Behavioral Health

Mobile Applications in Healthcare – Here to Stay


Mobile Applications in Healthcare – Here to Stay

mehealth pic

We at mehealth know that the future of care delivery relies on digital health. More and more healthcare providers are taking notice.
Case in point: Earlier this month The Wall Street Journal’s Laura Landro wrote a great piece on the use of mobile applications to help manage costly and complex medical conditions.

Landro reports that “Hospitals are developing new mobile apps to help patients manage serious medical conditions and feed information back to their doctors between visits, often in real time.”

In the article, she describes examples of the multi-faceted use of mobile health tools to:

  • Help patients adhere to HIV medications
  • Manage the symptoms of inflammatory bowel disease and asthma
  • Prevent repeat heart problems after a cardiovascular rehabilitation program

Interestingly, Landro writes: “Because they are prescribed by physicians and used under medical supervision, researchers say, they stand a better chance of being integrated into patients’ daily routines, compared with health apps that consumers download and use without their doctors’ involvement.

This statement is directly correlated to what we at mehealth have long known; when treating patients with complex conditions ( such as behavioral health disorders), so much of what informs doctors’ decision-making is dependent on what takes place while the patient is out of the office between ‘physical appointments’. Further, the ability of these tools to collect information in all settings makes them more likely to be adopted by the patient, as they are often not only willing, but thrilled to take a part in their own care delivery.

As Landro mentions, the true benefit of digital health apps is that clinicians can use these tools to answer questions and gather details that are often impossible to observe from brief 20-minute patient encounters. Since there are often weeks or months between appointments, being able to accurately collect this information provides a fuller, more comprehensive patient picture, answering important clinical queries such as “What were the immediate effects of the medication?” or “Could you rate how your symptoms have progressed over the past two weeks?”.

For an improved, inclusive care continuum to be a reality, the healthcare industry must realize the value of digital health technologies, such as apps, and further continue to dedicate time and resources to develop and use these tools. Kudos to Ms. Landro for her piece and all those who continue to join mehealth in advocating for our patients and the benefits that digital health provides.


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A Good Read for Behavioral Healthcare Providers


A Good Read for Behavioral Healthcare Providers


When I scanned over the first paragraph, I knew that Jill Sederstrom’s article “Clinicians must turn evidence into practice” in Behavioral Healthcare was going to be a good read. So, I got myself a coffee and settled down to enjoy it; I was not disappointed. I recommend you read it too.

As researcher and a clinician, I have sat on both sides of the table in the struggle to create an evidence base that is robust and valid, but also able to inform clinical care. I understand the problem and I’m very pleased to see it so eloquently acknowledged and explored by the author, including interviews with Kelly Clark, MD, President-elect of the American Society of Addiction Medicine, and Melanie Smith, Licensed Mental Health Counselor and Program & Training Manager of the Renfrew Center in Florida.

Some key messages from the article:

  • With an emphasis on quality initiatives, the importance of evidence-based practice in behavioral healthcare is growing. Payers “will be evaluating whether facilities are embracing the latest evidence that has been shown to produce optimal patient outcomes. They want the most value for their healthcare dollar.”
  • Behavioral healthcare providers must be prepared or the next few years “will become very problematic” for them. But, incorporating evidence into care is not an easy process and it takes time. Facilities need to invest to “translate what’s discovered in a research setting into everyday practice”.
  • Evidence-based approaches give clinicians a framework based on empirical data. “We don’t really have a lot of ability to know in the long-term how our patients are doing, [and]…whether or not what we’re doing is the most effective and efficient way to help someone get better”, says Smith.
  • Clark points out that evidence-based medicine (or evidence-informed medicine) “lends itself to quality metrics that are population-based and allow clinicians and facilities to see an issue from a broader population-based perspective that provides bench marking opportunities.”
  • The clinical trials that are required to bring a drug or device to market often do not represent real world scenarios. Distilling information from claims data or other big data sources can provide “actionable intelligence for clinicians”. “There’s not a lot of information that’s practical and usable for me in my office…” Smith says.

