John Ainsworth, a Research Fellow at The University of Manchester, and member of Manchester mHealth ecosystem introduces m-health and how it has been successful in monitoring mental health patients.
Business Experience in Implementing an Advanced Telemonitoring Service. Valdivieso Martinez B. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Appraisal to D C Bolangir sent for DAPCU SPEAKDAPCUSPEAK
1) The document discusses NACP-III activities at the district level in India. Under NACP-III, implementation is further decentralized to district and sub-district levels.
2) Each district is categorized based on epidemiological criteria, and a differential package of services is planned. District AIDS Prevention and Control Units (DAPCUs) are formed in A and B category districts to implement prevention strategies.
3) The role of DAPCUs is to implement NACP strategies, converge with NRHM activities, and facilitate intersectoral convergence across different departments. Key activities include prevention programs for high-risk groups, bridge populations, vulnerable groups, and the general population.
Toronto Rehab +10 Report on Rehabilitation ResearchDavidWyman
Toronto Rehab is leading research to revolutionize rehabilitation and maximize life for those affected by disability and aging. Their comprehensive research program includes studying fall prevention, exploiting brain plasticity, treating dementia, using exercise to fight disease, diagnosing and treating sleep apnea, helping seniors drive safely, and more. They are producing solutions that will improve rehabilitation and quality of life for millions worldwide living with injury, illness, or age-related conditions.
The document discusses the aging population challenge facing China and opportunities for French companies. It notes that China has the largest aging population in the world, with over 400 million people expected to be over 60 years old by 2050, creating huge needs for elderly care services, medical treatment, and hospitality. The Colisée Group joint venture with China Merchants aims to address these needs by bringing international expertise in geriatric care, facilities, and services to China.
This document discusses the relationship between medical and wellness approaches to health. It notes that prevention is better than cure and that wellness considers total health, including mental and physical health through lifestyle. Wellness is becoming more evidence-based and uses natural products and services. The document compares western preventative wellness approaches to eastern European curative models and notes countries like the UK emphasize alternative therapies while Hungary relies more on traditional medicine. Overall it argues that wellness and medical tourism are large industries that are converging to focus more on prevention, longevity and total health.
Business Experience in Implementing an Advanced Telemonitoring Service. Valdivieso Martinez B. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Appraisal to D C Bolangir sent for DAPCU SPEAKDAPCUSPEAK
1) The document discusses NACP-III activities at the district level in India. Under NACP-III, implementation is further decentralized to district and sub-district levels.
2) Each district is categorized based on epidemiological criteria, and a differential package of services is planned. District AIDS Prevention and Control Units (DAPCUs) are formed in A and B category districts to implement prevention strategies.
3) The role of DAPCUs is to implement NACP strategies, converge with NRHM activities, and facilitate intersectoral convergence across different departments. Key activities include prevention programs for high-risk groups, bridge populations, vulnerable groups, and the general population.
Toronto Rehab +10 Report on Rehabilitation ResearchDavidWyman
Toronto Rehab is leading research to revolutionize rehabilitation and maximize life for those affected by disability and aging. Their comprehensive research program includes studying fall prevention, exploiting brain plasticity, treating dementia, using exercise to fight disease, diagnosing and treating sleep apnea, helping seniors drive safely, and more. They are producing solutions that will improve rehabilitation and quality of life for millions worldwide living with injury, illness, or age-related conditions.
The document discusses the aging population challenge facing China and opportunities for French companies. It notes that China has the largest aging population in the world, with over 400 million people expected to be over 60 years old by 2050, creating huge needs for elderly care services, medical treatment, and hospitality. The Colisée Group joint venture with China Merchants aims to address these needs by bringing international expertise in geriatric care, facilities, and services to China.
This document discusses the relationship between medical and wellness approaches to health. It notes that prevention is better than cure and that wellness considers total health, including mental and physical health through lifestyle. Wellness is becoming more evidence-based and uses natural products and services. The document compares western preventative wellness approaches to eastern European curative models and notes countries like the UK emphasize alternative therapies while Hungary relies more on traditional medicine. Overall it argues that wellness and medical tourism are large industries that are converging to focus more on prevention, longevity and total health.
