e-Solutions May 2015
eSolutions: May 2015
Feature article: Tapping Mobile Technology for Improved Integrated Care
Grantee Feature: Mobile Apps for Self-Management: Didi Hirsch Mental Health Services
Quick Tips: How to Incorporate Mobile Apps into Care
Featured resource: Video: Technology for Participatory Medicine
Based on an interview with Lisa Marsch, Director, Center for Technology for Behavioral Health, Dartmouth College, an interdisciplinary research and development group focused on the systematic application of cutting-edge technologies to the delivery of behavior change interventions for individuals with mental health and substance use conditions.
Today’s innovations place tools intended to improve our health right at our fingertips, in the form of mobile applications. Since 2010, the number of health-related mobile apps has grown from just under 6,000 to well more than 40,000., Nearly two-thirds of adults in the U.S. own a smartphone and one in five smartphone owners regularly use a health-related app — to do anything from counting calories and monitoring the nutrition of their meals to tracking their mood and reducing their drinking., Among individuals with a serious mental illness, 72 percent own a mobile device. Individuals with chronic health conditions, and their caregivers, are more likely to engage in mobile health activities.
This increased access to mobile apps means that integrated primary and behavioral health care providers can have extended reach and access to people when clients aren’t in the clinic. There is tremendous potential to harness these technologies to drive health outcomes and support activation of self-management in integrated care.
What mobile technology can mean for integrated care
Learning to incorporate mobile apps and other technology into care isn’t about replacing aspects of clinical treatment. Mobile apps extend the scope and impact of what integrated primary and behavioral health care providers can do.
The benefits and value that mobile apps can bring to integrated health care can vary depending on how the app is incorporated into practice. Mobile apps can help:
Change the clinical dialogue
A lot of times people use an app to work on building a skill (e.g., heart-healthy cooking) or to meet a health goal (e.g., reduce blood pressure). It is important to think about and recognize what value this can bring to the clinical interaction. Apps can present valuable data and key metrics to inform actionable goals and flag scenarios or emerging patterns where a clinician may need to intervene or pay attention. Using this health information creates a new dialogue, allowing a clinician to follow up on it in the therapy session, to reinforce client-set goals and allow people to practice and apply new health behaviors in between sessions.
Collect important health information
With a health tracking app, people report more accurate health data (e.g., blood pressure) because information is collected in real-time and not reliant on recollection. Health apps collect volumes of data, but not all data needs to go to the clinician; not all data is actionable — or available — to the provider, but it can inform and guide the clinical discussion.
Communicate and develop social supports
Some apps feature texting or other messaging components that allow individuals to connect with peers or providers. In any case of sharing health information, it is important for providers to be clear on the potential benefit and risks of being able to connect via an app. When you use an app, you should know that there is a possibility you are making information about your health available (even health data that may be considered sensitive) to the app developer or publisher, but also to third parties. The Office of the National Coordinator for Health Information Technology offers useful information for individuals and tips for providers on securely using mobile devices.
Comparing apps: how to tell the good from the bad
New apps become available daily and not all of them are tested before entering the market. Looking at user ratings only, it is very difficult to assess if an app is science-based, tested and secure. The Federal Trade Commission created a checklist of what individuals should review about an app before downloading it to their phone. For health-related apps, the Center for Technology in Behavioral Health has a program review tool for behavioral health applications. Federal agencies including SAMHSA, CDC and the VA offer a variety of tested mobile apps for consideration.
Cost benefits of adopting mobile technology
Integrated primary and behavioral health care providers should ask, “If I adopt this as part of my service model, then how do I reap the benefits?” instead of “How do I bill for this?” Adopting mobile technology is about long-term investment in the triple aim; it’s about finding multiple ways to get people better care, improve health outcomes and save money.
Increasing use of mobile technology
Learning to incorporate mobile apps into service delivery requires a provider to meet people where they are and connect with them in their preferred ways. Clinicians, particularly those who work with adolescents, should ask if individuals use any health-related apps to work toward health goals. If a person chooses to share information from an app with their provider, then the provider should recognize that the individual is using the app to participate in their own care planning. It may be best to think of mobile apps in terms of a prescription model: you prescribe app XYZ to help support a particular health goal.
Clinical considerations should drive how people engage with technology, not the other way around. Incorporating mobile apps in this way is one more step toward patient-centered care. If you’d like to encourage further adoption of mobile technology, then first think about what your (and your clients’) needs are: would you like to do more screening, track health information, or enhance the scope of your services? Once you’ve determined what you’d like to improve, you can then start exploring the technologies that can help you reach your goals.
Learn more about how integrated care providers adopt and incorporate health information technology into their services on CIHS’ website.
Based on an interview with Olga Felton, RN, MSN, NCM, Director of Nursing, Didi Hirsch Mental Health Services
As the use of health-related mobile applications grows, more organizations, like Didi Hirsch Mental Health Services, a SAMHSA Primary and Behavioral Health Care Integration (PBHCI) grantee in Southern California, are finding ways to incorporate these technologies in their work to support people living with mental illness and/or addictions and chronic health conditions, like diabetes and hypertension. Didi Hirsch is one of 29 organizations participating in a Mobile Technology and Smartphone Apps Learning Community with the National Council for Behavioral Health.