So how can we bring evidence into care? Highlights of the Renfrew Centers’ successful approach are described in the article; they are trailblazing. There is also an opportunity for large and small behavioral healthcare provider organizations to implement evidence-based care without needing to be the pioneers.

As the CEO of a health IT company, I now wrestle with the challenge of helping clinicians (including those who don’t have the band-width to be trailblazers) to deliver evidence-informed medicine to each individual patient.

Digital health solutions are enabling the findings of research to be easily applied in clinical care; incidentally they are also generating a wealth of real-world data that in itself enriches the evidence base and our understanding of optimal treatments.

We can distill the evidence base and protocols derived from it into integrated software that clinicians can use at the point-of-care. We can then capture the clinical characteristics and the symptoms of each individual patient and map them (automatically) against those best-practice guidelines. This generates personalized care recommendations which enable clinicians and patients to together make evidence-informed treatment decisions. By monitoring an individual’s status both at and between clinical consultations (using remote technologies) we can track progress and treatment like never before. We can identify early when things are going awry and come back to the “electronic” protocols to guide care.

The growing database of clinical data generated allows an organization to explore concordance with quality measures and monitor outcomes at a population level. The improved understanding of optimal treatment practices improves care and ensures the best value for each healthcare dollar. That seems like good thing!

My cup of coffee’s finished. Thanks Jill Sederstrom for a great read.

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Telehealth-Can’t see the wood for the trees?


Telehealth – Can’t see the wood for the trees?

Let’s begin with what is it?

The Health Resources Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”

Under the large telehealth umbrella (which can include non-clinical services) “telemedicine” refers specifically to remote clinical services or “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status” (American TeleMedicine Association).

Despite the broader definitions, both terms are commonly used simply to refer to two-way conferencing for clinical consultations.

It’s worth noting that telemedicine is not a distinct medical specialty that we should leave to the experts; it’s the application of technology to improve the clinical services that we all provide every day in our various specialties.


So, how might you use it?

Equipped with the right device (which can be as simple as just a connected smartphone) a consultation can take place anytime anywhere, if you want it to! Telemedicine technology also allows sharing information with colleagues for second opinions and making or taking specialist referrals (live discussions, dual consultations, diagnostic images, videos…). Telemedicine helps with care and communication. It can speed up wait times and magically remove the miles that separate us from our colleagues and patients.

It also keeps us in touch with our patients’ status. Few physicians could say, hand on heart, that they wouldn’t provide better care if they knew (really knew) how their sickest patients were doing between clinic visits. Devices to remotely collect and send data from patients at home to the medical practice (or a dedicated monitoring facility) can revolutionise care. This applies to vital signs such as blood glucose or EKG tracings, but also patient reported outcomes such as pain or mood monitoring. And it’s a two-way street. We can remind patients to take medications, complete rating scales, check in with the nurse or have a blood test, automatically at pre-determined times. Like a cuckoo clock in the corner of the room that sings more than one song!

In addition, telemedicine technology can be “smart”, using clinical rules and algorithms to map best practice guidelines against an individual patient’s evolving clinical profile. When remote monitoring devices pick up a change in clinical status alerts are triggered. Early intervention and concordance with best practice care improves clinical outcomes and reduces costs.

Telemedicine also saves time by collecting the clinical information the clinician needs before the consultation begins. Rating scales and questionnaires can be automatically sent to and completed by patients before a normal clinic appointment. The information is collected, analysed, interpreted and delivered to the doctor before/at the start of the visit, allowing him/her to spend the face-to-face time focusing on addressing areas of difficulty (rather than finding them). That makes for a more satisfying visit for the patient and the doctor.

Telehealth also includes access to health information at our fingertips. Consumer medical and health information, and on-line support and discussion groups empower patients. Physicians have access to specialized health information and education materials including the ability to earn CME credits.

Two-way video is the most employed telemedicine technology in use by healthcare organizations, followed by patient engagement tools through patient portals or applications.

Is there something there to help you and your patients?

Talk to your professional organization or the American Telemedicine Association to see what‘s going on in your specialty. If you are in behavioral healthcare or treat children with ADHD, come straight to mehealth!

