Mental healthcare is increasingly in focus worldwide. Mostly, it is due (and thanks) to an important and positive trend taking place – the destigmatisation of issues related to this area of life. We’re becoming more aware of how these problems affect our existence and those around us. Also, we now better understand what role digitalisation plays in this respect.

Although innovation may have disrupted a number of consolidated ways of approaching life events, risks, and people, it can also offer solutions that dramatically increase our mental well-being. Ready-to-use and quick means of communication can bring us closer to others’ need for empathy and interaction. Digital solutions can support the work of healthcare professionals towards providing a more patient-centric, personalised treatment of mental disorders. Such is the paramount goal of Estonian company DocuMental, founded by award-winning psychiatrist Dr Eduard Maron.

The current framework in mental healthcare presents several issues with diagnostic and treatment. At a glance, as summarised from the call-to-action co-signed by Dr Maron:

• The median time to receive a psychiatric assessment and appropriate treatment after contacting a specialist is between 7 and 30 days in most EU countries;
• 69% of patients with mood disorders are misdiagnosed initially by mental health specialists, and remain misdiagnosed on average for 5 to 7.5 years;
• Between 35-50% of people with severe mental disorders receive no treatment for the specific issue at hand;
• About 40% of patients with depression or schizophrenia exhibit non-adherence to their psychiatric medications, mostly due to avoidable adverse effects.

DocuMental recently gained access to funds up to € 75 000 from EIT Health, the largest public-private European consortium for healthcare innovation. Selected among a pool of 104 applicants, the company led by Dr Maron is now looking forward to filling the care gaps that currently haunt everyday practice in mental health. In our insightful compelling interview, Dr Maron tells us how digitisation can help both patients and specialists in their path towards better treatment of mental disorders.

Dr Eduard Maron, Psychiatrist and Founder of DocuMental

Are there any dysfunctional patterns in traditional practices in mental health? What’s “wrong” with the current disease management, from diagnosis to treatment?

Unfortunately, current mental health services across the world remain expert-centric and associated with high rates of misdiagnosis and mistreatment. In other medical disciplines, diagnosing and treatment plan are based on highly sensitive and specific tests and technical solutions. Psychiatry, instead, is still positioned as a ‘medical art’. Practitioners engage in initial clinical impressions usually during the first minutes of interviewing or observation, and these often predetermine final decisions in terms of diagnosis and treatment choice. Despite the availability of internationally accepted diagnostic and treatment guidelines for mental disorders, the rates of adherence among clinicians to these standards remain low. This is largely due to traditional workflows.

Mental health teams are required to manage very high case loads and to put great effort on documentation, but as a result they spend less time with patients and may not pay enough attention to data quality, diagnostic, and treatment reliability. Psychiatrists are supposed to reach the most appropriate conclusions about diagnosis and treatment plan within short consultations – 45 minutes for the first contact, 15 minutes for follow-ups. Such time pressure may lead to lapses in the assessment process, medical errors and unreliable decisions. In particular, not observing properly diagnostic and treatment guidelines raises risks.

Why does this field need to be more digital? What are the advantages?

We already entered the digital area, starting the transformation of mental healthcare from paper-based to electronic health record (EHR) systems. However, to this day, only 61.3% of psychiatrists use any type of EHRs, with only 40.8% of them using certified systems. The rest still uses paper-based documentation. Moreover, the existing EHRs in mental health services are mostly designed to support administrative needs and case loads. Better outcomes definitely require more focus on decision making.

Our recent survey among European psychiatrists showed that the existing EHRs in mental health are:

• Old-fashioned;
• Lacking decision-making functionality;
• Not user-friendly;
• Time-consuming with regard to data recording;
• Poor in interdisciplinary transferability;
• Suffering from insufficient data quality.

To this, add a general resistance to meaningful data tracking and searching. Users increasingly perceive these limited functionalities and traditional patterns in workflow as a serious disadvantage in making appropriate and informed decisions for diagnosis and treatment.

Further digitalisation of current mental healthcare means, first, the implementation of decision support systems (DSS). Improving both diagnostic and treatment standards, they contribute to the personalised care and management of mental problems. The issue is that, to date, there are no well-designed reports on the potential of such applications and methods.