Digital healthcare will shape future care delivery by allowing care to occur outside hospitals through technologies that support remote care, self-management, and virtual interactions. This will lead to more integrated community and home-based care for long-term conditions. Hospitals will focus on more specialized services as routine care shifts elsewhere. Digital tools will empower patients through access to data and remote monitoring, while new types of community health hubs and an expanded workforce help support decentralized care models. However, ensuring equity, safety, and user acceptability of these new approaches will be important to avoid potential drawbacks.
Why Precision Medicine and Personalized Healthcare and Why Now? Links to Canada’s Rare Disease Strategy The Future is Now
1) Marc LePage, Genome Canada
2) Michael Duong, Roche
3) Danica Stanimirovic, National Research Council
4) Daniel Gaudet, University of Montreal
5) Christine Dalgleish, Patient Perspective
6) Jamie Bruce, Khure Health
This document summarizes work by the MIT Center for Biomedical Innovation on analyzing the cell and gene therapy pipeline. It estimates that there will be approximately 80-100 new gene and cell therapy product approvals in the United States by 2031, treating around 410,000-550,000 patients. The majority of these therapies will be for oncology (cancer) patients. It also provides estimates of total reimbursement for these new therapies in 2031 of $20-30 billion, with $15-21 billion for oncology treatments. Near term therapies discussed include already approved CAR-T cancer therapies and gene therapies for rare diseases like spinal muscular atrophy.
The document discusses innovative technology to improve medication adherence. It notes that between 30-50% of prescribed medicines are not taken as recommended, costing the NHS billions. The YOURmeds system is presented as an intelligent medication packaging solution that provides reminders and monitoring to improve adherence. It consolidates medications into clear blister packs with reminders. Sensors track when medications are accessed and share this data through a portal. The system aims to increase social care capacity by replacing some visits with remote monitoring. Clinical trials are planned to study its impact on conditions like heart failure and diabetes that account for a large burden on the healthcare system.
Healthy Vs. Unhealthy Route - Living with Chronic Diseases (NCD)G U Renukanand
This document discusses the rising issue of non-communicable diseases (NCDs) like diabetes and cardiovascular disease among Malaysians over 50 years old. According to a 2011 health survey, 15.2% of Malaysians have diabetes, 32.7% have hypertension, and 35.1% have hypercholesterolemia. Treatment costs for NCDs are increasing while the supply of specialists is limited. Current devices for detecting NCDs have restrictions for mobile health due to size, rigidity, battery life and cost. The document proposes that innovative wearable healthcare technologies using flexible electronics could help detect NCDs earlier and prevent diseases by remotely monitoring vital signs. This could help shift populations to a healthier route of living with
The document discusses Continua Health Alliance, an organization working to advance remote patient monitoring through open interoperability standards. It aims to address the growing costs of chronic diseases by enabling up to 60% of medications to be taken correctly through remote monitoring solutions. Continua brings the healthcare and technology industries together to develop guidelines and certify products, helping create an ecosystem to support the expanding connected health market, estimated to grow to $7.7 billion by 2012.
Existing healthcare systems face challenges in providing accurate, evidence-based, and sustainable care as populations age. There is a need to better utilize existing healthcare data and expertise to help people live healthier lives. IBM Watson Health aims to address this need by combining healthcare data and systems with cognitive computing to enhance care delivery, clinical decision making, research, and population health management.
The document discusses the global challenges of an aging population and increased rates of chronic diseases. It proposes that mobile health (m-Health) technologies can help shift healthcare to focus more on prevention, home care, and quality of life while lowering costs. The Manchester m-Health ecosystem is highlighted as a partnership between healthcare organizations, universities, and industry in the Manchester area. It aims to accelerate the adoption of mHealth innovations through collaboration across the value chain, from research and development to implementation and evaluation. Example projects mentioned include tools for monitoring metabolic health, assisted living, and mental health conditions like schizophrenia.
Cardiff University Healthy Ageing Conference & Public Lecture
The importance of a healthy lifestyle
A Conference and a Public Lecture
Thursday 30th October 2014
http://medicine.cardiff.ac.uk/event/healthy-ageing-conference-public-lecture/
Digital therapeutics startup Wundrsight is developing mixed reality platforms to address mental healthcare issues through evidence-based and standardized interventions. They have developed ReliefXR for stress and relaxation and ReviveXR for substance abuse rehabilitation. They plan to partner with clinics and hospitals to offer their digital therapeutics and establish physical-digital "brain gyms". Wundrsight aims to treat over 10,000 patients across India by 2023 through these offerings.
