Goal of Holistic Care With Remote Monitoring and Telehealth Integration

Shyam B. Paryani, MD, MD, MHA, FACRO, FACHE, continues his conversation with Meagan Thistle, associate digital editor, Psych Congress Network, and further explains the connection between digital mental health, telehealth, and clinical intervention to keep patients healthy.

Remote monitoring takes a holistic view by integrating the mind-body connection and uses telehealth interventions to stay in touch with patients. While this technology will be useful for many areas of medicine, Dr Paryani hopes mental health clinicians will be able to gain a better understanding of their patients' sleep patterns, daily mood and anxiety levels, activity levels, and other aspects of health that impact mental health.

Watch Part 1: Remote Health Monitoring Gives Opportunity for Early Medical Intervention

Read the transcript:

Meagan Thistle, associate digital editor: Incredible. As you know, our audience is mainly mental health clinicians.

Shyam B. Paryani, MD, MS, MHA, FACRO, FACHE: Yes.

Thistle: How do you see in the future this technology impacting their practice?

Dr Paryani: Well, I think even now, one of the things we have a concern about is especially with COVID because there's been lack of social interaction and getting out and even contact with family members, right, because there were some restrictions on how you could maybe interact with your grandparents because you were perhaps a risk of transferring that disease to them who are a little more susceptible to complications. All of these have had great influence on our senior citizen population.

One of the things also we're going to study is we're going to study a baseline mental status of how they're doing. We're going to use 3 factors. The first is sleep pattern. We're going to monitor their sleep pattern with the device that we have. That's done automatically. They don't have to do anything different. They just have to go to sleep like they'd normally do and we'll be able to monitor a sleep pattern. If we detect a change in sleep pattern, that's usually an early signal that things are not right as far as their mental status. Other things can do that also, but that's also a good early warning sign.

Second is we're actually going to “daily” in the morning, we're going to do a check-in, and ask them to do a check-in on their mood, or anxiety level. You probably use these emojis with laughing faces or sad faces, so it'll be an easy thing. It's not like 20 questions where they have to complete anything. Most people won't do that after a while. All they have to is type on their emoji whether they feel good today or is a bad today when they wake up in the early in the morning how they think their day is, or how their mood is.

What we look for is changes, so if you have 5 smiley faces in a row, and then you have 3 in a row that are sad faces, we know something's happened that week, and maybe it's just an external event that doesn't really mean anything to them, like maybe Ukraine. We're all sad about what's going on, and perhaps we can't change that, but if it's something personal that's happening with them, then we need to have some intervention.

All of this is in an app on your phone, so we can actually call the patient on the phone and chat with them and say, "Hey, how come the last couple of days you haven't been feeling well? Is there something going on?" We can have an early intervention. Most people who have changes in their early mental status, so we're again doing early detection here, not treating yet the patients who already have mental illness at a more advanced level, to try to prevent that from happening and progressing so they don't get problems with depression or other mental problems.

The third thing we're going to look at also is activity level. We'll monitor the activity level during the day because of the wearable advice they have. Again, one of the other early signs is the activity level goes down. If you get depressed, if you're down, you tend to be less active.

Again, other things can do that, but they'll certainly be a trigger. If you see the three triad of a less activity level, of a sad emoji face, and sleep pattern altered, we know there's something going, and that we need to intervene here, and we can do early intervention to prevent any serious mental illness, or mental problems.

Thistle: Those interventions you're mentioning, how does telehealth, digital mental health, how does that integrate into what you're planning on in the study and in the future versus bringing the patient in for a visit? What does that look like?

Dr Paryani: That's a great question because again, we've got this integrated in our app. Early intervention, I believe, is the key here. Everyone's going to get a problem sometime, of some sort. As we get older, or even when they're younger, we get problems, so early intervention's the key.

All of this data is monitored 24/7 by a nurse in a central monitoring station. I think that is our differentiator. There's all this data out there. Meagan, do you have an Apple Watch that you use, or a-

Thistle: I have a Fitbit.

Dr Paryani:... Yeah, Fitbit, same. I have an Apple Watch. I'm a physician, so I know whether as data means, but I don't know what I'm doing with this data. Nobody's really monitoring and in a systematic way telling me what's going on with my life. Well, we're going to monitor all this data and tell you systematically what's going on with your life. That's the difference, it's being monitored.

