Barriers and Misconceptions to Digital Therapeutic Integration

While digital therapeutics hold much promise as a virtual tool to aid in mental health treatment, integrating them into telehealth practice can be challenging.

In this video, Steven Chan, MD, MBA, FAPA, FAMIA, Psych Congress Steering Committee, explains some of the barriers that virtual clinicians should anticipate when weighing digital therapeutic options for major depressive disorder (MDD) treatment.

Don’t miss these other telehealth insights from Dr Chan:

>>Tapping into Neuroplasticity Through Digital Therapeutics for MDD

>>An Introduction to Artificial Intelligence for Telepsychiatry

>>The Fundamentals of Digital Psychiatry for Telehealth Providers

For more expert insights for your virtual practice, visit the Telehealth Excellence Forum right here on Psych Congress Network.

Read the Transcript

Psych Congress Network: What are some if the barriers to integrating digital therapeutics into clinical practice for the treatment of major depressive disorder? How can they be addressed?

Steven Chan, MD, MBA, FAPA, FAMIA: When it comes to thinking about some of the barriers for digital therapeutics, here are a couple of things to keep in mind. Who are the users? Well, the users are the patient and the clinician. Those are the two primary users.

Here are the things that may be barriers for patients. First off, they may have something called the digital divide. The digital divide is where they may not have the ability or the understanding to engage with the technology. They may not have access to the technology, they may not have access to the subscriptions to power the technology. By subscriptions we mean things like a fast broadband internet connection. They may not have all the tools that you'd want them to have. Maybe a headset or a really sharp webcam. Those are some of the things they think about. So those are more logistics.

When it comes to the apps, I think about the APA app evaluation model. So this is a model that some colleagues and I came up with at the American Psychiatric Association that talks about all the things that should go into a good mobile health app. One of the things can be price. Are they able to afford the app? Some digital therapeutics run hundreds of dollars for a couple months’ worth of subscription, and some of the other obstacles could be, do they have the right phone type? Do they have any concerns about privacy and security? Ease of use is probably the biggest one. If they are finding it cumbersome to use or it's not up to date with the latest design standards, like any modern app, they may not find it palatable to use. Just like any sort of medication with sort of off tastes.

When it comes to the clinicians, some of the barriers that they face are, well, do they have enough time during a very limited visit to actually talk about or teach about digital therapeutics? Or how to engage with any technologies to begin with. And do they have the ability for their own technology support teams to support these therapies and the apps?

One of the biggest barriers can be ordering or referring or installing the apps. We've had questions come in my talks where clinicians would come up and say, "How do I install this app?" There are so many different ways because there's no single pathway for one to get a digital therapeutic. It could be a code, it could be a medication-style order, it could also be a durable medical equipment style order. So, there are many different pathways, but I think that also means that we all need to learn about all the different resources, just like we would if we wanted to learn about how to refer someone to a specific social service or to another department. These are all the nuances we all need to learn about.

Finally, I think one of the biggest challenges can be data interoperability. What is interoperability? Well, it is essentially things that can operate in different environments. One of my favorite analogies is that when I buy software for my Android phone, well, I then changed over to an iPhone. All that software I bought doesn't work with the iPhone. In fact, a lot of these times the software don't talk to each other between phones. Same thing if you buy a video game and you buy it for an Xbox, that doesn't work for a PlayStation. Same thing here with these apps.

A lot of times the data just doesn't get transferred into the electronic health record system, and it makes it frustrating for all involved. So one of the things to think about is would this app or digital therapeutic integrate with the EMR? Or are there any workarounds that could allow you to still document your patient's progress? So those are some of the barriers I can think about.

PCN: What are some of the misconceptions about using digital therapeutics in pscyhiatric practice that you'd like to address?

Dr Chan: One of the biggest misconceptions with people who don't want to change, like the providers who are in the psychiatric community, is that they don't want to adopt new technologies. I think that we are perfectly willing to adopt new technologies if it actually has good outcomes and it's usable. We see that with digital therapeutics there are a lot of mental health apps that are being adopted.

A perfect example would be the Veterans Affairs. The VA has a lot of excellent resources and a lot of excellent apps that can be used in-house. And we're seeing this in a lot of other health systems too. I can imagine Stanford has their own pam.stanford.edu and these are all tools that can be adopted quite readily. But as we talked about, there are a lot of different barriers to adopting technologies, but these are all things that we can overcome if we design these correctly. They're developed with a lot of clinician and patient needs in mind.

Steven Chan, MD, MBA, FAPA, FAMIA, is a member of Stanford Psychiatry’s TechHub Leadership Committee, faculty with the Stanford Addiction Medicine Fellowship, and a clinical educator caring for patients with substance use disorders (SUD) and addictions. Dr Chan is a clinical informaticist, addiction medicine physician, and psychiatrist. He is a clinical associate professor affiliated with the Stanford University School of Medicine, and Immediate Past Chair of the Committee on Innovation at the American Psychiatric Association. He serves on the Board of Directors at Mental Health America. Dr. Chan is a sought-after national speaker whose ideas, thoughts, and research have been featured at Google headquarters, JAMA, Telemedicine and e-Health, JMIR, Wired, PBS, and NPR Ideastream. He serves as Chief Technology Officer and co-founder of AsyncHealth — a University of California-backed digital mental health startup supported by Berkeley SkyDeck PAD-13 and the National Science Foundation Innovation Corps (NSF i-Corps) — and writes at both @stevenchanMD and @mpowerhacks.