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Psychiatrist Kristoffer Södersten from PsykiatriResurs in Sweden shares his experience using the Monsenso mHealth solution.
How does the Monsenso mHealth solution encourage and empower better mental health treatment?
Kristoffer explains how the Monsenso mHealth solution helps him to enhance and inform treatment. Specifically, the solution helps him to gain more relevant information about his patients, such as information that couldn’t have been obtained through the traditional method of verbal sessions. “It’s difficult to retrieve reliable and consistent data from each patient during a verbal consultation with them,” says Kristoffer.
Obtaining the right information is key for psychiatrists and psychologists to provide an accurate diagnosis
“[The accuracy from a diagnosis obtained] from face-to-face consultation depends so much on factors like personal relations, how comfortable the patient is in the conversation, cultural background, etc. Therefore, [due to these factors] it can be very arbitrary about which diagnosis a patient receives. This diagnosis can depend on which clinician he meets, and these other factors.” says Kristoffer. The information gathered from the Monsenso Clinic can help to provide a consistent and clearer view of the patient’s mental health, to better inform a diagnosis.
Kristoffer finds the Monsenso mHealth solution to be particularly helpful in capturing relevant objective data. The solution provides a comprehensive and easily accessible overview of relevant patient data, such as day score, mood score, sleep and medication adherence. Moreover, overview of collected sensor data, such as physical activity, social activity, phone usage and voice features can also be provided. This objective data can help to supplement the subjective data provided during verbal therapy.
“The technology of Monsenso can help us to gather more objective data that – together with the subjective experience – provide a more holistic picture of the patient’s problems, to help provide a more accurate diagnosis and follow-up treatment in a totally different way,” says Kristoffer.
Monsenso mHealth solution is providing a visualization of a historical data, which in some cases can identify why the symptoms appear and help to prevent them.
“You can also use this tool to predict future psychological outcomes, which can help us intervene early and prevent relapse.”
In 1998, the Quality Chasm series was launched by the Institute of Medicine which included an informative report about delivering high quality healthcare. The report was entitled “Crossing the Quality Chasm: A New Health System for the 21st Century”.The strategies proposed in this report were to be used as an organizational model for a patient centered healthcare system, and to provide informative guidelines on how a healthcare delivery system can be redesigned to innovate and improve care.
This informative report uses six primary aims to achieve and implement high quality healthcare systems. Mobile Health solutions, such as our mHealth solution, can meet all of those six aims. See how below:
According to the Centres for Medicare and Medicaid Services (CMS), Medicare has been overwhelmed with excessive hospital re-admissions – with total costs up to $17.5 billion a year. 
From 2007 to 2010, the national re-admissions rate remained at 19.2%, with an average Medicare cost for a hospital readmission stay at $9,600.
Therefore, the Hospital Re-admissions Reduction Program (HRRP), under the Affordable Care Act (ACA), aims to reduce re-admissions for all acute-care hospitals receiving payment under the Medicare Inpatient Prospective Payment System. 
In 2012, more than 2,000 hospitals were penalized for having excessive re-admission rates. The Medicare Payment Advisory Committee (MedPAC) estimates that these hospitals paid an average penalty of $125,000. 
Mobile technology ripe for greater adoption
Hospitals and health care systems are looking into developing new strategies, redesigning discharge procedures, and hiring more staff to follow up with patients at home.
They also need to rely on health information technology to scale their programs since they are also required to meet meaningful use criteria.
Hospitals and health systems are being urged to include mobile technology such as remote monitoring devices to connect patients and clinicians and impact care outside of their organizations.
According to the Pew Mobile technology fact sheet, as of October 2014, 64% of American adults have a smartphone. 
According to the 2015 HIMSS Mobile Technology Survey, 90% of respondents uses at least one type of mobile device to engage patients. 
Mobile health technology has created a demand for the concept of care from any location, which includes being able to communicate, share patient information, and receive services remotely.
The acceptance of mobile technology in the care setting continues to grow. 52% of survey respondents believe that the use of mobile technology will “substantially impact the delivery of healthcare in the future.” An additional 16% noted that the use of mobile technology will “dramatically change the way healthcare is delivered in the future.” 
Respondents also ranked that medication reminders, remote patient monitoring and preventative support care are benefits that mobile technology can deliver on patient care.