Stephen Johnson: Can assistive technology support people with LTCs?Nuffield Trust
The document discusses how assistive technology can support people with long term conditions (LTCs). It notes that over 15 million people in England have a LTC, and treatment accounts for 70% of health spending. The UK strategy for LTCs uses a three-tier model, with different levels of support. Telehealth aims to help the majority who are in Tier 1 and manage their conditions through self-care. The Whole System Demonstrator trial showed promising early results for telehealth in improving outcomes and reducing costs. Barriers to adoption include lack of a strong evidence base, upfront technology costs, and workforce training needs.
HIMSS 16 Connected Health Experience Presentation on Telehealth in Population...Donna Cusano
This document summarizes a presentation about using remote patient monitoring technologies to improve outcomes for patients in accountable care organizations (ACOs). It discusses how the Veterans Health Administration has used remote monitoring successfully for over 12 years, improving outcomes and saving money. Remote monitoring is well-suited for ACOs seeking to improve quality and lower costs by focusing on high-risk patients. The document outlines a pilot program between an equipment provider and two physician-led ACOs to study the impact of remote monitoring on costs, utilization, and outcomes for high-risk patients with chronic conditions. Preliminary findings suggest remote monitoring shows potential for cost avoidance and reducing emergency room and hospital visits while improving patient satisfaction.
This document summarizes a presentation about dealing with complexity at Bridgepoint Health Hospital. It discusses (1) the increasing burden of complex chronic diseases, (2) Bridgepoint Health's focus on improving care for patients with multiple chronic conditions, and (3) the Bridgepoint Collaboratory for Research and Innovation, which conducts leading edge research to advance understanding and care of complex chronic diseases.
Long term conditions like diabetes place a large burden on healthcare systems. A study in Yorkshire examined experiences providing care for long term conditions. It found that telehealth interventions can reduce hospital admissions, bed days, and costs while improving patients' quality of life. The Whole System Demonstrator Programme trial of telehealth and telecare in various UK regions showed a 45% reduction in mortality rates and 20% fewer emergency admissions among other benefits. Telehealth represents an opportunity to deliver more specialized care while reducing strain on hospitals and caregivers.
Challenges and improvements in diagnostic services across seven day services NHS Improving Quality
Prof Erika Denton, National Clinical Director for Diagnostics. Slides from Erika's presentation at the 7 Day services events in West Midlands 11th June and East Midlands 12th June, 2014.
Let's get digital
What happens when forty researchers, patients, entrepreneurs and health and social care staff come together to discuss digital technologies and their impact on NHS sustainability and transformation?
That was the experiment at the University of Southampton' s Web Sciences Institute on 16 January, at a workshop sponsored by the Institute, the CLAHRC and Wessex AHSN.
And the result?
A highly energetic and constructive exchange of views from the diverse stakeholders in the room.
The take away messages:
1. The NHS has to embrace digital technologies to survive but precisely how it embraces these is critical;
2. successful adoption of digital technologies needs to take account of:
• the political imperative of developing a compact between public services, service providers and citizens about how their data may be used;
• the social processes involved in patient and workforce adaption to technologies and the substantial research base that already exists in this field *the technical challenges involved in ensuring that a proliferation of health data and digital devices develops in a way that supports integrated, patient-centred care rather than promoting fragmented data and digital silos;
• developing the capacity to adapt to and exploit fundamentally disruptive innovation from within the NHS and from SMEs many of which have their origins in academic research or front-line clinical practice
Next steps?
How might we maintain and develop the coalition of interests that met in the workshop to underpin a research-driven, innovation-friendly digital technologies implementation plan for the NHS in Hampshire and the Isle of Wight. Watch this space.
