreal- researches from 1990 • Content and quality of patient interactions were preserved • Notes were more clearer and legible • Difficulty with documentation and maintaining confidential information Salomon RM et al. Openness of patients’ reporting with use of electronic records: psychiatric clinicians’ views. J Am Med Inform Assoc 2010;17(1) 29
  • 30.
    Patient Portals 30 •A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection.
  • 31.
    Facilities provided byPatient portals Patients can: Exchange secure e-mail with their health care teams Request prescription refills Schedule non-urgent appointments Check benefits and coverage Update contact information Make payments Download and complete forms View educational materials 31
  • 32.
    Psychiatry and PatientPortals • Most behavioral health notes are now excluded • Many health portals and organizations are moving to full transparency • Driving factors: Research like “OpenNote” study 32
  • 33.
  • 34.
    Studies on ‘OpenNotes’ •Most patients expressed “better control over their care” • More compliant with their medication regime • 30% had worries about privacy issues • No increase in SMS s sent to providers (in contrast to earlier concerns by doctors) • Providers-  Increase in the documentation time(21%)  Slight alteration to the content documented Leveille SG, Walker J, Ralston JD, et al. Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project. BMC Med Inform Decis Mak 2012;12:32. 34
  • 35.
    Implementable in Psychiatry? • Entering a minefield !  How will a patient respond if he/she reads about the personality disorder diagnosis?  What about F20 patient reading that her firm beliefs are ‘delusional’? Kahn MW, Bell SK, Walker J, et al. A piece of my mind. Let’s show patients their mental health records. JAMA 2014;311(13):1291–2. 35
  • 36.
    Implementable in Psychiatry? • TransparencyOpportunities More active participation by patients and may reduce the stigma they experience. Kahn MW, Bell SK, Walker J, et al. A piece of my mind. Let’s show patients their mental health records. JAMA 2014;311(13):1291–2. 36
  • 37.
    Better notes areto be created if patients are freely accessing it… • Succinct formulation “medical tweet” • Preventing ‘note bloat’ • Not merely focusing on positive symptoms, but focus on strength and resilience points Patient should feel more ‘like people’ than patients 37
  • 38.
    Clinical benefit ofEMR and interdisciplinary collaboration in Psychiatry • SUD-delay in referral of more than 10 years • Better tracking of substance use across a multidisciplinary team • Similar pattern of delay in internalizing disorders, eating disorders and even depression 38 Peters TE. Transformational Impact of Health Information Technology on the Clinical Practice of Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2017;26(1):55-66.
  • 39.
  • 40.
    CDS-Clinical decision Support Computerized alerts and reminders for providers and patients  Clinical guidelines  Condition-specific order sets  Focused patient data reports and summaries Documentation templates  Diagnostic support  Contextually relevant reference information 40
  • 41.
    Electronic Clinical Decisionsupport (CDS) 5 ‘Rights’ Right information To Right people Through Right channels In Right intervention format At the Right point 41
  • 42.
    Example: Advantages oftimely alerts in CDS • Suicide risk assessments were completed in only 38% people who later committed suicide1 • Screening questionnaires in the waiting room or via a secure email before patients appointment could have helped ? 1 Milton J, Ferguson B, Mills T. Risk assessment and suicide prevention in primary care. Crisis 1999;20(4):171–7. 42
  • 43.
    Impact on doctorpatient relationships 43
  • 44.
  • 45.
    Computer in consultationroom • Need active attention on the monitor and keyboard • Computer as a ‘third party’ in the room 45
  • 46.
    Effect of EMRon patient interaction • Less data for psychiatry • Extrapolation from few studies in psychiatry and many studies in general medicine • Difference in population and their needs to be kept in mind while interpreting results 46
  • 47.
    Evidence… • The Generalmedical literature over the last 20 years Consistently shows that computers in the examining room do not have a negative effect on Patient perceptions of the encounter May even increase patient satisfaction Koide D, Asonuma M, Naito K, et al. Evaluation of electronic health records from viewpoint of patients. Stud Health Technol Inform 2006;122:304. 47
  • 48.
    Evidence… • Physicians usingan EHR produced more complete assessments1 • But they tend to have less focus on psychosocial issues or issues of how illness affects a patient’s life1 • Use of EHR can alter or disrupt nonverbal communication between physician and patient, which can alter rapport building, patient comfort, and disclosure patterns.2 1). Makoul G, Curry RH, Tang PC. The use of electronic medical records: communication patterns in outpatient encounters. J Am Med Inform Assoc 2001;8(6):610–5. 2). Mcgrath JM, Arar NH, Pugh JA. The influence of electronic medical record usage on nonverbal communication in the medical interview. Health Informatics J 2007; 13(2):105–18. 48
  • 49.