Overcoming the barriers
While remote monitoring technology (RMT) and mobile technology improve the quality of care and outcomes overall, barriers still exist.
In the case of mental health, mobile technology solutions like the one offered by Monsenso can help reduce the number of hospital re-admissions as well as the health care spending.
For example, a patient is brought into the emergency room as a consequence of displaying severe symptoms of mental illness.
After a couple of weeks of hospitalisation, the patient is released into the care of a close relative. Even though things seem to be going well, the patient is readmitted to the hospital again after six months.
This scenario can be quite common for people suffering from severe mental illness. Patients receive the treatment they need while being hospitalised, however once they are released into the care of their relatives, they receive no support, which gradually deteriorates their mental health.
It is very seldom that patients suffering from mental illness are called in for follow-up appointments, and as a consequence patients remain “stable” for a short period and then hospitalised after relapses.
Monsenso mobile health solution
The Monsenso mHealth solution can help reduce the number of hospital re-admissions in psychiatric treatment. Once a patient is released from the hospital, clinicians can establish a remote care plan that includes monitoring and self-treatment.
Every day, patients will complete a self-assessment in their smartphone. The information on the self-assessment is synchronized in real-time with the clinical web portal.
With the information obtained from the self-assessments, the system can identify the triggers and early warning signs of all active patients. A clinician can access the system every morning and be informed on which patients may need urgent care.
After accessing the patient’s records and reviewing the patient’s behavioural patterns, the clinician can make an informed decision. He can determine if the patient needs to be called in for an emergency appointment or just monitored more closely.
The clinician can also send an encrypted message to the patient asking if everything is fine and encouraging the patient to reach out if he feels ill.
In addition, the Monsenso mHealth solution provides patients with personalised action plans that suggest certain activities in case the patient displays certain symptoms.
Telehealth for mental healthcare makes a lot of sense since mental health care is generally harder to access than other health services, due to a shortage of qualified mental health providers and coverage limits.
A report released by the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) titled “Increasing access to behavioural health care through technology” suggests that to be able to reach a larger amount of people, organisations should consider the use of telehealth for mental healthcare.
Teleahealth for mental healthcare
The report mentions that broadly speaking, telehealth for mental health can take two forms:
A caregiver such as a nurse or social worker can use telehealth technology to conduct a distance-based consultation with a mental health specialist to discuss how to handle a patient’s mental health needs
A patient can participate in a videoconference session with a mental health specialist
The value telehealth for mental healthcare, was identified by HRSA safety net providers in terms of potential cost savings, efficiency, and expanded access to services. In general the HRSA report mentions the five main benefits of using telehealth tools for mental healthcare:
Improved care delivery
Provide a more efficient patient care when they combine patient data with best practices in order to make care decisions. For example, in mental health, clinicians can review data and identify early warning signs for behavioral health concerns
Facilitate the access, use and sharing of data and it supports the health system’s move toward collaborative and integrated approaches by strengthening relationships within a team and across agencies
The patient-centered medical home (PCMH) model of care recognizes the value of care coordination supported by wireless technology
Clinics can gain expanded access to experts, like mental health specialists, residing outside the local community. Telehealth can also ease the task of convening consultation sessions between primary care clinicians and behavioral health specialists
Expanded staff capacity
Offer care providers more flexibility to deliver health care while on-the-go or from different locations—expanding the clinic’s service offerings
Facilitates the hire of part-time, specialized staff who work remotely for multiple clinics
Telehealth for mental health can be added to existing clinic operations. Thus, putting a team together is a matter of figuring how to make it work within the context of existing staff and budgets
Enhanced training opportunities
Conduct trainings for staff when sessions are devoted to sharing of insights and best practices. These trainings can elevate expertise within an agency and across multiple providers
Reduces the cost of care delivery. For example, if a patient suffers a relapse, telehealth enables a care providers to deliver counseling and intervention services quickly through teleconferencing sessions
Patient acceptance and engagement
Works around patient fears over accessing services at a certain clinic or neighborhood. Health center patients are frequently reported to be either unable or unwilling to seek services outside of their communities
Patient acceptance rates for telehealth in mental health are generally high. One HRSA grantee was surprised over one of their early adopters: a psychiatric patient with a paranoid belief that TV was speaking to him. Surely, telehealth would not work with him. However, the patient successfully participated in a session, and, at one point, looked over to his sister with a grin and said: “see, the television does talk to me.”