Professor Jeremy Wyatt- Health Futures: Real or Virtual? Warwick Knowledge
This document discusses the potential for virtual healthcare to address current and future challenges facing the UK healthcare system. It outlines problems with the current NHS model and explores how digital technologies could enable new forms of virtual healthcare delivery. While virtual healthcare may increase access and lower costs, the document notes important ethical, implementation, and public acceptance issues that would need to be addressed for it to become a widespread replacement for traditional healthcare delivery.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Digital healthcare will shape future care delivery by allowing care to occur outside hospitals through technologies that support remote care, self-management, and virtual interactions. This will lead to more integrated community and home-based care for long-term conditions. Hospitals will focus on more specialized services as routine care shifts elsewhere. Digital tools will empower patients through access to data and remote monitoring, while new types of community health hubs and an expanded workforce help support decentralized care models. However, ensuring equity, safety, and user acceptability of these new approaches will be important to avoid potential drawbacks.
Why Precision Medicine and Personalized Healthcare and Why Now? Links to Canada’s Rare Disease Strategy The Future is Now
1) Marc LePage, Genome Canada
2) Michael Duong, Roche
3) Danica Stanimirovic, National Research Council
4) Daniel Gaudet, University of Montreal
5) Christine Dalgleish, Patient Perspective
6) Jamie Bruce, Khure Health
This document summarizes work by the MIT Center for Biomedical Innovation on analyzing the cell and gene therapy pipeline. It estimates that there will be approximately 80-100 new gene and cell therapy product approvals in the United States by 2031, treating around 410,000-550,000 patients. The majority of these therapies will be for oncology (cancer) patients. It also provides estimates of total reimbursement for these new therapies in 2031 of $20-30 billion, with $15-21 billion for oncology treatments. Near term therapies discussed include already approved CAR-T cancer therapies and gene therapies for rare diseases like spinal muscular atrophy.
The document discusses innovative technology to improve medication adherence. It notes that between 30-50% of prescribed medicines are not taken as recommended, costing the NHS billions. The YOURmeds system is presented as an intelligent medication packaging solution that provides reminders and monitoring to improve adherence. It consolidates medications into clear blister packs with reminders. Sensors track when medications are accessed and share this data through a portal. The system aims to increase social care capacity by replacing some visits with remote monitoring. Clinical trials are planned to study its impact on conditions like heart failure and diabetes that account for a large burden on the healthcare system.
Healthy Vs. Unhealthy Route - Living with Chronic Diseases (NCD)G U Renukanand
This document discusses the rising issue of non-communicable diseases (NCDs) like diabetes and cardiovascular disease among Malaysians over 50 years old. According to a 2011 health survey, 15.2% of Malaysians have diabetes, 32.7% have hypertension, and 35.1% have hypercholesterolemia. Treatment costs for NCDs are increasing while the supply of specialists is limited. Current devices for detecting NCDs have restrictions for mobile health due to size, rigidity, battery life and cost. The document proposes that innovative wearable healthcare technologies using flexible electronics could help detect NCDs earlier and prevent diseases by remotely monitoring vital signs. This could help shift populations to a healthier route of living with
The document discusses Continua Health Alliance, an organization working to advance remote patient monitoring through open interoperability standards. It aims to address the growing costs of chronic diseases by enabling up to 60% of medications to be taken correctly through remote monitoring solutions. Continua brings the healthcare and technology industries together to develop guidelines and certify products, helping create an ecosystem to support the expanding connected health market, estimated to grow to $7.7 billion by 2012.
Existing healthcare systems face challenges in providing accurate, evidence-based, and sustainable care as populations age. There is a need to better utilize existing healthcare data and expertise to help people live healthier lives. IBM Watson Health aims to address this need by combining healthcare data and systems with cognitive computing to enhance care delivery, clinical decision making, research, and population health management.
The document discusses the global challenges of an aging population and increased rates of chronic diseases. It proposes that mobile health (m-Health) technologies can help shift healthcare to focus more on prevention, home care, and quality of life while lowering costs. The Manchester m-Health ecosystem is highlighted as a partnership between healthcare organizations, universities, and industry in the Manchester area. It aims to accelerate the adoption of mHealth innovations through collaboration across the value chain, from research and development to implementation and evaluation. Example projects mentioned include tools for monitoring metabolic health, assisted living, and mental health conditions like schizophrenia.
Cardiff University Healthy Ageing Conference & Public Lecture
The importance of a healthy lifestyle
A Conference and a Public Lecture
Thursday 30th October 2014
http://medicine.cardiff.ac.uk/event/healthy-ageing-conference-public-lecture/
Digital therapeutics startup Wundrsight is developing mixed reality platforms to address mental healthcare issues through evidence-based and standardized interventions. They have developed ReliefXR for stress and relaxation and ReviveXR for substance abuse rehabilitation. They plan to partner with clinics and hospitals to offer their digital therapeutics and establish physical-digital "brain gyms". Wundrsight aims to treat over 10,000 patients across India by 2023 through these offerings.
