Mental Illness to Master's Degree: Holistic Psychiatric Information Technology

1The INI is a cooperative endeavor of: College of Engineering School of Computer Science

Tepper School of Business Heinz College

Holistic Psychiatric Information TechnologyA Decision Support System for Mood and Personality Disorders

Sirbrittie C.L. Grant

Fall 2011

The Information Networking Institute is a cooperative endeavor of:

College of EngineeringSchool of Computer Science

Tepper School of BusinessHeinz College



Technology BackgroundDecision Support System (DSS)

Gathers, analyzes, presents data to help users make decisions Ultimate decision is still users to make

Clinical Decision Support System (C-DSS) Provider Centric (Diagnosis, Psychotropic Meds)

Psychiatric Decisions Support System (P-DSS) None (for consumer) WebMD.com HealthLine.com

Knowledge System(Dynamically built by community)



Market Segment2003 New Freedom Commission on Mental Health

Consumer driven mental health Technology used to access mental health care and information

Mental Health Population 1 in 4 adults with at least one diagnosable mental illness per year 18M with diagnosable mood and/or personality disorders 90% of suicides $193B society cost (lost earnings, co-existing conditions,

incarceration) 60% don't seek any treatment from mental health providers Vested Interest (Disclosure) Holistic Psychiatric Consumer (HPC) (Mind, Body, Spirit)



Present Business Model

Pre-CarePoint of Care

Post-CareProvider Consumer

Individual Follower

Unregulated

Group Leader

Regulations

Beliefs

Opinions

Decisions

Decisions



Project P-DSS Survey MethodsParticipants

3 Holistic Psychiatric Consumers (HPCs)8 HPC Supporters1 Provider

Methods2 Surveys (WebMD.com, HealthLine.com) + Prototype Evaluation5 Open-ended questionsThink-aloud protocolGuided Tasks (Interviews)

Study LimitationsSurveyor AssumptionsDirect InfluenceSample SizeNon-Discriminated Results



Project P-DSS Gap Analysis



Project P-DSS Requirements Consumer-centered

Leading to equitable psychiatric system One-stop location Pre-Care, Point-of-Care, Post-Care Decision Support Diary Tracking/Behavior Identification Peer Knowledge/Support, ie Alternative Medications, Coping Skills Rating System Ad-Free Simplicity



Project P-DSS Public Policy IssuesCertifications/Accreditation

Providers, non/profit health organizations, insurers, public interest Health on the Net Foundation (HonCode)

For medical and health Web sites. trustworthy, reliable, credible information Utilization Review Accreditation Commission (URAC)

Best practices for operational policies/procedures health care technology orgs Health Level Seven International (HL7)

ANSI-accredited, framework and related standards in (electronic) healthcare

Health Insurance Portability and Accountability Act (HIPAA) Protects security/privacy of all medical records/shared information Patient right to access and control of health information Fines/Penalties P-DSS may not be a covered entity



Project P-DSS Public Policy IssuesNaturopath/Homeopaths

Inability to Fully Define Inability to Fully Regulate North Carolina Legislation SB31

Criminal felony violations for practicing medicine without a license

Liability/Insurability Mental health economic system

Self-Medicating Benefits/exclusion of medical establishment Illegal substances Risky behaviors



Project P-DSS Demo Disclosures Copyright © 2011 drBrettaGrant.com (Screen Shots vs Live Demo)

Exploratory application without industry based guidelines

Personal experiences, observations, communication

Information capture/dissemination via pre-populated tables

HPC inactivity with the system, med noncompliance and decision support for 2 mood state changes, 'escalating' and 'critical'



Project P-DSS Demo Disclosures

Meditation Music (YouTube.com) Training Video (YoutTube.com) Chatting Tool (© 2011 LivePerson.com) Gmail Calendar (calendar.gmail.com) Breathing Apparatus (© 2011 Mobile Health Innovations)

Prototype hosted at GoDaddy.com

Integrated Architecture



Screen Demo Login Screen

Holistic Mental Health Network



Project P-DSS Demo User Management



Screen Demo User Views

ProviderSupporterConsumer

Administrator



Project P-DSS Daily Diary Questions

What did I do today?What did I wear?What did I eat?Where did I go?What music did I listen to?Any new ailment today?How much do I weigh?How much water did I drink?My notes/Comments of the day.My networks observations/feedback.

Questions derived from observed behavior

Tracks daily changes to better define triggers

Specific to HPC



Screen Demo Diary Mandatory Fields

• Stable mood is a normal state, no intervention needed.• Escalating mood, patient should be monitored. • Critical mood, patient no longer in control.• Meds - assumption that the patient is on one main meds.