Starting with assessment
Staff at Didi Hirsch ask clients about technology use during visits. Questions on the assessment include if the person has a smartphone or if they already use any mobile apps to monitor their health. While the team at the center knows not every person they see will have a smartphone, asking basic questions about technology use has become a gateway to conversations about whole health and self-management.
Meeting people where they are
Through these initial questions, clinicians found that many of their clients were already comfortable using apps like My Fitness Pal to track exercise or food intake. Staff talk with clients about weight loss or diet based on how the app talks about nutrition.
If clients have smartphones or tablets, but do not use any health-related apps (or want help self-managing a certain aspect of their health), staff offer information on apps that can support self-management for a variety of health conditions such as to track blood pressure, BMI or blood sugar levels.
Tracking outcomes together
Many clients at the center now use Tactio, an app that tracks exercise, blood sugar and mood — and share this information with providers. With the push of a button, a client can send their provider an email with blood sugar reports. During appointments, the individual and the provider review the data in conversation about healthy habits, exercise, diet and treatment plans. Since tracking blood sugar and how it changes throughout the day is vital to managing diabetes, this can provide a framework to improve care — all while encouraging self-management.
Not everyone is comfortable using a new app, not all clients will have access to smartphones and tablets, and some clients may have concerns about cost of adopting the technology. The Didi Hirsch staff carefully suggests using mobile apps as only one approach to self-management, and where possible and after reviewing them, suggests free or low-cost mobile apps as options. Staff also may demonstrate a particular app on their own smartphones during visits as a starting point for conversation on ways to track health goals.
The future of health care
Years ago, to evolve with the changing health care environment, organizations knew they would have to adjust the way they delivered care, which led to the emergence of the integrated care movement. Forward-looking integrated primary and behavioral health care organizations know that incorporating mobile technology and apps into services is another adjustment toward health care’s future.
Didi Hirsch’s integrated care team views the use of technology as an extension of the client and provider relationship, promoting self-management and supporting better health outcomes.
How do you use mobile apps to manage and monitor your health? Share your story with us at Integration@TheNationalCouncil.org, or share your tips for using apps for whole health on Twitter and be sure to tag us at @SAMHSAgov and @HRSAgov.
With increased access to mobile technology, how can integrated primary and behavioral health care providers take advantage of health-related apps to enhance their services?
- Consider your organization’s clinical needs and quality improvement activities and mobile technology that may be most useful to those you serve.
- Research and review health-focused apps before recommending them for use. Read reviews of specific programs from the Center for Technology for Behavioral Health or assess federally-funded mobile apps from SAMHSA, the Office of the National Coordinator for Health Information Technology, CDC and the National Center for Telehealth and Technology.
- Ask basic questions during appointments about technology use and self-management. Questions could include, “Do you have a smartphone?” or “Do you use any mobile apps to monitor your health?” Follow-up to ask about how to incorporate this information into conversations about care.
- Know the benefits and the risks of using mobile technology and communicate best practices with team members. The Office of the National Coordinator for Health Information Technology gathered tips and information on privacy and security when using a mobile device.
Listen to this CIHS webinar for more information and guidance on how to make apps and web-based tools part of your integrated care delivery.
What is participatory medicine and how do health-related mobile apps relate to it? Watch this video from the Society for Participatory Medicine to hear how technology fosters the sharing of information between an individual and their provider(s) and ultimately keeps individuals engaged, equipped and empowered to manage their own health.
CDC released Community Health Improvement Navigator, a website for people who lead or participate in community health improvement work within health care systems. The website offers expert-vetted tools and resources to improve community health.
In May, SAMHSA announced the launch of a new pilot for opioid treatment program service continuity. This pilot project will promote service continuity by allowing patient dosing information to be exchanged between opioid treatment programs through health information exchanges.
On Monday, June 15, the NASMHPD Technical Assistance Coalition, funded by SAMHSA, is hosting a webinar on Strategies for Effective Supervision of a Growing Peer Workforce.
HRSA announced $5 million in awards to support Family-to-Family Health Information Centers, non-profit organizations run by and for families with children and youth with special health care needs.
A new chartbook from SAMHSA uses combined 2008 to 2012 data from the National Survey on Drug Use and Health (NSDUH) to present national estimates of mental health service utilization among adults aged 18 or older within different racial/ethnic groups in the United States.
Individuals with mental health and substance use conditions are at greater risk for medical conditions - such as metabolic syndrome, diabetes and COPD - than the general population. In partnership with the American Psychiatric Association, CIHS invites you to join this webinar on June 30 at 2 pm Eastern to learn how to transfer the latest research and on-the-ground experiences on medical monitoring into implementable practices for psychiatrists and other behavioral health providers in community behavioral health care settings. Register at https://goto.webcasts.com/starthere.jsp?ei=1066523.