    Important to notethat… • What is important for psychiatry may be ancillary to general medical visit • So the impact may be more 49
  • 50.
    How to managethese concerns 1. Review the patient’s chart before the visit allowing for immediate engagement 2. with the patient rather than an initial chart review. 3. Learn/practice touch typing 4. Defer extensive data entry until after the visit. 5. Set aside time during the visit to disengage from the computer and focus full attention to patient and family Krishna R. The Impact of Health Information Technology on the Doctor-Patient Relationship in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2017;26(1):67-75. 50
  • 51.
    How to managethese concerns 6. Set aside time for completing work on the computer. 7. Talk to patients and families about what you are doing on the EHR to maintain engagement. 8. Computer can be operated while facing the patient/family to maximizes opportunities to monitor affect and nonverbal cues Krishna R. The Impact of Health Information Technology on the Doctor-Patient Relationship in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2017;26(1):67-75. 51
  • 52.
    Evidence… • In contraryto their own hypothesis; no significant change in patient satisfaction with communication, education, confidentiality, anxiety and several other subscales Stewart RF, Kroth PJ, Schuyler M, et al. Do electronic health records affect the patient-psychiatrist relationship? A before & after study of psychiatric outpatients. BMC Psychiatry 2010;10(1):3. 52
  • 53.
  • 54.
    Tele-mental health activities •Accessibility gap exist in Psychiatry care • ‘Tele-mental health’-Umbrella term • Definition:  Behavioral and mental health services that are provided via synchronous telecommunications technologies, including discipline-specific applications such as tele- psychiatry and tele-psychology1 1) Luxton D, Nelson E, Maheu M. A practitioner’s guide to telemental health: how to conduct legal, ethical, and evidence-based telepractice. Washington, DC: American Psychological Association Press; 2016 54
  • 55.
    Tele-mental health • Providersand patients/families at different locations interact in real time • Relatively low-cost technology solution • Relies largely rely on verbal communication and observation 55 Luxton D, Nelson E, Maheu M. A practitioner’s guide to telemental health: how to conduct legal, ethical, and evidence-based telepractice. Washington, DC: American Psychological Association Press; 2016
  • 56.
    Tele-mental health • Maybe a particularly good fit for younger age group. • Saves the time and expense of travel • Both rural and urban settings • Connecting systems of care and enhancing care coordination. 56 Supervised settings Unsupervised settings
  • 57.
    ECHOTM Model • ProjectECHO® (Extension for Community Healthcare Outcomes) • Movement to de-monopolize knowledge and amplify the capacity to provide best practice care for underserved people all over the world • A range of behavioural health topics also • Weekly brief didactic updates around best practices & Case presentations from participating sites Moto- “Move knowledge, not patients ! ” 57
  • 58.
    ECHOTM Model 58 Video SanjeevArora MD, Director, Project ECHO
  • 59.
    Evidence… 1.Arora, S. etal. Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers. New England Journal of Medicine 364, 2199–2207 (2011). 59 • Quality of hepatitis C care provided by Project ECHO-trained clinicians was equal to that of care provided by university-based specialists.
  • 60.
  • 61.
    Evidence.. • Tele Psychiatry consultationresulted in- Change in diagnosis in 48 % Change in treatment in 81.6% Clinical improvement in 60. 1% 1.Marcin, J. P. et al. Changes in Diagnosis, Treatment, and Clinical Improvement Among Patients Receiving Telemedicine Consultations. Telemedicine and e-Health 11, 36–43 (2005). 61
  • 62.
  • 63.
    e-Prescribing • e-Prescribing isdefined as the process of electronically generating, transmission and filing a prescription order by a physician, instead of using paper or faxed prescriptions 63 • Physicians can transmit an electronic prescription to a pharmacy directly from the point of care. • e-Prescribing improves accuracy, enhances patient safety and quality of care since there is no handwriting for the pharmacist to interpret Virk P, Bates DW, Halamka J, Fournier GA, Rothschild JM. Analyzing Transaction Workflows in an ePrescribing System. AMIA Annual Symposium Proceedings. 2006;2006:1129.
  • 64.
  • 65.
  • 66.