The recent feasibility assessment of DocuMental as a DSS, carried out among an international network of experienced clinicians from 14 countries, gives hope in this direction. We concluded that the diagnostic verification, treatment guidance, and data collection provided by DocuMental significantly improved and secured clinical workflow. This includes also assessment and management of mental disorders, and meeting the needs of patients and services. We see a higher diagnostic accuracy, guided treatment choice, and higher time-effectiveness due to automated documentation and quicker overview.

So what is DocuMental, and who is it meant to be used by?

DocuMental is a clinical DSS, purposefully designed for diagnosis, treatment and management of mental disorders. It is an impactful and innovative contribution to the digitalisation of clinical workflows in mental health. To our best knowledge and based on our competitive analysis, DocuMental is the only clinical DSS with digitised and structured ICD-10 diagnostic criteria for all mental disorders. It also provides clinical presentation to treatment register tracking medication choices, and management of care plans in a standardised way.

According to specialisation level and tasks, DocuMental suits a broad range of primary users involved in mental health services provision. Clinicians, nurses, psychologists, social workers, care-coordinators and healthcare managers, they all can benefit from its use. It also provides access for patients to support bilateral communication with mental health teams and services.

There are gaps between the need for treatment and service provision. These care voids span across countries too, generating inequalities in the treatment of severe mental disorders. How can a shift to digital mental health tackle these problems?

It seems a very complex and multi-layered problem, where there’s no existing single solution to solve it.  For example, the median treatment gap in Europe for major depression is 45%, ranging from 36% in the Netherlands to 73% in Finland. No doubt that Finland is one of the leaders worldwide in digital innovation for healthcare, so it’s not just about digitalisation in itself. The problem calls for new approaches to deliver care and support for people with mental disorders and needs. But first, a change of heart in our attitude is necessary.

Fears, biases and a certain resistance towards digital solutions were well present until recently. And it was all coming from mental health practitioners. Fortunately, a new understanding and system of priorities marked a dramatic positive change. This is mostly due to political will, but also to the involvement of patients’ organisations. From clinicians to patients and authorities, we’re all starting to recognise that mental health systems need to provide more precise and personalised diagnosis, treatment and management of mental disorders.

We need a shift from traditional, outdated approaches and, as clinicians, we should accept digital solutions as a valuable ally. They don’t diminish or replace our professional skills, but help us instead put them to good use in full accordance with international quality standards. Digital mental health is the only effective solution to close current gaps in patients’ needs for accessible support, personalised care, and better outcomes.

From this conversation, it seems that mental health services have yet to become fully patient-centric. What steps lie ahead towards more precise and personalised approaches?

Patient-centric mental healthcare is our ultimate goal and a near reality, and not just because all countries are facing scarcity of specialised human resources. Patients and their representatives take more and more an active role practically in all respects. From legal issues to data access and protection, as well as regarding the collaborative design of digital solutions. By introducing new approaches, such as digital phenotyping, they become active players in health management and care plan. It’s important, and it’s the right direction towards more precise and personalised medicine.

All the possibilities are there. But to assure the implementation of preventive and more proactive approaches, we need close collaboration with patients and their representatives. For example, in our case, pan-European patient-driven organisation GAMIAN is a member of DocuMental’s scientific committee, helping us in designing the most suitable solutions and approaches to meet patients’ needs.

DocuMental recently received funding from EIT Health, the EU consortium. What’s the action plan from now on?

This very important recognition shows that what we are doing has potential and is needed. We take our development and business plan realistically, we know that replacing all existing EHR systems is unlikely. Our goal, instead, is to fill the gap in their missing functionalities via interoperability standards, enabling the integration of DocuMental with the current EHR systems. In this way, we ensure the implementation of digitised guidelines and personalised approaches in everyday practice.

We are currently testing this scenario in Estonian psychiatric clinics, and planning then to implement our integrated solution more broadly. In the long run, in full accordance with the strategic objectives of EIT Health, we are aiming to:

• Transform mental healthcare systems across Europe from their current traditional approach to a digitised, personalised and patient-centric approach;
• Develop a preventive and more proactive mental healthcare based on digital (DSS, machine learning, artificial intelligence) and genetic technologies;
• Achieve a significant reduction of mental healthcare and public burden;
• Support the creation of a single and more cost-effective healthcare system across EU.

Link: https://e-estonia.com/documental-healtcare-innovation/