Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
I don't want to cut short any discussion on my last couple involuntary treatment posts, but I wanted to let people know we've got a new Shrink Rap News column up over on Clinical Psychiatry News. My titles over there tend to run on the wordy side, but it's called "RAND Report Signals Threat to Patient Privacy." It's about a recently published think tank report discussing the state of the art of current digital surveillance sources, how they can be analyzed and interpreted and potential applications in national security systems. It's relevant to Shrink Rap because one of the sources they mention----quite transiently and in passing, but it's there----is medical information. And once a person is identified through this Big Data analysis, the report suggests they could be arrested, put under surveillance or taken in for interrogation. Whoa, there's one application of an EMR I never anticipated!
To my knowledge none of this is happening yet, but five years ago I never expected we'd ever hear about anything like PRISM. Go over and read.
Meanwhile, over on KevinMD today there's a similar post by T. J. Derham entitled "How Edward Snowden and PRISM affect health care social media" in which he encourages doctors to still be involved in social media and health care IT systems in spite of PRISM. I'm not sure I'm totally sold on the argument. I want Roy to think about this and put up a Shrink Rap News post pro- or con. Read the KevinMD post here.
I'm going to have to invent new Blogger labels for posts like this now. What should they be? #nsa? #blackchopper? #dontquestionmebro?
This is the question that the Bipolar Collaborative is asking, using its WhatsMyM3 screening tool [PubMed]. “Many other illnesses have a 'number' that one can track – cholesterol, high blood pressure, diabetes. What’s the number for mental health?” asks Michael Byer, president of M3 Information, based in Bethesda, Md.
Today's USA Today newspaper ran a story titled, "Screening for mental illness? Yes, there's an app for that," by Michelle Healy.
WhatsMyM3 is a validated, 3-minute tool that screens for symptoms of depression, bipolar disorder, PTSD, and anxiety, and can be used to monitor changes in symptom severity over time.
One of the developers, Michael Byer, approached me about a year ago for my opinions on development and use of the screening tool. Disclosure: After reviewing the research and seeing how useful it is, I have become more involved in the organization, becoming an adviser to the group that was started nearly ten years ago by past NIMH chief, Robert Post MD. (listen to podcast #63)
It differs from other mental health screening tools, such as the PHQ-9 and the MDQ, in that these are all unidimensional -- they only measure one domain of symptoms. The M3 is multidimensional, measuring four areas of symptoms. Furthermore, when compared to results from the standardized interview tool, the Mini International Neuropsychiatric Interview (the MINI measures for 15 different mental illness diagnoses), WhatsMyM3 provides a total mental health score that is 83% sensitive in finding true positives and 76% specific in finding true negatives. In addition to the total score, there are four subscores, one each for depression, bipolar, PTSD, and anxiety.
Put another way, the negative predictive value of the total score is 89%, meaning that if you score under the threshold, there is an 89% chance that you do not have any mental health diagnosis by the MINI. As with most screening tests, you want the negative predictive value to be high so that you don't have to subject the "negatives" to more specific testing. The positive predictive value, or PPV, is generally lower for screening tests. It is 65% for WhatsMyM3, meaning that if you score positive (total score >= 33 and positive for functional impairment), the odds of you having a diagnosis is almost two-thirds. A clinical evaluation can then help to determine if you do have a diagnosis. (Note: this tool cannot give you a diagnosis; it can only describe your relative risk of having, or not, a diagnosis.)
What people have found to be most helpful is using WhatsMyM3 to monitor their symptoms over time once they do have a diagnosis. This can be done for free on the website, or for $2.99 using the iPad or iPhone apps, or the Android app. For mental health clinicians, they can download the free M3Clinician iPad app and then screen their own patients. For about a dollar per screen, they can register their patients who want to track their symptoms over time and share their scores with the clinician. Primary care providers also purchase screens, and can even obtain insurance reimbursement by billing for an annual health risk assessment. The patient reports can be viewed by logging into m3clinician.com.
A sample report for a fake patient can be viewed here.
I think this sort of tool, or app, is exactly the sort of mHealth thing that empowers consumers to better manage and become engaged in their health care needs. This is happening in other areas, like diabetes, heart disease, and obesity. Mental health is also making great strides in mHealth.
I should also point out here that the folks at M3 Information were the only ones to take us up on our offer of a free "advertisement" on Shrink Rap in return for donating at least $200 to our NAMIWalk for Mental Health Month (we don't typically accept display ads). A logo ad will be running soon on Shrink Rap soon for two weeks in recognition of their charitable donations. It will look like this and link to the iPhone and Droid apps. [We received no money ourselves from M3 nor from NAMI. We've never accepted any money from Pharma companies, nor does M3.]
