Summit on Behavioral Telehealth 2008: Day 1 Morning Summary

I’m in Boston today and tomorrow attending (and moderating a panel) at the 2nd annual Summit on Behavioral Telehealth. “Behavioral Telehealth” is a fancy way of saying e-Mental Health (instead of eHealth) or Mental Health 2.0 (whichever cool term you prefer). I’m not directly live-blogging, but will post updates from time to time over the next day or so.

Ron Kessler was first up, discussing methods that he and his research team have looked at mental health issues in the workplace. He talked about the Health and Work Performance Questionnaire (HPQ) that he uses to help companies learn about what impact different health and mental health concerns have on their employees’ workplace performance.

The costs of mental health concerns to employers includes sickness absence, presenteeism (being at work, but performing poorly), ripple effects (someone who has depression in a small team affects the rest of team’s members), big losses, disability, other related health care costs.

A model depression disease management program, as described by Dr. Kessler, would include:

• Health risk assessment (HRA) screening for depression
• Care manager outreach calls
• Stages of change — recruitment and retention
• Best practices-focused treatment

Second up was Al Lewis who had a very interesting talk about the future of disease management. Lewis really focused on how a lot of disease management data “lie,” in that they show trends that, when you look at the real underlying data, don’t actually exist.

He emphasized that in disease management research, one shouldn’t just look at claims data and take changes noted at face value. He had good, clear examples of why it is inaccurate if researchers or actuaries just do a simple pre-post check looking for a return on investment in a disease management process. Instead, he emphasized the need for researchers to use a “plausibility check” — check to ensure the underlying hypothesis and assumptions from the data are likely.

Dr. Warner Slack, one of the pioneers in computer-based interviewing (publishing the first study on such technology over 40 years ago in 1966), talked about lessons learned in his career in a talk entitled Cybermedicine for the Patient. Dr. Slack focused on how patient-computer dialogue is used and why it’s ultimately beneficial — because the computer program often picks up on problems or possible issues that the doctor does not in a standard interview. The computer does this because it is more thorough and asks relevant, detailed followup questions, and because people are more comfortable talking about many of their health issues with a computer rather than a person (the disinhibitory behavior effect noted in online behavior is really computer-specific, not online-specific).

After talking about the computer-driven interview, he ended by mentioning Patient Site, a web-based patient portal from Beth Israel Hospital here in Boston. It offers a patientthe ability to view the results from diagnostic and laboratory studies, view their medications, and request prescription appointments and referrals. Dr. Slack and his research are also working on a comprehensive, computer based medical interview for the site.

The last talk of the morning was by Dr. Rob Friedman, who talked about the “Virtual Visit,” which seeks to help patients manage their disease. The Virtual Visit’s foundation is the telephone linked communications (TLC) system — a telephone-based, interactive, computer-controlled monitoring system for patients. It allows a doctor to get status updates from their patients without actually having to talk to them.

The TLC system is focused on monitoring patients, as well as educating and helping patients change specific behaviors. It does this through an initial assessment, and then offering pre-recorded tidbits of motivational audio. Including, yes, something they even consider “counseling.” Here’s a breakdown of a typical TLC telephone visit or intervention:

1. Assessment of targeted behaviors, comparison to previous assessments & goals & feedback
2. Assessment of factors that influence the targeted behaviors
3. Establish intermediate goals for behavior change
4. Intervention (education, advice and counseling)
5. Take home message

Surprisingly, the program works. They have published research that shows the TLC program is helpful for a variety of conditions and specific behavioral changes. For instance, one study showed that the TLC program helped in the positive change of physical activity promotion for sedentary seniors.