Jun 19, 2024
00:00:00
You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone.
00:00:11
David
My name's David. I'm the chairman of Oracle Health. And before I
introduce this esteemed panel, there's a few patients that I've
cared for, and I'm a child psychiatrist that have just stuck with
me. And for a lot of reasons. Well, I actually feel like for
whatever long I've been in this 30 plus years, I'm just trying to
make it better for these patients and their families.
00:00:34
David
So let me describe them. And I think it really sets the stage for
the role of technology in mental health. Okay. This little girl in
third grade at the local school where my kids actually went to
school writes in her haiku poem that she wants to commit suicide.
And this is pre cell phone guys pre technology. The teacher reads
the haiku poem and tells the prince at home that night tells the
principal.
00:01:01
David
The next morning, the principal then calls the mother at home. And
then this is L.A. And because they knew people, they were able to
get in to see me in three weeks. And I was like, my God, if my kid
was suicidal, it doesn't matter who, you know, you got to be seen
today, right? I didn't know this word, but I know.
00:01:22
David
And now I'm going to fix access. I mean, that's what we use is this
term access to me is my kid is suicidal and I'm calling an 800
number and my insurance doesn't cover it or I got to pull strings
and God forbid I'm from the other side of the tracks where I don't
know anyone. I will never get it like.
00:01:40
David
So how can technology help there? Right now, I think what we're
supposed to talk about, too, is the negative part of technology,
right? I'm stuck on my phone. I'm not I'm not socializing. I'm, you
know, we all go to dinner and we're like this instead of actually
being together. So why don't we go down the line and introduce
yourselves?
00:02:03
Michelle
Okay, everybody, I'm Michel Patrick Quinn, and I'm a psychologist
and a child psychologist, and I'm director of research at the
Menninger Clinic and an associate professor at Baylor College of
Medicine. I'm excited for this conversation. The Menninger Clinic
is really known for humane treatment of mental illness. We are
historic, known as an inpatient psychiatric hospital and really
revolutionary and something called the therapeutic milieu.
00:02:30
Michelle
And so kind of actively intervene and doing psychotherapy while
someone is inpatient. So it's not a passive intervention. And it's
really just remarkable. We still hold on to that kind of
psychotherapy within an inpatient context.
00:02:47
Tracy
I am Tracy Neal Walden. I'm a clinical health psychologist. I work
for I'm the chief clinical officer for Coimbatore and Network.
We're a network of mental health clinics across the US. We have
clinics in 16 states covering, supporting 25 states. So and that's
because of telehealth. So we utilize we don't do solely telehealth,
but we've been able to utilize telehealth in order to expand our
reach across the US.
00:03:18
Tracy
I'm also a veteran of the United States Air Force. I served for 24
years and served as a psychologist during that time in the Air
Force as well. We serve not only the veteran but the veteran's
family members. As a veteran, myself, my family doesn't have access
to care in the VA, and that's no fault of the VA.
00:03:37
Tracy
It's the way the system is set up. And so we're able to reach and
provide those resources to families and in a much shorter time
period, especially due to the advances that we're going to be
talking about now with technology,
00:03:53
Danny
Thank you and so I'm Danny Gladden. I'm the director of behavioral
health and social care for Oracle.
00:03:59
Danny
Happy to be the social worker on the stage. And I really proud to
work with just a whole group of social workers in the delivery of
mental health services and all the great work social workers
do.
00:04:11
David
Today, what in your organizations is happening from a technological
standpoint that you think is improving access, improving quality,
democratizing care, making care more affordable, more culturally
sensitive, helping with, you know, inequities that we know that are
in care? What are you doing to harness technology that's actually
helping individuals, patients, families, communities? Sorry, go for
it.
00:04:34
Michelle
Yeah. So it's not really revolutionary in any way, but we use iPads
and research assistants and collect outcomes data across our whole
hospital and with inpatients in outpatients, outpatients, it's
pretty standard. People are able to complete, you know, outcomes,
measure, self-report, inpatient. It gets more complicated. And we
have to we have to guide people, help people. Some good times,
people resist, don't want to do it, and that's fine.
00:05:00
Michelle
They don't do it. But that to me is the foundation, right? So if
you collect outcomes data that gives people a voice in their
treatment, particularly on inpatient. So our inpatient units are
locked units, you have reduced someone's on autonomy when you
measure how they're doing, from their perspective, it gives them
some control back. And I think that is one of the most powerful
things that we can do is give people control back through data and
measuring these things and measuring the change over time.