Stephen Johnson: Can assistive technology support people with LTCs?Nuffield Trust
The document discusses how assistive technology can support people with long term conditions (LTCs). It notes that over 15 million people in England have a LTC, and treatment accounts for 70% of health spending. The UK strategy for LTCs uses a three-tier model, with different levels of support. Telehealth aims to help the majority who are in Tier 1 and manage their conditions through self-care. The Whole System Demonstrator trial showed promising early results for telehealth in improving outcomes and reducing costs. Barriers to adoption include lack of a strong evidence base, upfront technology costs, and workforce training needs.
HIMSS 16 Connected Health Experience Presentation on Telehealth in Population...Donna Cusano
This document summarizes a presentation about using remote patient monitoring technologies to improve outcomes for patients in accountable care organizations (ACOs). It discusses how the Veterans Health Administration has used remote monitoring successfully for over 12 years, improving outcomes and saving money. Remote monitoring is well-suited for ACOs seeking to improve quality and lower costs by focusing on high-risk patients. The document outlines a pilot program between an equipment provider and two physician-led ACOs to study the impact of remote monitoring on costs, utilization, and outcomes for high-risk patients with chronic conditions. Preliminary findings suggest remote monitoring shows potential for cost avoidance and reducing emergency room and hospital visits while improving patient satisfaction.
This document summarizes a presentation about dealing with complexity at Bridgepoint Health Hospital. It discusses (1) the increasing burden of complex chronic diseases, (2) Bridgepoint Health's focus on improving care for patients with multiple chronic conditions, and (3) the Bridgepoint Collaboratory for Research and Innovation, which conducts leading edge research to advance understanding and care of complex chronic diseases.
Long term conditions like diabetes place a large burden on healthcare systems. A study in Yorkshire examined experiences providing care for long term conditions. It found that telehealth interventions can reduce hospital admissions, bed days, and costs while improving patients' quality of life. The Whole System Demonstrator Programme trial of telehealth and telecare in various UK regions showed a 45% reduction in mortality rates and 20% fewer emergency admissions among other benefits. Telehealth represents an opportunity to deliver more specialized care while reducing strain on hospitals and caregivers.
Challenges and improvements in diagnostic services across seven day services NHS Improving Quality
Prof Erika Denton, National Clinical Director for Diagnostics. Slides from Erika's presentation at the 7 Day services events in West Midlands 11th June and East Midlands 12th June, 2014.
Let's get digital
What happens when forty researchers, patients, entrepreneurs and health and social care staff come together to discuss digital technologies and their impact on NHS sustainability and transformation?
That was the experiment at the University of Southampton' s Web Sciences Institute on 16 January, at a workshop sponsored by the Institute, the CLAHRC and Wessex AHSN.
And the result?
A highly energetic and constructive exchange of views from the diverse stakeholders in the room.
The take away messages:
1. The NHS has to embrace digital technologies to survive but precisely how it embraces these is critical;
2. successful adoption of digital technologies needs to take account of:
• the political imperative of developing a compact between public services, service providers and citizens about how their data may be used;
• the social processes involved in patient and workforce adaption to technologies and the substantial research base that already exists in this field *the technical challenges involved in ensuring that a proliferation of health data and digital devices develops in a way that supports integrated, patient-centred care rather than promoting fragmented data and digital silos;
• developing the capacity to adapt to and exploit fundamentally disruptive innovation from within the NHS and from SMEs many of which have their origins in academic research or front-line clinical practice
Next steps?
How might we maintain and develop the coalition of interests that met in the workshop to underpin a research-driven, innovation-friendly digital technologies implementation plan for the NHS in Hampshire and the Isle of Wight. Watch this space.
Professor Jeremy Wyatt- Health Futures: Real or Virtual? Warwick Knowledge
This document discusses the potential for virtual healthcare to address current and future challenges facing the UK healthcare system. It outlines problems with the current NHS model and explores how digital technologies could enable new forms of virtual healthcare delivery. While virtual healthcare may increase access and lower costs, the document notes important ethical, implementation, and public acceptance issues that would need to be addressed for it to become a widespread replacement for traditional healthcare delivery.