Today's blog post can be found over on Shrink Rap News on our Clinical Psychiatry News site.
In it, I talk about why psychiatry is the best medical specialty : ~ ) and I reveal the results of a question we asked to Maryland psychiatrists: “Overall, are you satisfied with your career as a clinical psychiatrist?”
So what percentage of respondents do you think said "Yes, I find my work rewarding and would chose this career again?" Take a guess, then click over to Shrink Rap Newsand find out the answer! The article is entitled "Would You Do It Again? Psychiatrists and Career Satisfaction."
In case you missed it, Roy also has a post up from last week on Health Insurance Exchanges and Accurate Provider Directories. If you've ever tried to find an In-Network doc, only to discover that everyone listed on the insurance company website is now 6 feet under, you may want to read this. Ooooh...it's going to annoy Roy that I fooled with the color scheme. [fixed it. ~Roy]
I participate in a committee that establishes policies for our state's health information exchange (HIE). The HIE is the electronic infrastructure that permits hospitals, physician groups, labs, imaging companies, pharmacies, and others to share information about patients. The idea behind the sharing is to make it easier for your primary care doctor to share your health data (ideally, with your permission) with your cardiologist and your dermatologist. The potential benefits to this sharing include:
quicker exchange of information than with faxing or mailing
less likely for papers to get misfiled or lost (eg, think Hurricane Katrina)
better tracking of who accessed what information
less duplication of tests ("I know you had a CAT scan at the other hospital last week but I can't wait for the results to be sent to me so I'm getting another one.")
improved coordination of care
fewer medical errors due to more information available
decreased liability due to sharing of important information with other providers
The potential risks include:
decreased privacy due to potential for data breach, identity theft
loss of data due to technical problems (viruses, hardware failure, etc)
failure to secure data due to inadequate authentication, authorization, encryption, etc
more errors in health record due to automated data collection processes
increased liability due to sharing of sensitive information with other providers
I wanted to talk briefly about this notion of "sensitive health information." Our committee has spent many hours discussing what this might mean and how to define it. One view is that all health information should be treated as "sensitive," while another is that only certain categories of health information, such as mental illness, substance abuse, HIV status, domestic violence, abortion history, and genetic data, should be treated with additional safeguards against inadvertent access or disclosure. This latter viewpoint promotes the stigma about mental illness that we have been trying to erase. It wasn't so long ago that epilepsy and cancer might have been on this list. My viewpoint is that patients should be the one to decide which elements of their health information should be treated with extra precautions and which should be considered routine.
This was ultimately agreed upon by the other committee members, but it still didn't help us much because the technology for patients to review their health information and mark which bits should be tagged as sensitive is not yet built into nearly any of the electronic health record products or the HIE systems. There is no standard for doing so nor is there even any agreement about how or whether it should be done. Groups like healthdatarights.org and speakflower.org have promoted these ideals, but we are not much closer to achieving them.
Anyway, I discussed this topic in my Shrink Rap News blog post this week over on Clinical Psychiatry News. Read more about it over there. If you are a psychiatrist, log in or register on CPN and join the discussion (my mistake -- other professionals and also consumers are allowed to register over there).
Today (Tue Jan 26) at 12:00 noon Eastern Time, Gregg Masters (@2healthguru) will be interviewing Dirk Stanley, Tim Sturgill, and me about Flower on BlogTalkRadio. Flower promulgates the message that we should control our health data and have universal standards for sharing it.
Here's the blurb about it that Gregg wrote for the hour-long live show on BlogTalkRadio:
What is flower? At this time it’s an abstraction — a placeholder for several concepts centering on what would healthcare look like if....? And, more specifically what would personal health information (PHI) look like if....? A flower was chosen as the abstraction because it is easily and universally understood, regardless of language, anywhere in the world — a flower is a flower. Where a flower is flower carries the additional abstraction that there is a common ground — characterized by property and implementation. While a fluid and dynamic idea, this informed panel will provide both history and context for its genesis and diverse unfolding narrative. Join Dirk Stanley MD, @dirkstanley, http://twitter.com/dirkStanley, Tim Sturgil MD, @symtym, http://twitter.com/symtym, and Steven Daviss MD, @HITshrink, http://twitter.com/hitshrink, as we discuss Flower's granularity and transformational potential to make sense of a complex and moving target: informatics, health care and the patient. For additional context and insights on 'Speak Flower' see: http://speakflower.org/, and the threaded discussion on Howard J Luks, MD, blog: http://hjluks.posterous.com/thinking-about-flower-a-concept-is-born-hcflo