When we see a difference, we actually contact you. How can we contact you? Easily. Because you've got your phone, a telehealth, a secure chat, a video chat is built into the app. It's sort of like using FaceTime, if you're familiar, or Zoom, but it's a secure one that you can talk with the nurse and the nurse will call you and say, "What's wrong? What do we need to do?" If there's an immediate intervention, obviously, we'll call a medical authority to intervene on that part. If it requires an appointment or more further follow-up, we'll arrange that right away, so you don't have to wait.

What happens, you think, if you don't feel well? You wait for your next doctor's appointment, right? You wait 3 months, maybe 2 months, or you call the doctor and say, "I'm not feeling well." "Well, I can't see you until next week." Well, what happens between this and next week? Well, you won't have that.

All you'll have to do, if you don't feel well, you can either push the button and talk to the nurse right away, or better yet, I bet you we're going to call you before you call us, so we'll be able to know before you even know that you need intervention. I believe telehealth in that regard will help us a lot.

Again, we can have a doctor get on telehealth. We can have a visit, a specialist. We have a whole network of physicians already affiliated with this program to do that, so we'll have comprehensive care available. Obviously, if you physically need to go get care, then we can also arrange that expediently, not have to wait weeks or months to get that care.

Thistle: Great. It sounds like this technology is going to move even past the senior population in your upcoming study. Digital mental health, digital health, telehealth, it's all, we all think, probably here to stay post-COVID-19 pandemic world, so how do you see this incredible technology really impacting the field at large?

Dr Paryani: I think we just touched the surface with telehealth. We know that it's a very useful tool. It's can be used, again, episodically in certain conditions. We're thinking it's going to be used comprehensively for the whole care of the entire patient, so no matter what happens, we can figure out what's wrong with you and provide an intervention that's appropriate for you, whether it's in the psychiatric area, psychology area, or the physical area, it's all connected, right? We're all connected, it's all part of the same body. We're trying to take a holistic care of the patient rather than a piecemeal care.

I think at telehealth, one of the issues has been, I believe, is how to even access it properly in that area. Accessing the specialist has been a little difficult, accessing mental health sometimes has been difficult, but we have a list to providers that we have access to in all areas of healthcare, so I think we'll be able to provide comprehensive care. I see that happening everywhere. This is a model for care for America. It's a model of care for the whole world, we believe, so we're trying to change the whole pattern of delivery of healthcare.

Thistle: Yeah, like I said, I'm really excited about this technology. I just wanted to say, is there anything else that we didn't touch on, or anything else from the study, or moving forward that you see that you'd like to tell the audience of clinicians?

Dr Paryani: I think I would like to end it with a little story. I think the story is about telling an analogy of a security system. Meagan, you have a home and you have a security system, or you normally have a security system, and you are monitoring your doors and windows and your furniture and your valuables, but what's the most valuable asset in your home?

Thistle: Me?

Dr Paryani: Yeah, you, you and your family, right?

Thistle: Yeah.

Dr Paryani: Who's monitoring them? Well, the monitoring systems, it's helping to protect you, but it's not really monitoring you or your health. This is taking it to that next level where we have a personal health monitoring for every person in America, or the whole world, I believe, so again, we're shifting the care from waiting till you get sick to get to the doctor, or the hospital, or the emergency room, to the point where we can tell you and predict that you're going to be having problems if you don't do something and we can give you an early warning.

Not only that, but we can provide the intervention for you right there and there. You don't have to wait or go anywhere. We can provide it on a telehealth basis initially.

Some people will require physical intervention, like going to the doctor, or maybe the emergency room for urgent things, but the majority of cases, we can provide care right there, and keep you well and keep you at home.

I'm hoping that this will change the delivery of healthcare in America from a focus on just taking care of ill patients to keeping everyone well, so hopefully, they don't even get to the hospital, or need the hospital.

Thistle: As you know, we are all so busy. Sometimes it's hard to really put ourselves first and get to the doctor. Like you said, will prevent things from happening and going awry, so I really think this is going to change the game. Thank you so much.

Really honored to sit with you and talk with you more about your upcoming study and the changing face of telehealth and digital mental health and all of those things, so thank you so much.

Dr Paryani: Well, my pleasure. I hope to invite you to get a follow-up on our study in the next few months as we get some data on the pilot study.

Thistle: Absolutely, yes. Everyone, keep an eye out. We'll definitely be following up and getting you more in the know about what happened in this study so that you can hopefully implement that into your practices. Thank you so much for joining us.

Dr Paryani: My pleasure. Thank you.