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m-health technologies and mental health
1. mHealth
John Ainsworth
john.ainsworth@manchester.ac.uk
HI@M 9th July 2012
2. The Global Challenge: Ageing population and
management of long term conditions
Globally over 1 billion adults
and 155 million children are
overweight
700 million people are 60 or
older
Citizens - overweight & obesity effects
both small and large nations
•Britain- 25% men & women
Dramatic increase in people developing
•USA- 30% men & women
Asthma, Chronic Obstructive Pulmonary •Tonga- 47% men, 70% women
Disease (COPD), Diabetes and Hypertension •Samoa- 33% men, 63% women
Source WHO
New Innovation will be needed to help manage the challenges facing organisations
operating in this sector
3. Need to shift the Continuum of Care
Shift Left
Highest Quality of Life
Lowest Cost of Care
Quality of Life
Health and Wellness
Home Care
Residential Care
Acute Care
Cost of Care
Reproduced with permission of Intel™
4. mHealth
• Computing power
• Large display
• Usable
• Short range
connectivity
• Always on
• Always connected
• Always with you
• Familiar
5.
6. mHealth Now…
• Lots of pilots, very few progress further
• Barriers to be overcome
– deployment at scale – system not individual
studies
– large, diverse, ‘instrumented’ study population
– health economics assessment
– access and equity
– regulatory environment EU 2007/47/EC
7.
8. mHealth Ecosystem
• Multi-sector partnership of critical mass
– shared commitment to accelerate adoption
• Innovation factory
– co-develop innovative whole-system solutions
• Route from pilots to routine practice
– co-developed pilot-to-adoption business
plans, evidence
• Reduced barriers to new trials
9. The Manchester mHealth eco-system
• Manchester
– Social, ethnic, health and lifestyle diversity
– Only UK city in WHO network of age-friendly cities
• University of Manchester
– World-leading multidisciplinary research in health, particularly e-
health, informatics, social sciences, business models
– mHealth Innovation Centre (MHIC) founded in 2009 in partnership
with the GSM Association
• Partnership with NHS Trusts:
– Acute, specialist and primary care
– NW Exemplar clinical trials network
53 day trials set-up (UK av = 98 days)
• Partnerships with industry
10. Who is involved with the Manchester mHealth eco-
system?
Serves a population of > 3 million; delivers services to > 2 million patients p.a.
(3,700 beds); 8 Hospitals plus primary, community and social care; clinical
research network; c. 23,500NHS staff
University Hospital of South Manchester NHS Foundation Trust
J&J (Janssen Healthcare Innovation) The Christie NHS Foundation Trust
The University of Manchester
Intel
Manchester
Greater Manchester
MHealth
Comprehensive Local NWeHealth
Eco-system
Research Network
Manchester Mental Health &
Social Care Trust
Salford Royal NHS Foundation Trust
Central Manchester University Hospitals NHS Foundation Trust (comprising
Manchester Royal Infirmary, Manchester Royal Eye Hospital, Royal Manchester
Children’s Hospital, Saint Mary’s Hospital and University Dental Hospital)
11. m-Health Innovation Centre
Research
• Mental health
– Diagnosis & compliance with treatment
– psychological therapy via mobile
• Metabolic Health & Wellbeing
– bridging the gap: short-term decisions vs. long-term
outcomes
• Remote Monitoring for Post-operative
rehabilitation
– after knee replacement, cardiac surgery
• Intelligent Clothing
– wearer as mobile biosignal website
• Evaluation of long-term telecare interventions
12. Example projects
• Metabolic Health and Wellbeing (obesity,
diabetes)
• Assisted Living (including ICT and ageing, falls
prevention, self-care and remote monitoring)
• Mental Health & Wellbeing
• Process Optimisation
• Mobile Workforce
13. A new mobile assessment technology for psychosis
Jasper Palmier-Claus, PhD
The University of Manchester
Email: Jasper.Palmier-Claus@manchester.ac.uk
Tel: 01613067923
15. Background
• Schizophrenia is one of the most prevalent forms of mental
illness.
• Associated cost of 6.7 billion pounds each year.
