'Put end user at center of digitization of mental health care'

Waiting lists, staff shortages, exploding demand for care, administrative burden. The challenges in mental health care (GGZ) are many. Can digitization provide a solution? With solutions for both the treatment room and the back office, digitization certainly contributes. But the input of healthcare professional and client is crucial. This was the widely shared outcome of the recent Inspiration Sessions for the GGZ from supplier HCI.

"Digitization may not be the solution to all challenges in the mental health sector, but it is an important part of that solution," said HCI director Marc Prette. "There are great gains to be made in the back office, for example by digitally routing clients to the right type of care. But also by facilitating networks through which healthcare providers can efficiently exchange data with each other. So from that perspective, I say a resounding 'yes' to the question of whether digitization can help solve waiting lists. But digitization goes much broader. It can also make treatment itself not only more efficient, but better."

Ggz zonder grenzen
The perspective of care providers was expressed on the stage of the Singer Theater by director Jennifer van den Berg of SOL Psychotherapy. As a care provider that works completely digitally, the advantages of this way of working are obvious as far as Van den Berg is concerned. Both practitioner and client are no longer bound by boundaries in time and space. "We provide care throughout the country. If a practitioner is needed on Texel who speaks Turkish, that is no problem for us. If necessary, we 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 underscore the effectiveness of digital gzz, Van den Berg cited some telling figures. "In four regions where waiting lists were running out of steam, we managed to cut them down considerably. Instead of eight months, we were able to get people into therapy within two weeks."

Not distant
A common concern regarding digital health care is that it would be impersonal and distant. According to Van den Berg, the opposite is the case. "On the contrary, there is a lot of contact with the client and precisely at those moments when the client wants it. By video calling, chatting, exercises, questionnaires or a digital diary, we can not only involve the client more actively in the treatment, but the practitioner also has much more information than in a regular setting, where a practitioner sees a client only once in a while."

Client as starting point
Director Dienke Bos of interest group MIND also sees positive aspects to digital mental health. But she does formulate some important reservations from the client's perspective. For example, as far as she is concerned, the quality of treatment should always be the starting point. "Digitization can really improve the mental health care. In addition, it can certainly contribute to cost reduction and workload reduction. But we should not reverse the two. Cost reduction should not be the primary goal."

Physical alternative
As far as Bos is concerned, accessibility and inclusiveness of digital care also deserve serious attention. "More than half of people with serious psychiatric problems live around or below the poverty line. The chances that a working laptop and stable Internet are present there are not that great. Moreover, not everyone is digitally literate. So afull-fledged physical alternative must always be present."

Sensitive information
And then, of course, there is the issue of privacy and data security. Particularly in a sector like the mental health sector where highly sensitive, personal information is at stake, these issues 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 test it at the end of the process, but involve that client from development to implementation."

Scaling up
Inclusiveness is also a concern for Femke van de Pol, senior care buyer GGZ at CZ. "Perhaps digital care is not the right tool for everyone, but what strikes me is that at the front, certain target groups are excluded in advance."
On another front, too, digital tools are not yet being sufficiently exploited, as far as she is concerned. "Digital tools are often used for the one-on-one relationship with the client, but how do we ensure that caregivers find each other in digital networks. We will really have to invest in digital network care."
Of the care providers Van de Pol encounters in the CZ working area, about one-third are really working on digital care pathways. This suggests that digitization is an irreversible process. "We really can't and don't want to do without digital care anymore," Van de Pol said. "Given the growing care gap, we really need to organize care differently, but we don't yet see an impact on accessibility and costs. Many innovations fail at scale-up."

Artificial intelligence
At least scaling up is not the problem with the newest shoot on the tree of digital transformation: artificial intelligence. After the introduction of ChatGPT in 2023, the number of users grew to 200 million a week in no time. With the rise of generative ai, also known as general purpose ai or large language models (LLMs), also comes big budgets; Elon Musk's LLM Grok is reportedly worth $18 billion.

Given its meteoric rise and disruptive nature, no discussion of digital healthcare is complete without talking about ai, said Gideon Kreytz, innovation director at HCI. "Whether you're a consumer, client or healthcare provider, we're going to use it more and more," Kreytz said. "Right now it's mostly about speech-to-text. If you as a practitioner want to explain something in understandable language, ChatGPT can do that. But there are also already models that tell the practitioner when they forget to ask something. Automatic pattern recognition is already widely used in radiology. Soon the anamnesis will already have been done online and follow-up appointments will be scheduled without you having to do anything as a practitioner."

Staying critical
Dangers Kreytz also sees. Bias in source files and data models can negatively affect access and quality in healthcare. Privacy is a constant source of concern for data-eaters such as LLMs. And then, within the context of healthcare, there is an emphatic question of who is responsible for the outcomes: the creator of the model, the healthcare provider, or perhaps the client? Kreytz's advice: "Stay curious, but critical. We at HCI will certainly help you with that."

Speech-driven reporting
What ai can do in practice was made very clear in Maarten Timmers' presentation. As a general practitioner, he noticed to his frustration that he was increasingly glued to his screen during patient encounters. "Because I constantly had to fill out forms, I hardly had any attention left for the patient across from me." So Timmers took the initiative with an ai developer under the name Juvoly to develop his own application for voice-based reporting.

"The software listens in, transcribes and creates a summary for the file," Timmers said. "The computer is no longer on the table; it hangs on the wall. When a patient or client comes in, the file opens automatically. Any treatment plan or referral letter is ready in the background. Keyboard and mouse are no longer necessary. A referral follows automatically to someone further down the chain. 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 general practices. Together with HCI, Juvoly is now also setting its sights on hospitals and the mental health sector. With more than a thousand healthcare providers using the HCI GGZ EPD, HCI is a logical partner to scale up. One of the technical challenges the two parties are working on is further streamlining information transfer, which ideally will ensure that the spoken word automatically lands in the right place in the EHR.

Patient journey
For Quli director Hans ter Brake, "quality of care" always starts with the client or -better said- the citizen. "Actually, as a care provider, you are a temporary passerby in your client's life," Ter Brake told the mental health professionals at Singer Laren. "That person is the only constant in all care processes. You are occasionally part of his or her life journey."

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 taken for granted in the travel world for years. "I don't know how you book your vacation, but I do it through a travel app. Within that environment, I can book a flight and a hotel, as well as a bus or excursions."
Because of all the partitions, silos and domains, such a seamless experience in healthcare is often absent, Ter Brake said. "If you come out of the hospital with a broken leg, where do you get your crutches?"

People-centered platform
Ter Brakes ideal of an online "people-centered 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 are working on an integration. This will give both the functionality and reach of the platform a huge boost.