New Developments in Mental Health Informatics Information Utility Forum: Compass for Change

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New Developments in Mental Health Informatics
Information Utility Forum Compass for Change

• Dr Martin Orr
• Psychiatrist
• Clinical Director ISWaitemata District Health
  Board
• Clinical Director NIHI

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5 main advantages of E-mental health

• Cost reduction
• Facilitation of conventional service delivery
• Introduction of innovative services
• Democratisation of health care and facilitation
  of consumer empowerment
• Improved access

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Concerto clinical portal
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Patient Portal

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What does ManageMyHealth offer?

• Online personal health records can be made up of
• Consultation Notes
• Laboratory results
• Prescriptions
• Immunisations
• Allergies
• Diagnosis
• Recalls
• In addition to this you have the ability to do
  the following
• Secure email
• Journal
• Calendar
• Community forums
• Health news

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EPR HCC
Auckland Regional Mental Health IT System
(ARMHIT) objectives
Phase 2 NGOs, GPs and clients use ARMHIT to
participate in shared care
Phase 1 (2009) A single shared record across 3
Auckland DHBs (1.4 million pop), to facilitate
safe effective integrated care
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National collections Activity and Outcomes

• Project for the Integration of Mental Health Data
  (PRIMHD) MH-SMART MHINC
• PRIMHD integrates the two national mental health
  data collections
• the Mental Health Information National Collection
  (MHINC)
• and the Mental Health Standard Measures of
  Assessment and Recovery (MH-SMART)

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Case Finding and Help Assessment Tool (CHAT)
Touch screen study
Piloting touch screen for patients in GP waiting
rooms
Developed for lifestyle and mental health
assessment of adult patients in primary health
care
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Smartmed
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New joint NZ-KoreaRobotics for Elder Care Project

• Massive increase in Aging at Home and Dementia
  care needs
• Clinical Assistants, monitoring vital signs,
  behaviour, falls, medication
• Prevention versus Promotion of Physical and
  Mental Atrophy
• Companionship and building cognitive resilience
  personality, changes in accent and age to improve
  rapport
• Robots as inexpensive appliance rather than
  humanoid but strong focus on human/robot
  interaction

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Physical health monitoring Predict

• Predict computerised cardiovascular risk
  prediction and treatment decision support
• Developed by Enigma and University of Auckland
• Widely deployed in NZ general practices
• Waitemata DHB MHS

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Analysis of records

• Population to patient level prescribing data
• 2,879 patients
• 20,882 total prescriptions (around 4.3 for
  antidepressants)
• 14 different antidepressants identified in total
  889 scripts
• 7,587 patient classification codes (encoding 425
  depression related classifications based on Read
  Clinical Codes relating to 399 individual
  patients)

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Medication possession ratio

• MPR measure of adherence. Calculates the
  proportion within a fixed period that the patient
  has an available supply of medication
• MPR of days supply held during OP
  -------------------------------------------X 100
  of days during OP
• Can identify patterns of medication lapses and
  drive intervention by recall of patients with
  poor MPR

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Prescribing frequencies
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MPR thresholds
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Individual Reports Adherence/Persistence
101-day lapse during evaluation period
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www.thelowdown.co.nz

• Interactive
• Integrated use of cell phone, voice, text, email,
  bulletin board, webcam, chat
• Immediate human response from trained team
  including crisis intervention

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www.thelowdown.co.nz

• Website being used for community mental
  healthcare delivery
• NDI targeting 13-24 age group
• Social marketing draft FCB, Phoenix Research
• Information/socialisation/Signposting
• Recognises importance of the messenger and the
  media
• use of personalities can identify with as
  navigators
• use of personal narrative/stories
• multimedia songs/video that can
  identify/connect with

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Service uptakeJan 08 Jun 09

• 119,464 total website visits
• 148,802 text
• 5,265 emails
• 1,530 combined message board posts

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John Kirwan National Depression Initiative

• JK Campaign central to NDI and Mental Health
  Awareness NZ
• Synergic use of TV Web
• Next generation website, green screen, special
  effects, integrated animation
• Personal journal and integrated support
• Signposting, Stepped Integrated Care
• E-coaching
• Expert advice videos

http//www.depression.org.nz
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STOMP

• Stop smoking with mobile phones trial
• TXT based smoking cessation intervention
• A randomised-controlled trial
• 1700 STOMP users
• STOMP doubled self-reported quit rates from 13
  to 28 after six weeks

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Stubit

• Video diary messages of young people quitting
  smoking who act as role models
• observational learning
• Real life stories
• Effective quitting tips techniques
• Sent as automated programme of pushed messages

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ADAPT multimedia mobile phone depression study

• Aim is to determine whether a multimedia mobile
  phone-based depression prevention programme is
  effective at reducing depressive symptoms at 12
  months compared with adolescents receiving a
  control programme
• Cognitive Behavioural Therapy via video messages,
  text messages and animations
• www.ctru.ac.nz/

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Cogito Telephone Voice Analysis for Depression
and Intent

• Facilitating triage and monitoring  based on
  sophisticated voice analysis around the
  consumers potential to be depressed and their
  related likely  intent/ motivation to be
  congruent with self management.
• http//www.technologyreview.com/biomedicine/23856/
  

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Symtrend Symptom Checking, Charting and
Reminding

• Building up pattern of symptoms and own record
• Statistical analysis and ability to share record
• Links PDA/Web/EMR
• Can Purchase on iTunes

Depression, Anxiety, Bipolar, ADHD, Autism,
Aspergers
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Real Time, Real World Consumer Web Research and
Learning

• Real time emergent research based on large groups
  of consumer experience
• http//www.patientslikeme.com/
• Consumers charting their own individual
  experiences, symptoms and treatment response
  which can then be aggregated, shared and analysed
• Argument new paradigm for research and learning
• Real world, Real Time Outcomes

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Information Communication Technology Mental
Health

• Mental health has significant knowledge of, and
  a potential leadership role in many of the
  emerging health ICT focus areas
• patient centred care
• patient empowerment
• self care
• Shared notes
• Integrated multidisciplinary collaborative care
• Care pathways
• Stepped care
• NGO care
• Clinical networks
• Life charts
• Homecare
• Recovery planning etc

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http//www.hive.org.nz