• Clinical outcome often poor despite treatment with 80% of
individuals relapsing within 5 years after the first episode.
• Major need for new forms of intervention and symptom
management.
16. Momentary assessment
• Considerable evidence to suggest that patient self-report is valid.
• Momentary assessment common in research.
• Detailed view of individual’s symptoms in everyday settings.
• Different clinical populations.
– Anger
– Depression
– Pain
– Hyperactivity
– Psychosis
17. Why adapt for clinical use?
• Reduces need for averaging.
• Reduces retrospective recall bias.
• Contextual information.
• Temporal associations.
• Relapse-signatures.
• Treatment effects.
• Adjunct to psychosocial intervention.
18. Why use mobile phones?
Widespread and familiar interface
• Monitor symptoms in real time.
Alert clinician:
Early intervention
21. Administrator page
• Administrator
configures participant
details on the device.
• Selected delusions
influence questions
presented to the user.
22. Question display
• User responds on a
touch-screen mobile
phone.
• Branching means that
the questions change
depending on an
individual’s responses.
24. Aims
• To validate momentary assessment items against
corresponding gold standard interview scales.
• To ascertain levels of compliance and dropout in individuals
at different stages of psychosis (acute, remitted and ultra-
high risk).
25. Method
• Three groups:
– 12 acute patients.
– 12 remitted patients.
– 12 ultra-high risk individuals.
• Alerts 6 times per day for 1 week.
• PANSS and CDS performed before and after sampling
procedure by trained assessor.
• Telephone call during the week to encourage compliance.
26. Compliance
• Compliance = >33% of all possible entries.
• 44 individuals consented to take part.
• 8 individuals (6 acute, 2 remitted) failed to meet this
threshold and were excluded from later analysis (82%
compliance).
• Positive symptoms predicted non-compliance (OR = 0.68, p =
.033)
31. Conclusions for phase one
• Mobile phone based momentary assessment is feasible in
individuals with different levels of psychosis.
• Positive symptom momentary assessment scales showed
strong correlations with the PANSS.
• PANSS subscales based on care coordinator reports and
behaviour during the interview showed more attenuated
correlations.
33. Background
• Text messages may also effectively monitor psychotic
experiences in the real world.
• Texts may be advantageous in that individuals are familiar
with the technology.
• However, the ClinTouch application may show greater
functionality.
• Aim: To compare and contrast the new ClinTouch software
with a text based system.
35. Design
• 24 community-based individuals with psychosis.
• Compare devices on:
– Number of completed data-points.
– Quantitative feedback scores.
– Length of time to complete each entry.
• Qualitative interviews:
– Benefits and limitations of both approaches.
– Perceptions of phone-usage and integration of technology into
everyday life and clinical case management.
– Ways of improving technology.
36. MRC DPFS Mobile Assessment Technology for Schizophrenia (ClinTouch) Study
Milestone 3 Preliminary Results
• Demographics (n=24)
• Male, n =19
• White British, n =17
• Age = mean 33.0, SD 9.5, min 18, max 49
• Recruited through Community Mental Health
Teams (N=15), Early Intervention Services (N=8)
and supported living staff (N=1).
• Four individuals owned a touch-screen
SmartPhone at the time of taking part.
37. MRC DPFS Mobile Assessment Technology for Schizophrenia (ClinTouch) Study
Milestone 3 Preliminary Results
Table X: Quantative feedback scores for the SmartPhone devices and text-based system.