  • 67.
    Benefits Reduce prescribing anddispensing errors Avoid more adverse drug interactions and reactions Able offer to substitute less expensive drug alternatives by checking the formulary Improve medication compliance Reduce the incidence of drug diversion (drug abuse) by alerting providers and pharmacists of duplicative prescriptions for controlled substances Troy Trenkle, Director, Office of E-Health Standards and Services The Benefits of E-prescribingU.S. Department of Health & Human Services (Dec2007) https://web.archive.org/web/20080916200221/http://www.hhs.gov/asl/testify/2007/12/t2007120 4c.html 67
  • 68.
    Limitations • Financial Costand Return on Investment (ROI) • Change management • Hardware and software selection • Accidental data input • Security and privacy • Verification of electronic signatures, in ensuring the medical integrity of the prescriptions received by pharmacists • Hacking • System downtimeAmerican Medical Association. (2011). A Clinician's Guide to Electronic Prescribing. Retrieved December 17, 2011, from: http://www.ama- assn.org/ama1/pub/upload/mm/472/electronic-e-prescribing.pdf 68
  • 69.
    Online treatment andvirtual psychotherapies 69
  • 70.
    The need Only 20%of youth meeting cut-off points on mental health screening questionnaires receiving services1 1Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among US children: variation by ethnicity and insurance status. Am J Psychiatry 2002; 159(9):1548–55. 70
  • 71.
    Reasons Insufficient workforce Concentration inurban areas Costs and resources required to regularly attend sessions that are necessary for proper care Lack of knowledge and stigma toward mental health services 1Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among US children: variation by ethnicity and insurance status. Am J Psychiatry 2002; 159(9):1548–55. 71
  • 72.
    Solutions..?  Online andvirtual therapies that could serve as alternatives and adjuncts to other services  Creating low cost, widely available resources  Several methods, majority focused on CBT principles 72
  • 73.
    Online and virtualtherapies Online and Virtual therapies Self Guided Supported Therapist Teacher Parent Higher efficacy and adherence Spek V, Cuijpers P, Nyklicek I, et al. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007; 37(3):319–28. 73
  • 74.
    Online and virtualtherapies  Completion rates-vary between 12% to 100% with a median rate of 56% 1  Higher in supported programs  For youth-A parent, caregiver, or teacher could play the role of supporter -More knowledge about the child’s behaviour and context 1. Waller R, Gilbody S. Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence. Psychol Med 2009;39(5):705–12. 74
  • 75.
    Delivery platforms • CD-ROMsor Web sites • Several sessions or modules Interactive lessons Didactic materials Complete assignments to reinforce and practice the skills Moving on to the next lesson. 75
  • 76.
    Cope-A-Lot The Coping CatCD • 12-session interactive computer-assisted treatment for anxious youth • Each session 35 minutes each 76
  • 77.
  • 78.
  • 79.
  • 80.
    3 D Game PersonalInvestigator (PI) 80
  • 81.
    • Increased therapeuticrelationship, improved structure in session, and boosted child • Engagement Coyle D, Doherty G, Sharry J. An evaluation of a solution focused computer game in adolescent interventions. Clin Child Psychol Psychiatry 2009;14(3):345–60 81
  • 82.
    Internet based interventionsalso useful in : • Depression and anxiety1 , Chronic pain 2, • Encopresis 3 , Smoking cessation 4 • 1 Richardson T, Stallard P, Velleman S. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review. Clin Child Fam Psychol Rev 2010;13(3): • 2 Palermo TM, Wilson AC, Peters M, et al. Randomized controlled trial of an Internet- delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain 2009;146(1–2):205–13. • 3Ritterband LM, Thorndike FP, Lord HR, et al. An RCTof an Internet Intervention for pediatric encopresis with one year follow-up. Clin Pract pediatr Psychol 2013 • 4Patten CA, Croghan IT, Meis TM, et al. Randomized clinical trial of an Internet based versus brief office intervention for adolescent smoking cessation. Patient Educ Couns 2006 82
  • 83.
    Social networking platforms •Social networking and messaging apps are increasingly growing in popularity • Children and adolescent populations • New avenues for interventions and drive engaging platforms • Panoply 83
  • 84.
  • 85.
    Beginning of SocialMedia Psychiatry? 85
  • 86.
  • 87.
    IT in psychiatriceducation 87
  • 88.
