In the late ’90s, together with a retired general, a prominent attorney and several professors from the University of Hawaii College of Business, I became a partner in an IT startup, East-West Telehealth. Our vision, based on available technology, was that a physician specialist in an urban setting would peer into the screen of a powerful workstation and render advice not only to distant locations, but also into the home of those unable to present to clinic.
We also imagined offering telehealth services to busy executives through their office desktops.
Today, with smartphones that sport screens with retinal displays, Facebook, text messaging and Twitter, the potential for telehealth, rather "mobile health," has expanded exponentially. In recent years HMSA launched a program titled "On-line Care" in which patients can interact by phone and screen with their own physician or an on-call physician. Many electronic medical record systems offer a "patient portal" enabling a limited view of one’s own medical records and an opportunity to query a provider.
Consider the implications for psychiatric and psychological services. Historically, psychotherapy always meant that patient and therapist sat together in an office and interacted face to face. That business model is changing. Psychiatrists and psychologists are increasingly using electronic communications, including videoconferencing and Internet telephonic applications, to provide psychotherapy to their clients. Patients can access smartphone applications that follow mood changes, remind them to take medications and track completion of psychotherapeutic homework assignments.
A local psychologist recently remarked, "I used Skype to provide therapy to my patient who had to travel to Brazil for a family emergency. I am planning sessions with another patient — via Skype — who is moving to Los Angeles. The potential is great. Both patients paid cash for this service because we were unclear as to the reimbursement policies of HMSA and other carriers. I anticipate this type of practice will grow."
How well do these technology-based interventions work? Research assessing the effectiveness of videoconferencing in the Veterans Health Administration demonstrated that videoconferencing is just as effective as face-to-face therapy. In fact, there may be situations in which videoconferencing is more beneficial. Consider an individual undergoing treatment for compulsive hoarding. Without having to visit the client’s home or workplace, the mental health provider is able to view the physical environment: "Let me see the sink, please," or "Are you able to point the camera under your bed?"
Cognitive-behavioral therapy (CBT) is based on the idea that our thought patterns cause our feelings and behaviors, more than external factors such as people, situations and events. Psychotherapists support their clients to identify and alter specific triggers that might result, for example, in a panic attack, compulsive eating or a depressed mood. One large clinical trial used secure instant messaging to provide cognitive behavioral therapy, and demonstrated significantly better results than those achieved by general practitioners treating depression.
Nevertheless, another psychologist warned that "mobile intervention, while at times beneficial, can also mirror a state of human disconnection that threatens to break down family and community in an overly technological world. I worry that this could become one more diversion that contributes to the estrangement human beings can feel from one another."
Each year, almost 9 percent of Americans experience mood disorders, and 18 percent struggle with anxiety. Mobile technologies offer tremendous potential to address these far-reaching treatment needs. Today, so many of us have smart technologies at our fingertips. Estimates are that one-half of the population will be using smartphones by the end of 2011, albeit weighted disproportionally to middle- and upper-income users. If used appropriately, there is a tremendous opportunity to leverage technology to empower mobile health care and expand available services in a time-efficient, cost-effective manner.