Smartphone Text messages
Mean SD Min Max Mean SD Min Max β
Time taken to complete questions (seconds) 68.4 39.5 18.8 179.7 325.5 145.6 118.8 686.9 0.78**
Number of entries completed 16.5 5.5 4.0 24.0 13.5 6.6 0.0 24.0 -0.25*
Did answering the questions take a lot of work? 1.8 1.1 1 5 2.3 1.6 1 6 0.16
Were there times when you felt like not answering? 2.3 1.3 1 5 3.0 2.1 1 7 0.22.073
Did answering the questions take up a lot of time? 1.7 0.9 1 4 2.3 1.6 1 7 0.24
Were there times where you had to stop doing something in order to answer the questions? 3.4 1.7 1 7 4.1 1.7 1 7 0.200.97
Was it difficult to keep track of what the questions were asking you? 1.6 1.2 1 7 1.9 1.7 1 7 0.11
Were you familiar with using this type of technology? 4.7 2.3 1 7 5.3 2.2 1 7 0.14
Was it difficult to keep the device with you or carry it around? 1.9 1.4 1 6 2.4 1.8 1 6 0.16
Did you ever lose or forget the device? 1.7 0.9 1 4 1.8 1.4 1 6 0.06
Was using the key pad/touch screen difficult to use? 2.0 1.3 1 5 1.8 1.4 1 6 -0.08
Do you think other people would find the software easy to use? 5.3 1.8 2 7 5.9 1.4 3 7 0.19
Do you think you could make use of this approach in your everyday life? 4.0 1.8 1 7 3.9 2.2 1 7 -0.02
Do you think that this approach could help you or other service users? 5.3 1.9 1 7 5.6 1.2 3 7 0.11
Overall, this experience was stressful. 1.8 1.1 1 5 1.8 1.3 1 6 -0.04
Overall, this experience was challenging. 2.2 1.6 1 7 2.7 1.7 1 6 0.16
Overall, this experience was pleasing. 3.7 2.0 1 7 3.7 1.7 1 7 0.01
Did filling in the questions make you feel worse? 1.8 1.1 1 5 2.1 1.4 1 5 0.14
Did filling in the questions make you feel better? 2.8 1.5 1 6 3.0 1.6 1 7 0.08
Did you find the questions intrusive? 2.2 1.2 1 4 2.6 1.8 1 7 0.23
Was filling in the questions inconvenient? 2.0 1.0 1 4 2.5 1.4 1 5 0.01
Did you enjoy filling in the questions? 3.6 2.0 1 7 3.7 1.6 1 7 0.01
NB β represents the extent to which device type predicted the difference outcomes when controlling for order effect.
*p <.05 **p <.001
38. Future directions
• Feasible over longer periods of time?
• Can it be incorporated into clinical case
management?
• Is it effective at assessing other clinical
phenomena?
39. Quote
‘This is like quantitative stuff isn’t it? So as long
as it was balanced with interviews, however
often that person needs them then yeah [it
would be useful], but I wouldn’t give all the
power to the robots just yet. I think it would be
useful, but not to put all of our eggs in one
basket’
40. Acknowledgements
Manchester
• Prof Shon Lewis
• Mr John Ainsworth
• Mr Matt Machin
• Prof Christine Barrowclough
• Prof Graham Dunn
• Prof Anne Rogers
• Mrs Christine Day
Institute of Psychiatry
• Prof Til Wykes
• Prof Shitij Kapur
So I’ll start with some brief background information on how and why ambulant assessment has been used in clinical settings, before going on to show you what the technology looks like and some of the functioning's of the app we’ve designed. I’ll then describe the first phase of our validation study, before going to tell you about what we’re working on at the moment. phase one of the project where
SO why adapt this approach for use as a clinical tool? Well typically when assessing psychotic phenomena clinicians will use these relatively lengthy semi structured interviews here patients are asked to recall
Why use mobile phones for momentary assessment? Mobile phone technology is becoming increasingly widespread and available. People are already highly familiar with the user interface. Additionally, individuals tend to carry their mobile phone with them anyway, obviating the need for an additional device. Well people are becoming more an more attached to their mobile phones, and increasingly widespread at least in the UK. As the market advances, this may mean that we can install mobile phones apps onto peoples own phones, which obviates the need for them to carry around an additional device when completing momentary assessment.
SoIm now going to show you what the software we’ve developed looks like now.
Text messages may also be an effective way of monitoring psychotic symptoms in real world settings. Indeed, text messages may be advantageous in that people might be more familiar with using them than smartphone applications, and do not require an individual to have a touch screen mobilephone. However, as out smartphone application is purpose built for momentary assessment it may have greater functionality and just be that bit easier to use. Therefore, our aim was to compare and contrast the new smartphone software that we’d developed against a text based system.
I mentioned earlier some of the applications of this technology. However, theres still quite a lot of work to be done before we get there. We still need to pilot test whether its feasible over longer periods of time
And I think that’s very right, I don’t think that this technology should be considered as an alternative to face time with a clinician, but rather as a complimentary strategy in order to improve the quality of clinical assessment and clinical case management.