00:05:32
Michelle
Whether it's positive or negative. And technology allows us to do
that. So many of our patients want to use the iPad, and then we
visualized the data in graphs that are provided to the treatment
team through our electronic health record. And so that gives data
driven feedback that the treatment teams can actually provide to
the patients at the patient level.
00:05:50
Michelle
We also use it for research to understand like aggregate results,
what's working for who and what's not. But I think, you know, I'm
biased, I'm director of research, so I love data. I'm the PI over
our outcomes. But I think that's tremendous. And we can advocate
for better inpatient environments, better inpatient care, better
inpatient outcome.
00:06:12
David
Can you? I think it's a great example. First of all, the simplicity
of it is sometimes to make things simple. It's really hard and so
this is great. Can you give an example of something you've done
based on the data to change how care is delivered?
00:06:23
Michelle
Yes. So well, something we're working on right now, all of our
results are lining up really around the role of sleep. One thing we
are constantly thinking about is suicide risk with inpatient, and
particularly suicide risk post-discharge for those of you who may
not know post-discharge from inpatient is the highest risk period
for suicide. Over and above any other time in someone's life and
also relapse.
00:06:52
Michelle
So post in our highest level of care. And to us that is incredibly
concerning. So we have been really thinking about the role of sleep
as well as other measures and look at longitudinally outcomes while
someone's inpatient what is predicting suicide risk and we have a
paper that we published, we showed it is sleep over and above
everything else that you can put in the model.
00:07:16
David
And you measure using our rings and things like that or how are
you.
00:07:18
Michelle
Not yet. We are now because it is so important and we've now
designed our own like API and with wearables to replace things that
we do in inpatient that actually disrupt sleep. So like you, 15
checks and these checks. So there's checks done on inpatient to
ensure someone's safety and sound checks. And these are often
pretty disruptive. We have data now from active Griffey that we've
lined up with the checks in about 75% of those checks.
00:07:48
Michelle
So someone going in their room, usually a stranger that they do not
know, opens the door, sometimes shines a flashlight in their face
to make sure that they're breathing and that they're asleep. Or if
they're not asleep, they'll ask them to raise their hand. And so
and for us at our hospital, it's every 15 minutes that happens.
That equals about 36 times a night.
00:08:06
Michelle
Someone comes in their room. So we've designed our own kind of
in-house homegrown system to replace that. And that is one and it's
just one thing that, like we always say, you know, when technology
is, you know, going to take over and ruin people's privacy, things
like that. But in that situation, it improves people's privacy.
People can sleep and be and have intact sleep.
00:08:29
Michelle
Great. So it's that and that has just that's one of our favorite
examples. Right. Just kind of generic outcomes data into a new
intervention that leverages technology that improves some of these
outcomes. Hopefully in the end we're still working on it, but so
cool.
00:08:46
Tracy
Yeah. I think it's really interesting what Michelle just discussed
in terms of outcomes because we do measurement based care for all
of our clients. So we measure their, their symptoms at every
session and we do that via iPad. If they come into the clinic or we
push it out electronically for those who are being seen for via
telehealth.
00:09:10
Tracy
And one thing that we found is that we actually we want to take a
look at how effective is telehealth, because many people say it's
not effective. You know, prior to the pandemic, people were very
skeptical. And we actually use this data and we have a research
institute that's part of our and veterans network. And within the
institute, they reviewed the data recently and we found clinically
significant change in Q nine scores is for depressed individuals
and for those with PTSD, a clinically significant change in their
PCL.
00:09:50
Tracy
So these are the measures that are the standard measures given for
those populations. And not only did we find clinically significant
change, but we also found that those individuals were in remission.
That's one of the things that I love about technology. It allows us
to get those additional data insights. We rolled out telehealth in
2018, so before the pandemic, and we did it to improve access and
not just access due to long wait, but to decrease no shows in to
improve that accessibility for clients who were already in
care.
00:10:29
Tracy
I remember a few years ago I had a client and we would advertise in
our clinic. We had rolling slides that would tell about the
different things that we offered, and we had a slide that talked
about telehealth and it said, Ask your clinician if you'd like to
know more about it. And my client came in that day and said, Hey,
would I be a candidate for telehealth because I fall asleep on the
drive home from here and I was like, Yes, you being silly.
00:10:59
Tracy
And that's also the beauty of telehealth, because it also it allows
you to oftentimes squeeze additional appointments in if someone
knows shows and it helps to prevent no shows, too, because
oftentimes some people like to come in, they will they like to come
in and see their clinician face to face, which is great. But
sometimes life gets in the way.