Patient portals are meeting a demand since people are increasingly turning to search engines to learn about their health concerns prior to accessing care. When patients go online, providers need to be there. Some portals provide patients with access to their health data so that they can take an active role in their treatment
The Monsenso mHealth solution
The Monsenso mHealth solution for mental healthcare supports the use of telehealth technology in the remote treatment of patients suffering from mental illness. Moreover, the report released by the HRSA mentions five main benefits that the use of telehealth brings to mental health care, and the Monsenso mHealth offers all these benefits.
Improved care delivery
With help of the patient’s smartphone, the Monsenso mHealth platform utilizes advanced technology to collect and analyze data on a patient’s behavior. This collection and analysis of data gives the clinician a deep insight into the relationships between the patient’s behavior and the illness.
Expanded staff capacity
The Monsenso mHealth solution enables clinicians to focus on patients who need immediate attention by notifying clinicians automatically if there are any patients who present any triggers or early warning signs.
Enhanced training opportunities
The information on the clinical web portal can be accessed and shared by multiple clinicians even if they are not based in the same geographical location.
The smartphone application enables patients to fill out self-assessments on a daily basis letting the clinicians know how they feel. This information as well as the information collected through the smartphone’s sensors can help clinicians intervene at an early stage, before the patient needs hospitalization.
Patient acceptance and engagement
The patient-oriented clinical evaluations by Monsenso have shown that the compliance rate is very high (87% to 93%), the solution is very useful and extremely usable by patients and clinicians, it helps patients to manage their illness better, and it helps clinicians offer a better treatment
mHealth offers the opportunity to offer scalable and cost-effective mental healthcare. One of the greatest challenges the healthcare systems face is the long-term care of individuals with severe mental disorders such as schizophrenia since the impact this has on individuals, families and societies is huge. Fortunately, some of these issues can be partially solved with the use of mHealth technology. Besides, the advantages of online therapy are many, including a more personalised treatment, patient-empowerment, teaching self-care and helping people who wouldn’t receive treatment otherwise.
Schizophrenia has an estimated point prevalence of 0.4% and a lifetime risk of 1%, which means that 1 in every 100 people will suffer from schizophrenia during their lifetime. It is the 7th most important illness in terms of years lived with disability, accounting for 2.8% of disability caused by all illnesses. For people aged 15 to 44 years, it is the 3rd most important disease, accounting for 4.9% of disability resulting from all illnesses.
During the last few decades, the European Union has made a huge effort to overcome these barriers and to ensure high-quality, longer-term care for people with severe mental disorders. These efforts started in the 60’s with the development of new pharmacological treatments for psychosis, which radically changed the prognosis of severe mental illness. In the 70’s and the 80’s, there was an emergence of new psychosocial interventions and new concepts of mental health care organisations .
Nowadays, there is a need to shift the health care model. The transition from traditional large psychiatric institutions to modern comprehensive community-based models of care, including acute patient units at general hospitals .
According to a report published by EU, this shift is necessary due to the following reasons:
Accessibility to mental health care of people with longer-term mental disorders is much better with community-based services than with the traditional psychiatric hospitals
Community-based services are associated with greater user satisfaction and increased met needs. They also promote better continuity of care making possible to identify and treat more often early relapses
The community-based services protect the human rights of people with mental disorders and prevent stigmatisation of those people
Studies comparing community-based services with other models of care consistently show significantly better outcomes on adherence to treatment 
However, European healthcare systems need to make lots of alterations if they want to provide accessible, effective, high-quality and long-term care to people suffering from severe mental disorders.
Challenges of the transition to new comprehensive community-based models of care
One of the main reasons why the development of long-term mental health services is insufficient is due to the lack of coordination between the different health services. A close coordination, and even joint funding and management of health and social care services is fundamental to cope with the new challenges European mental health systems are now facing. .
According to the report, these are the key principles to organise mental health services:
Accessibility: Essential mental health care should be available locally, including outpatient and inpatient care, as well as rehabilitative care. Local services provide continuity of care in a satisfactory manner.
Comprehensiveness: Mental health services should include all facilities and programmes required to meet the essential care needs of the populations.
Coordination and continuity of care: People suffering from severe mental disorders often find it extremely difficult to gain access to various basic services; therefore, it is crucial that services work in a coordinated manner. This coordination should also include services that are not directly related to health, such as social services and housing services.
