The digital clinic: Implementing technology and augmenting care for mental health

Abstract

Increasing both access to and quality of mental healthcare is a global priority. One solution is to integrate technologies such as smartphone apps and sensors directly into care. Acknowledging many prior attempts and barriers, we introduce the Digital Clinic which is an already functioning clinic using smartphone apps to augment and extend care today at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts. In this piece, we outline the theoretical foundation of the Digital Clinic and its emphasis on the therapeutic alliance, measurement-based care, and shared decision making. We explore both workflow and engagement challenges as well as solutions including a new care team member, the Digital Navigator, and the customization of technology. Acknowledging that the Digital Clinic is an evolving program, we offer details on our implementation in order to allow others to replicate, expand on, and improve these initial efforts.

Keywords: Digital clinic; Digital phenotyping; Individualized interventions; Mental health; Program model; Therapeutic alliance.

Fig. 1

The mindLAMP (Learn – Assess – Manage – Prevent) app can be customized to track symptoms and activity, collect data, and offer mindfulness resources. It is also possible to use a tool box of several independent apps to serve each of these features.

Fig. 2

The mindLAMP platform includes a visual representation of the patient's care team. The role of technology in capturing data as well as offering learning and interventions is also highlighted, as are at least three areas where a digital navigator is able to offer assistance.

Fig. 3

Quality improvement dashboards are accessible to the clinical team. Because of the custom nature of each patient's care, no two dashboards will be collecting the exact same types of outcomes data. Thus, as outlined in Table 2, it is important to have a standardized battery to ensure digital clinic metrics and overall outcomes can be tracked.

Fig. 4

The logic model details the foundation, objectives, and long term goals of the digital clinic.