00:11:23
Tracy
And so if someone calls to say, hey, I'm going to be late, then we
say, Would you like to convert that to a telehealth appointment so
that they don't have to miss that appointment?
00:11:34
David
Okay, Danny, take us home on that wonders of technology. Yeah. Then
we're going to flip it.
00:11:39
Danny
We're going to flip it. Okay, Well, so. So for Oracle, we build
tools. We build tools to ensure that the work that providers are
doing with consumers of care have what they need to sort of ensure
that that, you know, the clinical experience checks the box so
that, you know, the 15 minute check that Michelle was mentioning is
something that happens in our tools and the screening and the
screening that happens in our tools.
00:12:05
Danny
We've embedded in the workflow for nurses, for oncologists, for the
ED attending. We've embedded in the workflow a suicide screening
tools and, and then and then alerts so that if someone is at risk,
it's not just one person who's aware, but the entire treatment team
can have this ability face up to this type of information. And so
we sort of want to help folks use digital tools to be able to track
patient information, to be able to get folks get folks in
quicker.
00:12:37
Danny
But I think beyond that, the beauty of technology in general is
there's an opportunity to tell a fuller story, you know, through
wearables, through some of the cognitive behavioral interventions,
the digital therapeutics. It just really provides a variety of
different types of modalities for consumers of care to be able to
sort of deliver inputs about their experience.
00:13:02
Danny
You know, if I have to get in the car, drive to a clinic to see
Michelle in person, I'm putting on a mask. And all you really know
about this individual is probably what happened an hour or two
before they got to you. Like it's the stress of the moment using
wearables, using sort of digital inputs throughout the week in
between sessions, I'm able to I'm able to sort of have a more
holistic picture of what your week looked like.
00:13:31
Danny
And because you're doing the session in your own home, you don't
have to put on a mask. It is more intimate. And I'm able to, as the
provider, just have a more holistic picture of what I'm working
with. Okay.
00:13:45
Tracy
Can I add one more thing?
00:13:46
David
You could add ten more things.
00:13:47
Tracy
It gives you more accurate information. You know, as I was thinking
about what you were saying, Danny, about the technology and you,
Michelle, when you were talking about sleep, sleep is one of the
number one concerns within mental health. People may come in with
issues such as depression, anxiety, PTSD, but there's usually an
underlying sleep problem. And as a health psychologist, I love to
treat sleep, but clients history directly underrepresented the
amount of sleep that they actually get.
00:14:19
Tracy
And by using something like a wearable, a watch or a ring, you get
that accurate data that then you can immediately share with them or
they can see it immediately themselves.
00:14:32
Michelle
I completely, completely agree with Tracy and Danny, and I think
the beauty of the data when we talk about outcomes data,
self-reported data, those data are collected, you know, every week.
So you have huge gaps in the information that you are getting about
somebody's experience. You know, our emotions can change within
seconds. You know, there's a you know, can be a traumatic event
happen or just a, you know, an argument with someone.
00:15:01
Michelle
So our lives and our emotions behaviors are very dynamic and our
outcome measures and the data that we have now is why I love
wearables. And I've always loved wearables, psycho physiology,
because it fills a tremendous gap in our ability to measure the
dynamic fluctuations and the way our emotions and behaviors change.
That is so important, I think, for understanding the ultimate
outcome and just that that the kind of higher temporal resolution
of the data is something we don't have now in practice.
00:15:36
Michelle
There's such a research to practice gap there that I think
technology will certainly fill in and also has the potential. And
one reason I love the wearables, because it really demonstrates
that it's not all in your head. Yes, too, when you do a self
report, that is your perception, right, of how you feel in and with
the wearables, too, it gives an objective marker for the first time
in vivo in the situation to show, Hey, I'm really experiencing
this, this is real, this is how I'm inside.
00:16:11
Danny
Yeah. And I think about this just real quick. Like in our.
00:16:14
David
Now we’re cooking.
00:16:14
Danny
Yeah, I mean, well, in our discipline historically, you know, we
don't we don't get access to labs, We don't get access to some, you
know, some good radiology scan. We find out something about someone
by asking a bunch of really nosy and intrusive questions by
observation or someone has sort of engaged, you know, has had a
crisis in their, you know, the courts or corrections or a probation
and it is point in time, like, how many times do you start a
session where, you know, how have you been since I saw you,fine,
right.
00:16:49
Danny
I mean, and that's sort of the starting point. So the ability to
have real time inputs, the seven or the 14 days in between the
times of seeing each other it just enriches the clinical experience
so much.