Screen Demo Daily Diary

Provides date/time stamp

3 mood states

Assumes HPC is on one med, but scalable to more than one med



Screen Demo Select Button Functions

In functional state Search

Find keywords in the diary

In demo state List All

Retrieves all diary entries, filtered by date/time, mood, med Add New

Adds new diary entry Excel

Outputs raw data in Excel spreadsheet



Screen Demo Select Button Functions

In functional state: Provides system suggested coping skills complete

with comments, ratings, etc. (similar to other features of the prototype)

In demo state: Defaults to Breathing, Meditation Music, and Online

Chatting for an 'escalating' mood, in that order, and as a part of the 'critical' mood state's checklist



P-DSS Flow Chart for Analysis Questions



Project P-DSS Demo External Alerts



Project P-DSS Internal Demo Alerts



Screen Demo Ratings Systems

My Rating is HPC Ratings

Peer Rating is aggregate of 2 supporters and one provider (excludes HPC ratings)

Scores are based on a 1 (poor) to 5 (excellent) rating system. Total peer rating is out of 6 users.



Live Demo

Test case:

1 Holistic Psychiatric Consumer (HPC)2 Supporters

1 Provider



P-DSS Analysis Question #1Does the P-DSS make the HPC more accountable to their network in demonstrating their independence?



P-DSS Analysis Question #2Does the P-DSS help the HPC make an informed decision to take medications when specific warnings are provided?



P-DSS Analysis Question #3Does the P-DSS help the HPC de-escalate a potential crisis situation on their own prior to outside intervention?



P-DSS Analysis Question #3Does the P-DSS help the HPC de-escalate a potential crisis situation on their own prior to outside intervention?

© 2011 Mobile Health Interventions (© © 2011 Live Person



P-DSS Analysis Question #4Can the supporters and providers of the HPCs network make similar or complementary decisions as the HPC when in a crisis situation?

Critical Protocol CheckList.doc



P-DSS Analysis Question #4



P-DSS Effects on Direct Persuasion (HPC) Advantages

CamaraderieSimilar values, beliefs, motivationsSupportUnbiased opinionsFasterRemoves external barriersHPC specific EBR

DisadvantagesMinimizes provider inputLack of tested EBRQuestionable MotivesRemoves external barriersAnonymity



P-DSS Effect on Supporter ComparisonAdvantages

Reduce supporter learning curveSupport for the supporterStandardizationParadigm shiftExample

DisadvantagesParadigm shiftPersistenceLongevityExample



P-DSS Effect on Provider ComparisonAdvantages

Value added servicesDecentralizationExample

DisadvantagesPeer pressureOstracizedLicensing complianceLoss of controlExample



Limited or no consumer input

Limited or no data retrieval and distribution across health systems

Point of care focused

Lack of regulation and consensus on use

0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

P-DSS Shortcomings Prototype Evaluation

HealthLine.comWebMD.comPrototype

P-DSS Demo Evaluation




Question #1 Question #2 Question #3 Question #40.00%

20.00%

40.00%

60.00%

80.00%

100.00%

P-DSS Question Analysis Prototype Evaluation

YesNo



P-DSS Summary/Conclusion

PrescriptionTherapy

Institutionalize

Provider

Consumer


Post-Care

Provider

Consumer

PrescriptionTherapy

Institutionalize

Provider

Consumer


Post-Care

Provider

Consumer

Decisions



P-DSS Evidence Based Research Raw Data Output (Excel)Individual

Study and manipulate their own behavior Study pharmacological effectiveness specific to them Reduce habitual hospitalization Leads to long-term recovery Empowerment to “push” back to the establishment

Community Grassroots efforts Immediate benefits Reaches voluntarily or involuntarily remote segments Does not require widespread acceptance Creates demand for services



Future DevelopmentMore HPC Specific Protocols

Transitioning off Meds WRAP/Advanced Directives/Medical Power of Attorney

User/Profile Customization Color Code based “skins” based on Mood State

Portability Platform Independent (Smart phone, Desktop, Laptop) Social Networking Apps (Facebook, Blog sites, LinkedIn)

On-line Education/Training Certified Peer Supporter Mental Health First Aid

Children Specific Areas



Thank you for your time!

Questions?Feedback?

[email protected]

Mental Illness to Master's Degree: Holistic Psychiatric Information Technology

Technology

Transcript of Mental Illness to Master's Degree: Holistic Psychiatric Information Technology