Effectiveness: Service development should be guided by evidence of the effectiveness of particular interventions. For example, there is a growing evidence base of effective interventions for many mental disorders, among them depression, schizophrenia and alcohol dependence.
Equity: A person’s access to services of good quality should be based on need. It is quite often that the people who need these type of services the most are the least able to ask for help.
Respect for human rights: Services should respect the autonomy of persons with mental disorders, and encourage such persons to make decisions affecting their lives and treatment .
Scalable and cost-effective mental healthcare
The Monsenso mHealth solution does not only offer cost-effective mental healthcare, it can can facilitate five of the six points mentioned in the report to organise mental health services in an optimal way.
Accessibility: With mobile technology and telehealth, care providers can reach patients living in remote locations at a minimal cost. These technologies offer care providers more flexibility to deliver health care while on-the-go or from different locations—expanding the clinic’s service offerings .
Coordination and continuity of care: The Monsenso mobile health solution can facilitate and support the care of patients suffering from severe mental illnesses from community-based models. Due to its cloud-based model and unlimited scalability, patient records can be accessed by multiple organisations such as psychiatric institutions, general practitioners, and social services, among others.
Effectiveness and equity: With help of the Monsenso smartphone app, care providers can identify on a daily basis triggers and early warning signs of all patients in the system. With the Monsenso mHealth solution clinicians can prioritize caring for individuals who need immediate attention and continue to monitor individuals who are stable. According to the National Institute of mental health, early intervention is critical to treating mental illness before it can cause tragic results such as serious impairment, unemployment, homelessness, poverty, and suicide .
Respect for human rights: The Monsenso smartphone app enables patients to fill in daily self-assessments and write notes about how they feel. The information collected from these assessments is shared with the clinic, allowing individuals to be more involved with their treatment. The Monsenso smartphone app also provides individuals with customised action plans that act as guidelines in case their symptoms appear enabling individuals to take responsibility for their behaviours and actions.
Pharma can benefit from mHealth solutions by using them in clinical trials, and by offering them to healthcare providers as part of a comprehensive treatment solution.
Meeting the needs of healthcare providers
The healthcare industry is widely adopting digital technologies. But, today’s healthcare providers are extremely busy between seeing patients and filing paperwork, which limits their time online.
Nowadays, more than 80% of HCPs have a desktop/laptop computer and a smartphone, and 72% own a tablet.  Mobile assets are rapidly becoming components in the clinical environment.
Pharma can benefit from mHealth solutions since many healthcare providers would like to find new evidence-based medicine to provide better treatment for their patients, but in many cases, they don’t have time. In fact, according to a survey conducted by Publicis on Sermo, 81% of clinicians want higher quality pharma representatives capable of having serious discussions of multiple therapeutic options. 
Pharma can benefit from mHealth solutions by offering them to healthcare providers, and help them satisfy their needs – improving health outcomes, information sharing, and staying updated with the latest treatments. Providing this type of solution will not only facilitate their customers’ jobs, but they will also open new doors and new opportunities to propose comprehensive treatment solutions.
Pharma should reach out to healthcare providers and offer them digital tools, content, and communities that can help them do their jobs more efficiently.
Improving outcomes in clinical trials
Given the challenges faced during clinical trials, it is only natural that pharma turns to mHealth solutions to help them recruit patients, as well as monitoring and measuring their results.
Subjects are much more likely to participate in a study if they have the possibility to raise their concerns or ask any questions 24/7.
Pharma can benefit from mHealth solutions, since these tools can collect even more data in real-time, improve efficiencies in time and costs, shorten timelines, as well as increase patient satisfaction, retention, and future recruitment.
A key element of success when using mHealth solutions for clinical trials is the ease with which mHealth solutions can collect data, and how that information is integrated into the whole clinical database. These data integrations should be done as closely as possible to real-time, making it easy for clinicians to visualise all the patients’ data.
Conducting clinical studies using mobile devices can help collect and monitor behavioural data and vital signs in patients. These solutions can also work as medication reminders and gather patient feedback – all these improve the decision-making process when developing new medicines.
Monsenso can provide Pharma companies with a customised, white-label mHealth solution for their clients and to use on clinical trials. If you are interested in learning more about this, click here.