- Psychiatry Advisor

Christoph U. Correll, MD – Part II

Expert Perspective
Christoph U. Correll, MD

Expert Perspectives on Technology in Health Care: Part II

Cristoph U. Correll, MD

Hospital and Institutional Affiliations:
Professor of Psychiatry and Molecular Medicine
Hofstra Northwell School of Medicine
Hempstead, New York

Investigator, Center for Psychiatric Neuroscience
Feinstein Institute for Medical Research
Manhasset, New York, USA

Medical Director, Recognition and Prevention (RAP) Program
The Zucker Hillside Hospital, Department of Psychiatry

Dr Correll continues his discussion on the use of technology to improve delivery of health care in Part II of this series, “Expert Perspectives on Technology in Health Care.” Refer to Part I for Dr Correll’s guidance on barriers to the uptake of health-related technology, as well as how technology can empower patients to take better control of their mental health.

Question

How can healthcare practitioners better engage their patients to consider using technology as part of their treatment plans?

Answer

I think it is important for healthcare practitioners to make technology one of their talking points with patients. For example, you could ask a patient, Are you using any apps? Do you monitor yourself? You may be surprised by how many patients actually do. Whether it’s an activity, how many steps they take, or how they sleep, having them share that information with you is important so you stay informed. Ideally, you should provide patients with materials such as websites and links to apps that are ready to use and perhaps some easy tools that clinicians could use without requiring an FDA-approved medical device.

Question

Can you provide some examples of the successful implementation of technology in psychiatric practice?

Answer

One example is a simple step count. Many patients with psychiatric diagnoses have problems with weight, either because of their unhealthy lifestyle or their medications. You can help them set a goal of a certain number of daily steps. Some smartphones also record sleep duration, which allows a physician to review sleep hygiene with their patients.

Adherence, or actually nonadherence, to treatment is a significant issue in medicine, and it might be even more significant in mental illness, particularly in psychotic disorders. Patients might not want to take medication, but they don’t tell you that. In addition, they may have cognitive deficits and may not remember to take their medications. Simple technology tools that have been used in the past, such as reminders are effective (eg, pagers that beep when it is time to take the evening dose of medication). We now have smartphones that can easily alert patients to their medication doses. Although that doesn’t necessarily affect nonadherence, it does remind patients and eliminates some of the cognitive dysfunction-related or memory lapse-related nonadherence.

There is also medication technology, such as long-acting injectable agents, that alerts clinicians to nonadherence when patients don’t show up for treatment. You can address this by calling them and their families to ensure that there is enough medication in their system to keep them from falling below the threshold at which relapse becomes an issue.

As I mentioned earlier, MyCite is one way of monitoring ingestion time by the use of a biodegradable in the pill. We also have MEMS® caps, which is a microelectronic monitoring system pill bottle that emits a signal when the bottle is opened. This information is then stored in the cap by a chip. The problem with this technology is that you only know that the bottle has been opened; not whether the individual ingested anything. For this type of monitoring, MyCite is better, because you know the pill entered the patient’s body.

Question

What future research needs to be done to address unmet needs in the healthcare technology space?

Answer

I wish I had more tools that are easily packaged and that I could just pull out of my drawer and tell a patient, “Look, use this app, this website,” so that I could get the information the next time I see them.

Health technology needs to be relatively simple and easy to use. It has to be scalable, reliable, and safe and secure from a data management and Health Insurance Portability and Accountability Act standpoint. It has to be affordable and have some value that enhances clinical outcomes: more precision in diagnosis and, therefore, having better targeted treatments; covering some biosignatures that will drive selection of treatments; or helping with monitoring of treatment response, whether it be positive efficacy or adverse events. This can then also improve the patient’s decision-making.

We need more data, and we need to be able to measure that data. The overall premise is measurement-based care. In psychiatry, we have not used much in terms of measurement. Our assessments are often based on what people say, what they feel, and how we perceive what they say or how they look. It is therefore important to get more data, precision, and measurement. For example, having patients use their smartphone to fill out questionnaires to send to their physician before they see them can help streamline the encounter with the patient. We did that in the RAISE study, in which a computerized decision-making program was used to facilitate treatment.1 The study involved the use of a treatment algorithm for when the patient came to the clinic; their weight and height were measured, and they filled out questionnaires that were then presented to the physician at their evaluation visit.

Reference
Robinson DG, Schooler NR, Correll CU, et al. Psychopharmacological treatment in the RAISE-ETP study: outcomes of a manual and computer decision support system based intervention. Am J Psychiatry. 2018;175(2):169-179.

Disclosure: Dr Correll has been a consultant and/or adviser to or has received honoraria from: Alkermes, Allergan, Angelini, Boehringer-Ingelheim, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen, Johnson and Johnson, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He has provided expert testimony for Bristol-Myers Squibb, Janssen, and Otsuka. He served on a Data Safety Monitoring board for Boehringer-Ingelheim, Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a shareholder of LB Pharma.