IBHT Future of Technology in Behavioral Health
November 1, 2005, Pittsburgh, PA

Sylvia Caras, PhD

United changed my flights leaving me with a 42 minute connection and what looked like a long walk between gates in Chicago. I looked at ORD maps, made sure there was a later flight in case I needed it, planned in my head what to remove from my wheel-a-board if there was no longer overhead storage room and I had to check the bag, landed a few minutes early, found the walk only 10 minutes, and discovered a long long unmoving line waiting to board, because a seat was loose and two mechanics were stretched across the aisle rebolting the seat.  So much for all that options planning.

Perhaps 50 are gathered in a Westin ballroom. I see about 20% women, one African American man, no other obvious people of color. There was a glitch in my invited presentation. First I wasn't even in the program; now my PowerPoint isn't printed in the correct place in the program. <sigh>  However, people are welcoming and friendly.

Hillestad, RAND: dysfunctional market - savings go to payors; costs go to providers. Presented The RAND Study of Potential Costs and Benefits of Electronic Medical Record Systems. I sent the study URL to iris last week; it's on the RAND website.

Q: what about behavioral health and its uniqueness; what about privacy, we are different

A: patient identification is basic to inter-connected systems - how should we do this? Universal identifier v privacy. RAND would need a sponsor, government or private sector, to study behavioral health needs.

Q: maintenance costs?

A: we estimate maintenance to be about 20% of implementation

Q: standards, governments role?

A: standards czar has been appointed; there are plenty of standards - we just need to choose

Many were late -- there is a public transportation strike, there was a Steelers game last night, and some are moving slowly because of a post-Halloween sugar hangover. There are now some 125 in the room.

My presentation, Communication and Community, part of the panel titled The Future of Technology-Enabled Consumer Self-Help is at the remarks link at the end of the web page I made for this conference - http://www.peoplewho.org/openminds/index.htm   My remarks were well received and the organizers thanked me and several people later introduced themselves. The provided computer displaying the PowerPoint went to sleep, so the website URL didn't stay displayed <sigh>. Another panelist suggested the need for a National Informatics Institute, analogous to NIH. Two people afterwards came up to me and said, "So, what do you do with NAMI?" Me: "Umm, I'm not … ." "Oh, I heard you say NAMI." Me: "Umm, …" Hmm, ears hear what they want?   I've met two other consumers here, Paul Cummings from San Diego, and John McM... from New Jersey, part of a DBSA group.

The small group room AC was not set high enough; I'd guess it was about 74F; many were sleeping during the afternoon.

Brown: the real source of variance is around the person doing the treatment; the more severe the symptoms, the more important the therapist becomes; the therapist is more important than the meds.

Teller: www.bodymedia.com user-chosen wearable bio-sensor monitoring devices worn part of the time, all the time. Powerful implications for knowledge; scary potential for misuse.

VNS has been approved for treatment resistant depression. Implant a pulse generator and nerve stimulation for electrodes. A benefit is assured treatment compliance. Adverse effect: voice altered during pulse.

Coming next: neuromodulation centers, like trauma centers, cardiac centers

Kent: CD CBT tool, www.livinglifetothefull.com, www.fiveareas.com , www.calipso.co.uk

Kupfer: Is Behavioral Health Going to "Enter" The Mainstream of Medicine? concurrent medical disease is a fact; how monitor compliance, adverse effects: impact of behavioral health in the management of chronic medical diseases (diabetes, obesity, … ) IOM behavioral health care report will be out (I think by the time you are reading this) - primary care will be incentivized to screen for depression. National Health Information Network (NHIN) to be piloted 2006. (How capture data at the source, "bypass" data entry? Sylvia) Large data sets will afford propensity scores which can determine the best treatment for the individual and discover rare side effects. Kupfer is on the board of BodyMedia, see above, and those two were the two most exciting presentations! "Data mining of aggregated anonymized health records provides fundamentally new data about prevention just as it does for treatment." (Pre-overt-symptomatic interventions, moved back from pre-symptomatic, to a likely to likely to become. Sylvia) "Continuous physiological monitoring of individuals in their environment." (Some of the possibilities are literally making me feel a bit nauseous. Sylvia) Applying group data to an individual has good and bad (TMAP, … ). First, desired outcome, individualized. Then risk:benefit cost analysis.

Paying individual attention to outliers and removing them from data sets changes the analysis of the systems overall performance and development of standardized treatments.

 Ever since I read The Fountainhead in high school I have tracked modern architecture and seen much of the work of Frank Lloyd Wright.  So here in Pittsburgh, I went to see his most well known work, Falling Water, and also the nearby Kentuck Knob home.

Then, instead of flying from Pittsburgh to New Orleans for the APHA meeting, I came home to do laundry and repack for the WSIS meeting in Tunis.  That will be the next report.