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A Plea for the Integration of Social and Behavioral Health Data in EHRs


A Plea for the Integration of Social and Behavioral Health Data in EHRs

When Meaningful Use was drawn up to exclude behavioral health providers, the impact that this decision would have on increasing the divide between medical and behavioral health care providers was probably not fully considered.

Health IT Analytics recently published an article by Jennifer Bresnick, Social, Behavioral Data Must Be Included in EHRs, Nurses Say highlighting the problem. It’s a good read.


The American Academy of Nursing urges the integration of social and behavioral health data in EHRs to improve patient care

Bresnick reports, “Largely ineligible for the EHR Incentive Programs and somewhat ignored by mainstream primary care health IT developers, behavioral health providers have been slower to adopt EHR technology that might facilitate health information exchange.”

Effectively, we’ve put primary care and medical care providers on a high speed train en route to a modern digital connected world  of data and interoperability (the train hasn’t quite arrived yet!) while leaving behavioral health providers back at the station. As we arrive closer at the destination, we are now noticing that the distance between these groups is a real problem.

People don’t have just medical or mental health problems. The two are totally dovetailed, with social problems also having a significant impact on both. In her article, Bresnick tells us of the American Academy of Nursing’s new policy brief and call to action, stating that “Electronic health records are incomplete and potentially insufficient for use in population health management programs when they are missing social and behavioral data”.

Yet, not only are the EHRs failing to amalgamate the required data, but also many behavioral health providers don’t currently have the tools, infrastructure, budgets, training… in place to quickly catch up and join the digital health ecosystem.

Even the legislation and privacy policies around mental health data (whilst arguably historically driven by the right motivation) commonly now impede the way forward.

Hindsight can make us odious as well as smart. So, let’s move on from what’s been done wrong, to what we can do to make things better.

For starters, there is hope that pending legislation will expand meaningful use eligibility to psychologists and inpatient psychiatric hospitals. The Helping Families in Mental Health Crisis Act of 2015 includes several other provisions related to the adoption of health information technology and health data exchange, alongside the meaningful use eligibility. The proposed bill addresses provider access to protected health information (PHI) for people with serious mental illness and confidentiality of records, balanced against the need to improve care coordination. In its Federal Health IT Strategic Plan 2015-2020, the Office of the National Coordinator for Health Information Technology made increasing behavioral health EHR adoption an aim.

These are all good steps forward.

Surveys of behavioral health providers consistently demonstrate that the costs of EHR implementation and adoption are leading causes for failing to implement the technologies, so it is essential to free up funds. Meaningful use incentives would do that, to some extent. It’s also noteworthy that a failure to find the right system is also a barrier to adoption. That’s a plea for other companies to join mehealth’s efforts and provide health IT solutions that address the clinical needs of behavioral health providers.

The Health IT Analytics article eloquently sums up the AAN’s vision of how we should move forward with the following statement:

“The Academy urges EHR vendors, health systems, and clinicians to collaborate on developing standards that will enable providers to collect behavioral and social determinants of health that can be readily integrated into EHR workflows.

Stakeholders must work together to create connections between social and behavioral healthcare organizations and the primary care ecosystem in order to develop a richer portrait of patient challenges and needs.

By implementing an industry-wide effort to better integrate socioeconomic and behavioral health data into EHR technologies, stakeholders “will begin to address the global changes that must be made in clinical practice to assure EHRs capture and permit sharing of contextual patient information, promote shared decision-making, enhance appropriate inter-professional planning/providing of health care services, and facilitate monitoring of patterns of health and outcomes of care for entire populations,” the brief concludes.”


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A time machine for behavioral healthcare!


A time machine for behavioral healthcare!

Many years ago…
“John” had been referred to the psychiatric ward for specialist help managing his schizophrenia. Over the preceding 15 years he had been treated with every antipsychotic available (often in very high doses and with multiple drugs prescribed simultaneously) in a desperate attempt to help his symptoms. It’s an all too familiar story.

I was a junior doctor on my first ward round; the psychiatry professor asked me to work back through John’s medical record and determine which single treatment he had responded best to. On which drug had he had the best symptom control and the fewest side effects?
Doctor surrounded by paper files

With a loud thud, five volumes of John’s medical records landed on my desk! I waded through the tomes and, as best I could, plotted the scanty information about his clinical state over the years against the medication prescribed. The next ward round we started John back on the best treatment.

