APA’s App Panel Offers Guidance on Digital Tools

“Ask an App Advisor” is a new feature of Psychiatric News in which members of APA’s App Advisor Expert Panel discuss the general use of mental health apps and answer APA members’ questions. This group is composed of APA members and other subject matter experts in mental health from related professions (for example, social work, psychology, nurse practitioners, informaticists) and patients with lived experience of mental illness. The purpose of this panel is to maintain APA’s App Evaluation Model and to provide resources for professionals and patients to give them tools they can use when deciding what app is appropriate. The articles will also explore clinical, research, and policy interests of the panelists around mHealth (mobile health).

This month’s panelist is Steven Chan, M.D., M.B.A. Dr. Chan works with APA’s App Advisor Expert Panel, APA’s Committee on Mental Health Information Technology, and APA’s Committee on Telepsychiatry. He is a clinical informaticist and medical director for addiction consultation and treatment at Palo Alto (Calif.) Veterans Affairs Health. In the interview with Dr. Chan, I asked him about some key trends he is seeing in the use of digital health at the VA.

Q: Tell me a little bit about how you use mobile health at the Veterans Affairs.

A: I’m extremely proud to be part of a health system that has a lot of mobile app resources available. I’ve been able to recommend the Veterans Affairs’ apps to my patients and to my teammates and support their use. We have a very active Office of Connected Care and the National Center for PTSD, which have developed all sorts of apps that help people with sleep issues, managing emotions, and getting through the COVID-19 pandemic.

We have also been using the VA Video Connect telehealth service because it allows us to virtually see patients from a distance and reach more veterans who may be living in faraway places. Finally, the VA just released a wonderful new version of an app called VetChange, which helps people who want to reduce alcohol use. It provides coaching and tracking. There’s always something new—it seems—at the VA, and I’m excited to see what further resources come up next.

I’m also personally very interested in how the VA has bridged the digital divide. We have an incredible team that helps people with technology issues and getting connected to video services.

Q: Are you currently working on any research involving apps?

A: I’m involved with the APA App Advisor and collaborate on guidance for digital mental health tools and work with our internal teams to make apps and related technologies available for our staff and our patients. I’ve also spearheaded the technology for clinical research as a research affiliate at the University of California, Davis, where our investigators—Michelle Burke Parish and Peter Yellowlees—have been working on access to care through asynchronous telepsychiatry technologies. It’s a HIPAA-secure, cloud-based platform that’s a mashup of YouTube and a miniature electronic health record that allows us to capture videos, transcribe them, and translate them into the psychiatrist’s language. This tool allows psychiatrists to view patient interview videos, view captions, and input diagnoses and notes. This app is cross-platform and works on mobile phones, tablets, and desktop browsers.

I’ve also done consulting, teaching, and advising for multiple projects and classes at the Stanford Graduate School of Business at UC San Francisco (UCSF), as well as with various companies and, of course, students. I’ve also participated in many of APA’s technology-focused events and with Psych Congress, the American Medical Informatics Association, and many media outlets.

Finally, I’m working with a fantastic group of health informaticists on ADVICE Health at UCSF, who have assembled a consortium of health systems to evaluate digital health apps that are integrated with electronic medical records. We’ve created a system and a workflow to catalog these apps, in hopes of bringing sense to the wild frontier of health care technologies. This applies not only to mental health apps, but also apps in all medical specialties.

Q: We’re seeing a lot when it comes to mHealth and psychiatry. Where do you see the field going in a few years?

A: We’re seeing a lot of different app services come into play: apps for purely patient use, apps for clinician-to-patient use, and apps for clinician-to-clinician use. We have already seen a rapid digitization of services with the COVID-19 public health emergency. We will continue seeing enthusiasm and support for hybrid models of care that blend components of virtual and in-person care. The use of telepsychiatry, mental health information technology, new models of care, and new ways of delivering compelling psychoeducation continue to evolve and converge at the point of patient care and, in the near future, will work together and form a comprehensive, all-inclusive patient experience in digital therapeutics and services. 5G [fifth-generation global wireless or broadband standard] will become more widespread to provide faster, more stable audiovisual connections. We will also see psychiatry continue to adopt virtual reality and mixed reality, smartwatch apps, and more culturally sensitive user experiences.

These trends will certainly not happen overnight. However, there’s an enormous amount of interest in evidence-based, accessible digital solutions in the mental health field because of the increased demand for mental health, addictions, and substance use disorder care and a greater recognition that psychiatric issues affect home life, work life, and school life. ■