Dialogue is crucial for digitalization of mental health care

Waiting lists, staff shortages, exploding demand for care, administrative burden. The challenges in mental health care (GGZ) are legion. Can digitalization provide a solution? Perhaps the use of digital tools is not a panacea. But with solutions for both the treatment room and the back office, digitalization definitely contributes to sustainable, future-proof mental health care. This is the widely shared outcome of the recent HCI Inspiration Sessions for Mental Health Care. More than two hundred professionals gave substance to the event's motto in Singer Laren: 'Together for better mental health care through digitalization!'.

“Digitalisation may not be the solution to all challenges in mental health care, but it is an important part of that solution,” says director Marc Prette of HCI. “There are major gains to be made in the back office, for example by digitally guiding clients to the right type of care. But also by facilitating networks that allow care providers to efficiently exchange data with each other. So from that perspective, I say a resounding 'yes' to the question of whether digitalisation can help solve waiting lists. But digitalisation has a much broader scope. It can also make the treatment itself not only more efficient, but also better.”

Meaningful solutions

With a broad portfolio that includes an electronic patient file, e-health modules and a digital patient environment, Health Cloud Initiative (HCI) serves more than 40.000 healthcare providers and -via the Uw Zorg Online-environment millions of patients in primary care. Software may be the core business, HCI wants to be more than a supplier of digital tricks. Ultimately, HCI is about meaningful, effective solutions that actually contribute to better mental health care. For that reason, HCI explicitly seeks dialogue with the most important stakeholders. In Laren, that dialogue revolved around questions such as: does digitalization shorten waiting lists in healthcare? Do professionals and clients have sufficient input into digital innovation? And: is digitalization the fastest route to good, accessible and future-proof mental health care?

Mental health care without borders

The perspective of the healthcare providers was expressed on stage at the Singer Theater by director Jennifer van den Berg of SOL Psychotherapy. As a healthcare provider that works completely digitally, the advantages of this method are obvious to Van den Berg. Both the therapist and the client are no longer bound by boundaries in time and space. “We provide care throughout the country. If a therapist who speaks Turkish is needed on Texel, that is no problem for us. If necessary, we will also cross the border. For example, if psychological care is needed for a soldier on a mission abroad, that is no problem for us.”
To underline the effectiveness of digital mental health care, Van den Berg cited a few telling figures. “In four regions where waiting lists were out of control, we were able to shorten them considerably. Instead of eight months, we were able to take people into therapy within two weeks.”

Not distant

A common objection to digital mental health care is that it is impersonal and distant. According to Van den Berg, the opposite is true. “There is a lot of contact with the client, and precisely at those moments when the client wants it. Through video calling, chatting, exercises, questionnaires or a digital diary, we can not only involve the client more actively in the treatment, but the therapist also has much more information than in a regular setting, where a therapist only sees a client once in a while.”

Client as starting point

Director Dienke Bos of the MIND interest group also sees positive aspects of digital mental health care. However, she does formulate a number of important considerations from a client perspective. For example, in her opinion, the quality of treatment should always be the starting point. “Digitalisation can really improve mental health care. In addition, it can certainly contribute to cost reduction and reduced workload. But we should not reverse the two. Cost reduction should not be the primary goal.”

Physical alternative

Accessibility and inclusivity of digital care also deserve serious attention, according to Bos. “More than half of the people with serious psychiatric problems live around or below the poverty line. The chance that a working laptop and stable internet are available there is not that great. Moreover, not everyone is digitally skilled. So there must always be a fully-fledged physical alternative.”

Sensitive information

And then of course there is the issue of privacy and data security. Especially in a sector like mental health care, where it revolves around extremely sensitive, personal information, these matters deserve extra attention. According to Bos, the best recipe for preventing accidents is client inclusion. “Developing digital solutions should always be done together with the end user. Not just testing at the end of the process, but involving the client from development to implementation.”

Upscaling

In another area, too, digital tools are still not being used enough, she says. “Digital tools are often used for the one-on-one relationship with the client, but how do we ensure that care providers find each other in digital networks? We will really have to invest in digital network care.”
Of the healthcare providers that Van de Pol encounters in the CZ work area, approximately one third are really working on digital care pathways. This shows that digitalization is an irreversible process. “We really can't and don't want to do without digital care anymore,” says Van de Pol. “Given the growing care gap, we really have to organize care differently, but we don't see any effect on accessibility and costs yet. Many innovations fail when scaling up.”