While I agreed with the goal of the exercise it occurred to me that there must be a better way to monitor patients with chronic illnesses over time.

This happened long before the introduction of electronic medical records. But John stayed in my mind.

Much more recently…
When we began developing the mehealth clinical decision support software I asked clinicians how they now managed long term monitoring in the digital health era. I was shocked to be told that I had been lucky “back in the olden days” to be able to flick quickly over whole sections of the paper notes to focus just on the relevant information. Apparently it could now be impossible to find where in the EHR side effects and symptoms were consistently recorded. “You’d be clicking boxes open and shut forever”.

You can’t manage what you don’t measure…
Demonstrating longitudinal status and impact of interventions helps identify optimal treatment and avoids crises by allowing clinical teams to react to deteriorating mental health early and effectively.

Changes in clinical state cannot be accurately collected retrospectively. Unless healthcare providers are capturing information about symptoms and side effects on an ongoing basis, disease progression cannot be monitored and the appropriate interventions implemented in a timely manner. Making the right clinical decisions quickly and effectively has huge health, safety and budgetary implications:


  • A hospital admission for a patient experiencing a schizophrenia relapse costs approximately $40k.1
  • The cost of healthcare services for individuals who experience a relapse is four times higher than for those who do not.2
  • Risk factors for relapse include poor treatment adherence, severe residual psychopathology and poor insight.3
  • 40% of relapses are caused by poor treatment adherence, which is influenced by medication side effects, efficacy and dosing schedules.4

Even if we ignore the human burden of a relapse of a mental illness, it’s easy to see how better monitoring of symptoms and side effects can cut healthcare costs.

Measure. Monitor. Manage.
Because of “John”, and all the other “Johns” out there, our clinical decision support software incorporates a timeline capturing all interventions (pharmacological and non-pharmacological) and key clinical outcome measures over time.

Beginning data entry (using the intuitive assessment tools) on the first day of care is best, but the timeline can also be retrospectively populated if relevant clinical measures are available electronically. We’ve done it in thousands of patients already! The timeline incorporates data from point-of-care evaluations and from remote assessments made by patients and other informants using smartphone apps or web-portals.

A time machine for behavioral healthcare…
Using this system a clinician can easily view all the treatments a patient has had, when they were prescribed, and their impact on key clinical parameters like symptoms, side effects, physical measures, labs… you can go back to a date in the past and see exactly how the patient was doing. You can plot any parameters against each other and that gives you, and your patients, better insight into clinical patterns and the best care pathway.

You can also share the timeline with clinical colleagues, so everyone knows what’s going on.

Back to the Future!
If this resonates with you (and you want to travel back to the future) check out mehealth.


Dr Janet Munro, CEO mehealth


1 Munro J et al. Hospital treatment and management in relapse of schizophrenia in the UK: associated costs. The Psychiatrist 2011 35:95-100.
2 Almond S, Knapp M, Francois C, Toumi M, Brugha T. Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry 2004; 184: 346 -51.
3 Csernansky JG, Schuchart EK. Relapse and rehospitalisation rates in patients with schizophrenia: effects of second generation antipsychotics. CNS Drugs 2002; 16: 473-84.
4 Weiden P, Mott T, Curcio N. Recognition and management of neuroleptic noncompliance in schizophrenia. In Contemporary Issues in the Treatment of Schizophrenia (eds CL Shriqui, HA Nasrallah): 411 -34. American Psychiatric Publishing, 1995.
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“What’s yours is mine… and what’s mine is mine too”


“What’s yours is mine… and what’s mine is mine too”

Is this really physicians’ approach to their patient’s health data?

Dan Munro (no relation!) wrote a fantastic article for Forbes earlier this month about doctors’ reluctance to share health data with patients, commenting on a poll of Sermo members.

SERMO is the #1 social network of physicians. Verified members discuss practice management, collaborate on cases, and vote on the latest polls.