00:17:03
David
We're flipping gears. What are your concerns around tech not
helping us, tech distracting us from human connection?
00:17:14
Danny
I'll start us here. And so, you know, I, I still see I still see a
few clients from time to time. I particularly enjoy working with
adolescents and sort of the narrative from adolescence in the
stories they sort of come up with in their mind about the world
around them is really quite distorted, you know, based on the
stories they get from social media.
00:17:40
Danny
And I'm not talking about sort of what fake news, which is its own
lane, but sort of the attitude that, you know, folks around me are
just having a much better experience than I am. And what we all
know is that there's likely all of it is inflated a little bit or a
lot of it.
00:17:59
Danny
Right. And so we know this. We know that the data on sort of
overuse of social media and the link to depression and anxiety in
young people is real. What we are seeing, though, is that
transition, you know, it's not. So if I'm down, I'm feeling bad
about myself. I'm now starting to engage in, you know, in ways to
numb that pain.
00:18:25
Danny
And that's, you know, through self-harm, through self-injury. It's,
you know, through alcohol use or other substances or it's sort of
engaging in relationships that are unhealthy. So I'm really I'm
from the adolescents that I get to work with. I'm really concerned
about that. On the other side, the part that concerns me about tech
is, is I mean, we've just sat here and talked about all of the
benefits that technology can bring, the access, the data, physio,
bio physiology data.
00:18:55
Danny
But the problem is there are people left behind, there are people
left behind in the in the most remote parts of Alaska. There are
there are folks that are left behind within a, you know, a mile
radius around here. And so, you know, we have to ensure that that
the tools that are created impact and benefit all of the
people.
00:19:19
Danny
And you know, so I think tech access, tech literacy, all are
concerning to me as so much of our particular discipline moves into
the tech space.
00:19:30
Michelle
I'll kind of jump off from there. You know, I think when, you know,
I'm not in the tech space, but I love technology. But I think
technology does such a good job with some of these data privacy
issues, and they do a lot in terms of the technicalities of how
things are going to work with the interface. Looks like is are
there protections in place, right, that safety is built in?
00:19:54
Michelle
I think one thing that is forgotten, though, and, you know, I don't
know if we even knew that was going to be a consequence is no one
was testing the psychological safety of these technologies,
especially when it comes to social media. Right. As we, you know,
are kind of zooming forward with technology. There's all these, you
know, kind of ethical safety guidelines, American Psychological
Association.
00:20:18
Michelle
These are really good job at starting to think about the
psychological safety. What are the psychological kind of safety
parameters that we need to test as we develop new technologies? But
also then how do we put the guardrails up on the things that are
here now?
00:20:35
David
Tell me other things that concern you about technology and mental
health.
00:20:39
Tracy
I actually have another thing, and I'm going to shift it a little
bit. I get concerned from the clinician perspective because we've
technology has really helped us. We instead of, you know, giving a
and I remember when we gave out the paper and pencil measures to
our clients when they came in to the door, you had to wait for them
to finish it.
00:21:01
Tracy
But the good thing about that is when they did, then I immediately
had it. I reviewed the scores. Now measures are sent to us, you
know, automatically, and then they go into our system. And so you
really have to train the clinicians to utilize that data and not
just have the client submit their data without it being
utilized.
00:21:29
Tracy
Someone could submit data that could indicate that their risk
status has changed. And if it's not being looked at, that's a huge
concern. We're also looking at ways to help clinicians with
documentation. However, a concern that I have with that too, is
that, you know, if you're using AI to do your documentation, there
could potentially be errors. And so we have to train our clinicians
to properly utilize these wonderful technologies so that they can
use them effectively.
00:22:03
David
Yeah, we're working really hard on that. I think we've got good
stuff coming out.
00:22:08
Danny
Well, yeah, and, and actually so big because we don't have labs and
radiology scan to sort of show a paper. Here's the evidence for the
diagnosis. Our word, our discipline is very narrative rich. And you
know, just to be able to sort of either get a prior authorization
for service or to be able to continue service. And so we have a
clinician burnout issue because of the administrative burden, the
documentation burden.
00:22:36
Danny
And, you know, so that's and the tech just facilitates that. But I
do think is exciting, you know, ambient genitive AI and ambient for
documentation. Our little our slice of the pie has been carved out
and I'm so excited. And, you know, so Microsoft has gone there's
some other startups out there that got Oracle's working on its tool
that will really shift the burden away from documentation.
00:23:04
Danny
I think it's going to be a game changer.
00:23:06
David
Great gratitude to all of you folks, and thank you for
participating. Thank you.
00:23:11
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