The Wisconsin health network prescribes apps through its Epic EHR to help patients successfully combat depression and anxiety.
Mental health conditions often are under-diagnosed and under-treated. Screening for conditions in the primary care space can be helpful for detecting struggles or concerns that patients may not immediately feel comfortable voicing, or that are important but not the main agenda item for the patient and clinician.
Data shows that at least 1 in 5 people has a diagnosable mental health condition. But in most cases, there is a mismatch between demand for services and their supply.
When the Froedtert & Medical College of Wisconsin Health Network instituted routine depression screenings, it knew that it needed to have options to help its providers meet the mental health needs of patients.
It had looked to SilverCloud as a major player in the digital mental health space, which provides a scalable way to help meet the demand for services, and could be used either as a primary strategy or as a supplement or bridge to in-person treatment by a specialist, said Dr. Bradley Crotty, chief digital engagement officer and an internist at Froedtert.
“As a clinical enterprise, we needed a way to manage the ordering, monitoring and data flows for our formulary of digital therapeutics,” Crotty explained. “SilverCloud represented our initial use-case. Clinicians wanted visibility into how their patients were progressing in the application. Technology from Xealth provides a way for clinicians to order and for patients to seamlessly be enrolled in the digital service; for clinicians to be able to view patient progress through their current workflows in the electronic health record; and for data to flow back to the Epic EHR.”
SilverCloud provided a way for patients to work toward improvement in terms of their mental health needs in a way that can be scalable, and to meet needs in the time/space that works best for the patient, Crotty said.
“Broadly, we needed to have a system-wide approach for managing our formulary of digital therapeutics,” he said. “Our requirements were to enable ordering and monitoring within the usual workflows for patients, to enable recommendations for clinicians to sort through and find the most appropriate tools based on the needs of patients, and to enable selected data to flow back for clinical care analytics.”
MEETING THE CHALLENGE
Clinicians currently can go to the digital health formulary, located directly within the Epic EHR, through the Xealth implementation to identify appropriate digital health tools and “prescribe” within the electronic health record. This enables the organization to curate and provide to clinicians with evidence-based tools and to monitor engagement and clinical results.
“We look at digital therapeutics as a way to help influence and nudge behavior, which we know, along with the social environment, to make up a majority of one’s health,” Crotty explained. “Pharmaceuticals influence biology. Medical devices influence physiology. Digital can influence behavior, and be there in the home or in the pocket of someone who is working toward improved mental health.”
Froedtert & Medical College of Wisconsin Health Network’s results were positive. 64.7% of patients with moderate symptoms registered for digital health. Of those with severe depression, 74.8% showed improvement and 59.3% experienced significant improvement. Of those with severe anxiety, 70% showed improvement and 58.9% experienced significant improvement.
“In our initial two years of the program, with those having moderate depression, for example, 54% showed a clinical improvement,” Crotty added. “With moderately severe depression, 57% showed clinical improvement. By ordering SilverCloud through Xealth, the care team was involved throughout, gaining deeper knowledge about program progression.”
Physicians had data for the first time about which patients followed through with enrolling in the program and information about the severity of their condition. Patients took comfort in knowing that their physician was involved in this course of treatment, which made them more likely to follow through with the program, Crotty noted.
ADVICE FOR OTHERS
“Think about the longer-term strategy of how these technologies fit into care, and into the lives of the users,” Crotty advised. “We paid a lot of attention to how we could get a sustainable way to work with innovative companies and solutions while integrating into the work that our care teams are doing.
“We also have a monitoring plan in advance for each technology, so that we can be aware of how patients are engaging with the tools, and if we need to switch from digital and self-directed or automated to a call or virtual visit from a care team member,” he concluded. “We structured our digital health efforts to include a virtual care team that is capable of taking the first contact or review off of the shoulders of busy clinics, and that has been an asset toward getting our clinicians on board.”