Over 2300 physicians responded to the question
“Should patients have access to their entire medical record ‒ including MD notes, any audio recordings, etc…?”
49% ‒ Access to all records should only be given on a case-by-case basis
34% ‒ Yes, Always
17% ‒ No, Never

Dan Munro summarizes “In effect, a full two-thirds (66%) [of physicians] were clearly reluctant to share health data with their patients. A significant 17% were completely opposed to the idea outright ‒ ever.

So, from the opposite viewpoint, how willing are patients to share their health data with providers?

The recent Office of the National Coordinator for Health IT (ONC) survey of over 2000 respondents reported that fewer than one patient in 10 withholds information from their providers, and seven in 10 were willing to share their medical records electronically with other providers treating them even if they had security concerns.

I like the mind-set of Peter Elias, MD (Family Medicine and SERMO member) who shares all his patient data, including clinical notes, and makes the following case:

“It profoundly changes the nature of the relationship. If the record (or visit note) is written explicitly as a shared document, it is no longer possible to maintain a relationship based on asymmetric power. I can no longer keep secrets. If there is an issue or potential issue impacting care, I have to address it with the patients. This is often what clinicians find objectionable. The thinking is ‘how can I document that I think the patient is being unreasonable or that depression is contributing to their pain or that their report of symptoms is exaggerated if they will see it?’ This is exactly why I think it is so important. Hiding these issues and using them to alter care without involving the patient is manipulative and paternalistic and keeps the patient from being fully autonomous.”
Clinician at computer screen

In 2015, isn’t this the best way forward?

I think we can go a step further: Turn the computer screen round and share it with patients. That’s our approach at mehealth.


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Providing quality care despite a shortage of doctors


Providing quality care despite a shortage of doctors

There is a steady flow of academic articles and press coverage about how the shortage of physicians is impacting US healthcare. Many of the media stories recount personal tragedies; too little care, too late.

Patients are suffering from a lack of primary care physicians and specialists in towns that are medically underserved because of their remote location, or simply because there are insufficient numbers of medical practitioners covering the local population.

Nationwide Shortage and Surplus of Primary Care Physicians

This map from the American Action Forum colors the physician shortage or surplus in each county, where “shortage” and “surplus” are defined as the total number of physicians above or below the population-adjusted national average.

By way of example, some worrying statistics:


  • Nearly 20 percent of Americans live in areas with an insufficient number of primary care doctors (U.S. Department of Health and Human Services)
  • Almost 91 million adults live in areas where shortages of mental-health professionals make obtaining treatment difficult (U.S. Department of Health and Human Services)
  • The nation will face a shortage of between 46,000-90,000 physicians by 2025 (Association of American Medical Colleges)


It’s easy to rant in a blog about how bad it is that people have to wait to get the care they need. It’s much harder and slower to find appropriately qualified healthcare professionals and the funds to employ them. So is there a solution? Yes. It’s digital health.

Health informatics technologies can ensure that scarce resources are used most effectively to meet the needs of the population. These examples focus on the care of children with ADHD, but they apply to other domains also.

Improved efficiency is definitely a benefit of health IT. Automated electronic communication shortens the time it takes to gather the necessary information to assess and treat children with ADHD. A clinician using mehealth for ADHD tells us it reduces his assessment and diagnosis time by 75 percent. Replacing paper ratings with online assessments dramatically reduces the administrative burden and frees up clinical time.

Delivering the best, evidence-based care for all patients that come to the clinic isn’t easy; it’s hard for pediatricians to be experts in everything. There’s some controversy around the diagnosis and treatment of ADHD, so referring all suspected cases to a child psychiatrist has become standard practice for some pediatricians. With 11% of US children receiving a diagnosis of ADHD, the idea that child psychiatrists could, or should, see them all is clearly untenable. Software is empowering pediatricians to manage routine cases and triage those that need a referral. mehealth for ADHD maps symptoms (automatically collected, scored and analyzed) against DSM-5 criteria and AAP ADHD guidelines, and it provides assessment and treatment reports. It doesn’t remove the need for good clinical judgment, but it supports pediatricians in delivering optimal care… themselves.

