Patient monitoring is used in many physical illnesses and chronic diseases.
Yet when it comes to behavioral health it has traditionally been separated from physical health, resulting in patients undergoing divided treatment. As a result individuals with behavioral health issues such as schizophrenia, Alzheimer's disease and ADHD (attention deficit hyperactivity disorder), may be in dire need of care coordination and monitoring. However, the use of technology in behavioral health tends to lag behind other health disciplines, especially in the use of evidence-based assessment and patient monitoring. This is unfortunate since using Health IT can significantly improve the process and effectiveness of behavioral health monitoring for those patients. This article will explore how.
Patient monitoring, in a behavioral health discipline, enables feedback to be received from informants outside the conventional clinical setting, for example at work, school or in the home. However this is conventionally done with paper questionnaires/rating scales and exchanged by mail or phone. While this can still significantly improve a patient's treatment, informants may be slow to respond, and the collation of results has to be done manually.
Principles of effective behavioral health monitoring
For patient monitoring to be effective in any behavioral healthcare discipline it needs to be:
Easy to use and respond: so informants are encouraged to provide feedback
Empowering: so patients and caregivers can provide honest feedback
Actionable: giving meaning and a fuller understanding of information from outside the clinical setting e.g. home, work, school
Timely: facilitating intervention to drive behavior modification
Benefits of behavioral health monitoring
Several benefits can be achieved by implementing patient monitoring in behavioral health, such as:
Relief: patient involvement and self-management can reduce hospital visits, so relieving pressure on the healthcare system
Increased patient satisfaction: due to closer interaction with health professionals; anxiety and hospital stays are reduced and the overall quality of care is improved
Enhanced communication: between healthcare providers, caregivers and patients.
Sharpen your pencil
To monitor and assess a patient's status outside the office requires paper, pencil and homing pigeons! Seriously, in order to monitor the status of a patient beyond the clinical setting requires regular communication by phone, mail and house visits. This can be slow and burdensome, often resulting in missing or incomplete information.
Let's imagine a typical remote patient-monitoring scenario without the use of technology:
1. A patient is selected for monitoring
2. Paper-based questionnaire and rating scale(s) are given to the patient to be completed periodically.
3. Clinician phones the patient for the results. The patient has misplaced a page of the questionnaire! The patient returns to the clinic and is reissued a copy of the questionnaire.
4. The clinical nurse makes several failed attempts at retrieving the results.
5. Finally, some weeks later, the patient brings the completed questionnaire into the clinic to be scored and plotted on graph paper and filed in the patient chart.
While this example may be an extreme case, it underscores the difficulty of remotely monitoring a patient suffering with mental or behavioral illness. Any process that is manual and people-dependent is likely to break down over the course of a treatment. The data collected is rendered stale and may become irrelevant by the time the physician actually receives it.
Technology can help... yes, really!
Health IT should be considered the foundation of any effort to coordinate and integrate care for individuals across all modalities. Behavioral health is no exception! It can deliver data directly to the clinician without follow-up phone calls or visits to retrieve timely information; this improves efficiency as well as overall care. In addition patients benefit from knowing that they are being monitored and will be supported if a problem arises.
The technology solution can be designed to be flexible, to work agnostically within the informant's environment and run on any kind of system from a personal computer to a mobile device.
Reducing the time taken for inputs to be provided is particularly important for patients with erratic symptoms or side effects so timely interventions can take place.
Health IT in practice
Pediatric ADHD is a great example where Health IT has greatly improved both the quality of treatment and outcomes. A team of ADHD experts has developed a software solution to help physicians make American Academy of Pediatricians (AAP) recommended assessments and deliver the best care to each child. The software includes online rating scales and an individualized report of the child's symptoms that is endorsed by parents and teachers. The areas where the child is having difficulties are summarized, including whether the patterns are consistent with an ADHD diagnosis. If the ratings suggest the possibility of a different or coexisting problem then recommendations for further assessment and treatment are offered.
The ADHD solution successfully demonstrated engagement, quality improvement and outcomes by implementing the following:
Social networking is an important vehicle for communicating, sharing and empowering multiple informants. In the case of ADHD, connecting a clinician, parent and teacher together to communicate and share observations empowers quick and honest feedback.
Automated alerts and reminders instantly reminder parents and teachers to fill out the online rating scales. A doctor can be alerted once results are ready for review. This automation greatly improves the engagement.
Electronic rating scales and questionnaires is an easier mode to distribute, collect and score. This data is collected in the comfort of the home or school and is accurately scored by the system.
Professional best practice; the AAP publishes guidelines on the assessment and monitoring of children suspected of suffering from, or diagnosed with, ADHD. Trials have demonstrated that this solution significantly improves compliance with these guidelines.
Real-time view of patient severity allows a clinician to quickly engage with patients that are deteriorating.
Does this really work?
Yes it works; in this case the designers of the system have tested it in a cluster randomized trial and clearly demonstrated the improvements. Like any Health IT solution, to be successful, it must be secure, user-friendly and integrated into clinical workflow. This guarantees that the right level of support, training and incentives are provided to ensure high-level adoption by clinicians, and ongoing support for caregivers and patients.
There are many benefits that technology can bring to the behavioral health sector: improving the procedures of patient coordination and monitoring is one of them.
Ken is a seasoned IT professional with a passion for enhancing the interface between healthcare and technology. With extensive experience in enterprise-level software development and information architecture, Ken has a strong interest in the user experience. He specializes in crafting solutions that address complex business and clinical problems with simplicity and efficiency; focusing on internal and industry standards, automation and reusable technology. Prior to joining Optimal Medicine, Ken served as CEO of Claricode, a leading custom software development and consultancy in healthcare IT. He co-founded the electronic prescribing company, DoseSpot. Ken was formerly engaged with Allscripts (formally Eclipsys Corporation) as the Software Development Manager and was Program Manager for Sunrise Access Manager and Scheduling Products. He now acts as Chief Technology Officer for mehealth.