    Films and Television •Dissolution of stigma associated with psychiatric disorders, such as schizophrenia 1 • Traversing through time and place Understanding chronic illnesses in a holistic way 2 88 1 Akram A, O’Brien A, O’Neill A, et al. Crossing the line–learning psychiatry at the movies. Int Rev Psychiatry 2009;21(3):267–8. 2 Hankir A, Holloway D, Zaman R, et al. Cinematherapy and film as an educational tool in undergraduate psychiatry teaching: a case report and review of the literature. Psychiatr Danub 2015;27(Suppl 1):136–42
  • 89.
    Normal Development VideoSeries: A Longitudinal Stimulation Video Curriculum Resource for Educators 89
  • 90.
    Normal Development VideoSeries: A Longitudinal Stimulation Video Curriculum Resource for Educators 90
  • 91.
  • 92.
    Video feedback intreatment • In Treating personality disorder • Perinatal psychiatric illness • Improving Parent Child Interaction • SUD • Principle  Patient’s confused self image v/s real image on screen  Strong memory formation 92
  • 93.
    Impact of Videofeedback on an episode of DT and treatment outcome in patients of ADS PhD Thesis. Lt Col Sojan Baby, CAM NIMHANS Oct 2017 • 90 patients • Randomized to TAU and Video feedback arm • Result: Average quantity of drinking was reduced in intervention arm (narrowly missed statistical significance) • Denial was much less and motivation levels were high 93
  • 94.
    Web based simulations-Virtual patients •Web-based simulations- Are already being used for medical training • Advantages-Opportunity to practice clinical skills and problem solving in settings that are less anxiety provoking 94
  • 95.
    Web based simulations-Virtual patients 95 •Psychiatry case simulation-Challenging Difficulty in simulating affective and behavioural processes
  • 96.
    Evidence 96 • Computersimulation assessment tool to teach psychiatric residents how to obtain consent for treatment with antipsychotics • Results: Data suggested that the simulation increased physician confidence in obtaining informed consent and that it was easy to use. Gorrindo T, Baer L, Sanders K, et al. Web-based simulation in psychiatry residency training: a pilot study. Acad Psychiatry 2011;35:232–7
  • 97.
    MOOC • Typical MOOC-Course of few weekss, broken down into weekly modules • Each module-A single or few topics related to the subject • The format of teaching is through video lectures, demonstrations, essential readings and quizzes • Students can put forth their questions and opinions in discussion boards moderated by content providers • Courses typically require somewhere between 3 to 10 hours of participant involvement per week • Assessment of the participants is typically through multiple choice questions, extended matching questions and true-false type questions 97 S Sarkar et al. Adapting massive open online courses for medical education. International Journal of Advanced Medical and Health Research. 2015;2(1):68.
  • 98.
    Web based learning/e-Learning •MOOC • Set of educational material hosted on an internet site, accessible to the learners through their devices • Thousands of students-hence acknowledged as massive 98
  • 99.
    MOOC- Advantages  Easeof access  Attract students from all over the world, offering a chance of cross-fertilization of ideas from different parts of the globe  Globally renowned professors may reach out to a large number of students through these courses, which they might not be able to cater through regular classroom-based courses  Also, a course once made can be delivered a number of times, thus reducing the recurring efforts and costs.  Less administrative hassle and lower costs of delivery of the educational content. 99 S Sarkar et al. Adapting massive open online courses for medical education. International Journal of Advanced Medical and Health Research. 2015;2(1):68.
  • 100.
    MOOC- Disadvantages • Highdropout rates. • Assessments in MOOCs rely on self-reported fidelity to honour code • MOOCs are usually introductory short-duration courses which can hardly be substitutes of in- depth full-time courses. • How the employers and funders would appraise ? • There is limited financial incentive for course content developers 100 S Sarkar et al. Adapting massive open online courses for medical education. International Journal of Advanced Medical and Health Research. 2015;2(1):68.
  • 101.
    Mobile App basedMental health interventions 10 1
  • 102.
  • 103.
    103 Marley, Justin, andSaeed Farooq. “Mobile Telephone Apps in Mental Health Practice: Uses, Opportunities and Challenges.” BJPsych Bulletin 39.6 (2015): 288–290. PMC. Web. 27 July 2017.
  • 104.
    Evidence 104 • Tosystematically compile and analyze the evidence on the acceptability, feasibility, safety and benefits of online and mobile-based interventions for psychosis • Systematic review of peer-reviewed studies examining the usability, acceptability, feasibility, safety or efficacy of user-led, Internet or mobile- based interventions, with at least 80% of participants diagnosed with schizophrenia- spectrum disorders Alvarez et al. Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. Schizophr Res. 2014;156(1):96-106.