Telehealth consultations and e-consults are revolutionizing healthcare and providing under-served communities with essential pediatric and psychiatric medical expertise. But using an expert’s on-line time effectively is essential. A psychiatric expert 200 miles from the patient wants to have a succinct, standardized summary of what’s been happening since the last consultation, ideally viewable before the on-line session. ADHD monitoring software does just that; automatically rated scores of symptoms, impairments and side effects, from home and school, are plotted longitudinally against pharmacological and behavioral interventions. What’s more, from January this year The Centers for Medicare & Medicaid Services (CMS) expanded reimbursement for telehealth services provided to Medicare beneficiaries; more motivation for going digital. Details here.

So that’s it. It’s not rocket science.

  • Implement technology to improve efficiency so that primary care physicians can spend their time solving clinical problems, not administrative ones.
  • Use clinical decision support tools to help primary care physicians deliver the highest quality of care in their practice, themselves; that’s best for patients and for over-stretched specialists.
  • Exploit telehealth and remote monitoring tools, providing specialists with all the information they need to consult effectively with primary care physicians and patients, however far away they are.

It would be over zealous to say, “problem solved”, but it’s a great step in the right direction!


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Digital Health – Thinking positively and trying hard. Good enough?


Digital Health – Thinking positively and trying hard. Good enough?

This blog is a note of appreciation for those who patiently support the digital health revolution.

Let me explain.

I’m rather a perfectionist. I tend to want things to be absolutely right, the best they can be… perfect. One of my colleagues works hard to remind me that sometimes “good enough” is… well, good enough. Move on. Positively.

It’s that spirit that I applaud in many who are adopting health IT.

The task of shifting the healthcare world from disconnected paper to connected technology is enormous. We need integrated, streamlined, user-friendly technologies that fit seamlessly into medical practice when things are working optimally, and disrupt practice when it is flawed. The buy-in of all the healthcare stakeholders is required, and we need to work within budget and to schedule. Oh yes… I nearly forgot… improving healthcare outcomes and saving money would be good too. Over-simplified, but you get my point.

That’s a daunting mission at a technical level, politically, administratively and, of course, clinically. The long road to digital health nirvana is not likely to be smooth all the way.

So, I’m impressed how so many clinicians are tolerant, forgiving and positive even when the going gets rough. Surveys of their “digital health experiences” are by no means completely glorious, but the spirit is positive. They are excited by the vision of what digital health will do and understand that corrections and iterations are necessary steps on the journey. They find the path that works best for them; sometimes it’s going with the flow, sometimes it isn’t.

Consider Meaningful Use

When decision-makers at the highest level joined the digital health early adopters and innovators, they brought the potential for a rapid and game-changing shift in healthcare.

A huge amount has been achieved in a short time, but it hasn’t all been plain sailing. Despite the very sensible approach of dividing up the task into manageable stages, and the accompanying consultative process, it seems we’re now below the “good enough” bar.

Two recent blogs acknowledge this in a pragmatic and informative way:

Rob Lamberts is a practicing physician and blogger. He was an early EHR adopter and has been both on the inside (self-confessed “former HIMSS Groupie”) and the outside of the changes. But in a recent blog post on “KevinMD” he writes of his disillusionment with the current state of healthcare technology implementation, “…my care has become far more meaningful and useful for my patients since I abandoned meeting the criteria of CMS, ONC, and BCBS and focused on the only ones for which the care is truly meaningful: my patients.

John Halamka’s roles include Chief Information Officer of Beth Israel Deaconess Medical Center, and being a practicing Emergency Physician. In a recent post on his “Life as a Healthcare CIO” blog he talks us through the Good, Bad and Ugly of MU Stage 3. (Yes, there is a “Good”). He concludes, “The work of the country over the next few months needs to be achieving a consensus about what should be in the Certification rule and what should be removed. If industry, academia, clinicians, payers, and patients can align on a minimal set of requirements, we’re confident ONC will listen.

Yes – I think we can do that. Look how far we’ve come already!

So, thanks to all those who are patiently supporting the digital health movement when it’s achieving “good enough” (or better!). Also thanks to those who raise the red flag when what is being planned or done is not good enough.