Smart Artificiële

Scaling up is certainly not the problem with the latest addition to the digital transformation tree: artificial intelligence. After the introduction of ChatGPT in 2023, the number of users grew to 200 million per week in no time. The rise of generative AI, also known as general purpose AI or large language models (LLMs), also comes with big budgets; Elon Musk's LLM Grok is reportedly worth $18 billion.

Given the rapid advance and disruptive nature, no discussion about digital care is complete without talking about AI, says Gideon Kreytz, innovation director at HCI. “Whether you are a consumer, client or care provider, we will increasingly use it,” says Kreytz. “At the moment, it is mainly about speech-to-text. If you as a practitioner want to explain something in understandable language, ChatGPT can do that. But there are also models that tell the practitioner when they forget to ask something. Automatic pattern recognition is already used a lot in radiology. In the future, the anamnesis will already be done online and follow-up appointments will be scheduled without you as a practitioner having to do anything.”

stay critical

Kreytz also sees dangers. Bias in source files and data models can negatively affect access and quality in healthcare. Privacy is a constant source of concern for data guzzlers such as LLMs. And then, within the context of healthcare, the question of who is responsible for the results also plays a prominent role: the creator of the model, the healthcare provider or perhaps the client? Kreytz's advice: "Stay curious, but critical. As an HCI, we will certainly help you with that."

Voice-controlled reporting

Maarten Timmers' presentation clearly demonstrated what AI can do in practice. As a general practitioner, he noticed to his frustration that he was increasingly glued to his screen during patient contacts. "Because I had to fill in forms all the time, I hardly had any attention for the patient in front of me." So Timmers took the initiative for his own application for voice-controlled reporting together with an AI developer called Juvoly. "The software listens in, transcribes and makes a summary for the file," says Timmers. "The computer is no longer on the table, but hangs on the wall. When a patient or client comes in, the file opens automatically. Any treatment plan or referral letter is already ready in the background. A keyboard and mouse are no longer needed. A referral to someone further in the chain follows automatically. This further improves collaboration."

Challenge

With Juvoly, Timmers has not only made his own work fun again, but also that of colleagues in five hundred other GP practices. Together with HCI, Juvoly is now also focusing on hospitals and mental health care. With more than a thousand healthcare providers using the HCI GGZ EPD, HCI is a logical partner for scaling up. One of the technical challenges that the two parties are working on is further streamlining the information transfer, so that the spoken word ideally automatically ends up in the right place in the EPD.

To underline the scope, functionality and flexibility of this EPD, Chris-Jan van Schendel, segment lead GGZ at HCI, let users from different domains speak in his presentation. All three of them indicated that they had found a listening supplier in HCI, with an open ear for their context-specific needs and requirements.

In addition to this EPD, HCI offers under the brand name Embloom also offers a wide range of e-health applications. Embloom presents itself as an efficient, user-friendly online platform that helps healthcare providers and healthcare recipients with questionnaires, e-health modules and video calling.Embloom stands for enriching and improving care for people with mental and physical complaints," says Sanne Vrijhoeven, consultant EmbloomThe underlying mission is to ensure accessibility and affordability of high-quality care.

Patient journey

For director Hans ter Brake of Quli, “quality of care” always starts with the client or, better said, with the citizen. “As a care provider, you are actually a temporary passer-by in the life of your client,” Ter Brake told the mental health professionals in Singer Laren. “That person is the only constant in all care processes. You are part of his or her life journey every now and then.”

Ter Brake's choice of words is a deliberate one. For years, he has been advocating a digital environment in which citizens can direct their own healthcare and health journey. And that with the same ease of use that has been self-evident in the travel world for years. "I don't know how you book your holiday, but I do it via a travel app. Within that environment, I can book a flight and a hotel, but also a bus or excursions."

With all the partitions, silos and domains, such a seamless experience in healthcare is often not the case, says Ter Brake. “If you come out of the hospital with a broken leg, where do you get your crutches?”

People-oriented platform

Ter Brake's ideal of an online "people-oriented platform" where all lines - from informal support to social domain and formal care - come together has recently come a step closer. Under the umbrella of HCI, Quli and Uw Zorg Online to an integration. This will give a huge boost to both the functionality and reach of the platform.

The search for synergy between Quli and Uw Zorg Online makes clear what HCI wants to stand for: making an impact through scale without growing so big that the end user disappears from view. “As HCI, we have a lot of contact with our customers,” says director Prette in his closing speech. “But often that conversation is about specific platforms or solutions. I see this inspiration session as a first step to continue talking about digitalization at a higher level.”

Source: Dutch Health Hub