  • 105.
    Evidence 105 • 74-86%of patients used them efficiently • 75-92% perceived them as positive and useful • 70-86% completed or were engaged with the interventions over the follow-up • Preliminary evidence indicated that online and mobile-based interventions show promise in improving positive psychotic symptoms, hospital admissions, socialization, social connectedness, depression and medication adherence Alvarez et al. Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. Schizophr Res. 2014;156(1):96-106.
  • 106.
  • 107.
  • 108.
    Research 108 • Mixed-effectslinear modeling showed that sensor-derived geospatial activity , sleep duration , and variability in geospatial activity were associated with daily stress levels • Associations between changes in depression and sensor-derived speech duration, geospatial activity, and sleep duration • Changes in loneliness were associated with sensor-derived kinaesthetic activity (p<.01). Ben-Zeev, Dror et al. “Next-Generation Psychiatric Assessment: Using Smartphone Sensors to Monitor Behavior and Mental Health.” Psychiatric rehabilitation journal 38.3 (2015)
  • 109.
    Providing context drivensolutions in crisis situations 109
  • 110.
    Wearable Devices andMental Health • Ubiquitous fitness trackers Accelerometers Step counters • Smart watches Numerous sensors 110
  • 111.
    Wearable Devices andMental Health • Send and receive messages • Collect data on health indicators 111
  • 112.
    Can a wearabledevice improve mental health outcomes? • Activity levels • Collecting real time physiological data-as biomarkers of illness- “digital phenotyping” • May help redefine how we diagnose, monitor, and treat mental illness 112
  • 113.
    Can a wearabledevice improve mental health outcomes? • Medication reminders 113
  • 114.
    Will patients withmental illness want to use wearable devices? • Early evidence 25% of activity trackers are owned by those aged 55 years or older. 77% of participants found activity trackers useful and 45% reported that they increased motivation for healthier living 114 AARP. Building a Better Tracker: Older Consumers Weigh in on Activity and Sleep Monitoring Devices. 2016
  • 115.
    Will patients withmental illness want to use wearable devices? • Not a barrier • Small study (n=10)  All participants reported high satisfaction with the devices for help with motivation, goal setting, social connectivity, self-monitoring, and ease of use 115 Naslund JA, Aschbrenner KA, Barre LK, Bartels SJ. Feasibility of popular m-health technologies for activity tracking among individuals with serious mental illness. Telemed J E Health. 2015;21:213-216
  • 116.
  • 117.
  • 118.
    Levels of acceptanceof EHR in India 118 1 3 5 7 Available at: http://www.himssasiapac.org/. Accessed July 28, 2017.
  • 119.
    Levels of acceptanceof EHR in India 119 1 3 5 7 Available at: http://www.himssasiapac.org/. Accessed July 28, 2017. • Stage 0 -Small or nil acceptance • Stage 7-complete implementation or acceptance. Paperless work will be there to deliver and manage patient care
  • 120.
  • 121.
    Adoption by states121 • “that every clinical establishment shall immediately after coming into force of this Act, implement e-Prescription, maintain Electronic Medical Records and provide a set of all medical records and treatment details along with the discharge summary at the time of discharge of the service recipient”
  • 122.
    Summary and takehome message 12 2
  • 123.
    Summary and takehome message • Information technology in the 21st century  Dramatic changes to psychiatric practice and psychotherapy • There are many new possibilities are:  EMR/HER  Patient portals  Tele-psychiatry  Virtual therapies  e-Prescribing  Mobile Mental Health Apps 123
  • 124.
    Summary and takehome message • An EMR/HER-Systematized collection of patient’s health information stored in a digital format • Psychiatrist are least likely to adopt EMR • Patient confidentiality issues are a major concern • Content and quality of patient interactions were preserved 124
  • 125.
    Summary and takehome message • Tele-psychiatry technologies- allows wide outreach into the underserved population • e-Prescriptions-reduced error and enhances adherence • Youth may adopt better to online and virtual therapies • MOOC allows wider access to educational content 125
  • 126.
    Summary and takehome message • Context awareness systems and wearable devices uses numerous sensors to pick up real- time ‘biometric’ data • Governments across the globe including India are promoting eMental Health in a big way 126
  • 127.
  • 128.