Dr Janet Munro, CEO mehealth

Dr Janet Munro, CEO mehealth


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NatCon 2015 Wrap Up


NatCon 2015 Wrap Up


Last week we attended the National Council of Behavioral Health’s NatCon 2015 event in Orlando. As an exhibitor for the first time, we had the pleasure of encountering the countless clinician and organization attendees committed to helping improve care outcomes and quality of life for the millions of patients living with behavior health conditions.

As we opened the show and began to offer mehealth behavioral health demos, it became increasingly clear that the ability to assess and monitor patients’ behavior, moods, and social engagement with family, friends, and co-workers was particularly exciting to all who saw our platform. The ability to track trending behavioral activities between clinical in-person appointments is what the marketplace seems to be longing for, as these new insights both improve adherence of face-to-face scheduled appointments and also allow for a more complete and timely patient record. Like any of us, patients find it near impossible to speak accurately and confidently to how they were feeling and interacting with folks 11 weeks earlier, let alone being able to accurately describe activity seven days ago.

Beyond our non-scientific observations on the value of insight into patient lives, we were surprised to discover the true role and expectations of practice-based EMR solutions. Unrealistic expectations are increasingly causing providers to be disenchanted with their EHR systems, and it is clear that clinicians and business owners are open to parallel technology platforms that help drive patient-centric care. Beyond helping individuals, the importance of achieving meaningful use was top-of-mind as providers are beginning to embrace the reality of the outcomes-based healthcare economy as compared to the ‘old school’ fee-for service.

Despite both the excitement and frustrations of technology, our NatCon experience reaffirmed the industry-wide commitment of clinicians & caregivers to improving lives. There is something special about this community where patient-centric care really is needed to ensure the highest quality of outcomes, not only for the patient, but also the people who provide these treatments on a regular basis.

While this conference is barely past us, mehealth is looking forward to NatCon 2016 and the chance to gain further valuable insights as we attempt to provide meaningful and impactful tools that help define and shape the industry we admire so much.

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The Brand vs. Generic Medication Debate: What’s the Difference?


The Brand vs. Generic Medication Debate: What’s the Difference?

different meds

We recently shared a link to an article in The Hill in which Andrew Sperling explores an initiative from the Obama administration that would change the rules by which the Medicare Part D prescription drug program operates. If implemented, this change would cause the copayments for brand name drugs to double.

This move is clearly intended to encourage individuals, and their prescribing clinicians, to choose generic rather than branded drugs, which in turn is intended to reduce the cost of drugs to Medicare.

The article makes its case against this proposal, but the brand vs. generic drug issue is complex.

Generics can be just as effective

There is sufficient evidence to suggest that, in the majority of cases, the generic is just as effective as the brand drug and much cheaper as well.

Furthermore, if you start a new patient on a generic they will usually do fine (studies suggest they will respond just as well as if they were prescribed branded drugs).

Switching is more risky

However, when people are already established and stable on treatment, switching from brand to generic is more complicated.

We know that the “psyche” is very important in whether or not treatments work – groups of patients taking placebos in drug trials get better too, more than those subjects who take nothing and less than those who take the drug. So, if you switch people to what they may perceive as a “nasty cheap drug”, some of them will relapse. The consequences and care costs associated with the relapse need to be considered alongside the basic cost reduction that comes from switching to a generic.

Adherence is vital

The most important thing is that people take their medication.

Making treatment cheaper reduces the number of people who do not collect their prescription because they cannot afford to. Prescribing less costly generic drugs can improve adherence, as this study demonstrates:

It may not be a straight swap

Sometimes (but seemingly very rarely) there may be a chemical variation or issue with the quality of drug preparation, which means that the generic drug actually differs from the brand preparation. This article about a particular ADHD treatment describes such an issue:

It’s complicated

It’s essential to keep costs low, but we must guarantee that treatment is effective, and we must have a means of ensuring this.

The FDA must be vigilant in ensuring that generic drugs really are equivalent to their brand name alternates.

Clinicians must be vigilant in ensuring that each individual patient is responding, as desired, to their particular treatment. This means implementing and improving the regular monitoring of patients at all times, but particularly when new treatments regimens are prescribed or patients are switched from brand drugs to generics.

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