What is the Digital Clinic?
The Digital Clinic is a fully operating therapeutic clinic integrating technology from smartphone apps and sensors into outpatient visits to improve care. Patients meet regularly with a clinician and use the mindLAMP app between visits to monitor symptoms, access tips and resources, and complete clinician-assigned exercises.
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Patient-CenteredPatients are provided with skills and a toolkit to manage their symptoms beyond the short-term care context. The patient-driven approach aims to teach patients to manage their own emotions. |
AccessibleTotally cost-free with fully remote sessions. Targeted therapy is provided in a brief (7-8 sessions) structure. Digital Navigators (DN) guide patient engagement and are able to provide support with technology. |
Data-DrivenSurveys and various aspects of behavior and device use are collected and monitored through mindLAMP. This data is then fed back to the patient and clinician by the digital navigator to inform shared clinical decision making. |
Evidence-BasedThe therapy modules and mindLAMP resources and activities are informed by a growing evidence-base, utilizing CBTp and Unified Protocol principles and techniques. |
The Need
As demand for mental health care rises, the limited supply of clinicians makes it difficult to meet the need for services. To increase supply, there must be innovation in both workforce capacity and digital solutions. But innovation must not come at the price of reduced quality of care because the need to balance access and quality requires more than offering self-help applications (apps) or coaching. Toward exploring one such solution, the authors describe the Digital Clinic, a model of hybrid synchronous and asynchronous mental health care led by a licensed clinician. (Although they developed a treatment manual to address mental health, the Digital Clinic care delivery model can be applied to other areas.) To increase access and quality, they integrated into treatment a smartphone application offering digital phenotyping and digital interventions, as well as a new care team member, the Digital Navigator, to collectively support engagement, digital equity, and clinic integration.
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How does the Digital Clinic operate?
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What is a Digital Navigator?
A Digital Navigator supports the clinician by handling the technical aspects of the digital clinic from app set-up and customization to troubleshooting so the clinician is free to spend a full meaningful session with a patient.
Some tasks of the digital navigator include:
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Outcomes for the Digital Clinic
Mean PHQ-9 scores (left) and GAD-7 scores (right) for both the cohort that finished up to four visits and the cohort that completed all eight visits.
mindLAMP app
Digital phenotyping data from smartphones and wearables offer a powerful avenue to enhance clinical care by capturing real-time, ecologically valid metrics such as GPS, actigraphy, and sleep patterns. These data hold immense potential for optimizing personalized treatments and detecting clinically significant changes in disease processes. However, widespread impact is limited by the specialized expertise required to process these datasets and the lack of user-friendly tools to derive actionable insights. At the Digital Psychiatry Division of Beth Israel Deaconess Medical Center, our team has advanced this field by developing mindLAMP, an open-source platform for collecting and analyzing behavioral data, and its analytics suite, Cortex.
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Data sharing Reports
Designed to provide clinicians and patients with more valuable insights in a concise and efficient format, the current report is generated using Python.
Various visualization tools are utilized, including line graphs to track the changes of the daily or weekly active survey scores, bar graphs to illustrate the activity counts, a correlation matrix to explore the relationships between the phenotyping and psychopathological features, and polar graphs to show further relationships chronologically. The report is shared with clinicians and patients during weekly clinical and digital navigator meetings, providing ongoing care and support and facilitating the efficiency of digital clinics. This report develops a clearer and standardized approach to provide a consistent framework that enhances efficiency and ensures duplicability across different projects. |
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Digital Navigator Training
Our team has developed and freely shared training and resources around the Digital Navigator role. The Digital Navigator is a training member of the clinical team, whose goal is to support the uptake and implementation of technology into care. The role focuses on supporting the use of smartphones as these are now used by 85% of adults in the United States, and are commonly used by patients, compared with computers.
While the role is flexible so that responsibilities will vary with context, in our clinic, they include (1) helping patients in need access technology and offering digital literacy skills training to anyone in need, (2) supporting the selection of apps and engagement with app-based exercises for patients to use between visits, and (3) facilitating the integration of app data into care by providing interpretation of app data to patients and clinicians in a clinically relevant format to help guide care. The manual encompasses a quick protocol guide for training digital navigators. The Digital Navigator position requires roughly 10 hours of training before working with patients and can operate as a full-time job. It is also feasible for volunteers with large vocational workloads (full-time job or full-time student) without significant burden. Extensive clinical experience or knowledge is not required to become a digital navigator. |
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Relevant Publications
Hartstein, George Luke MD, MBA; Peck, Pamela PsyD; Yellowlees, Peter MBBS, MD; Torous, John MD, MBI. Psychotherapy in the Digital Era: A Case for Hybrid Care and Remote Therapeutic Monitoring. Harvard Review of Psychiatry 32(2):p 63-69, 3/4 2024. | DOI: 10.1097/HRP.0000000000000393
Chen, K., Lane, E., Burns, J., Macrynikola, N., Chang, S., & Torous, J. (2024). The Digital Navigator: Standardizing Human Technology Support in App-Integrated Clinical Care. Telemedicine and E-Health, 30(7), e1963–e1970. https://doi.org/10.1089/tmj.2024.0023
Chen, K., Huang, J.J. & Torous, J. Hybrid care in mental health: a framework for understanding care, research, and future opportunities. NPP—Digit Psychiatry Neurosci 2, 16 (2024). https://doi.org/10.1038/s44277-024-00016-7
Burns J, Chen K, Flathers M, Currey D, Macrynikola N, Vaidyam A, Langholm C, Barnett I, Byun A, Lane E, Torous J
Transforming Digital Phenotyping Raw Data Into Actionable Biomarkers, Quality Metrics, and Data Visualizations Using Cortex Software Package: Tutorial. J Med Internet Res 2024;26:e58502. URL: https://www.jmir.org/2024/1/e58502. DOI: 10.2196/58502
Rodriguez-Villa E, Rozatkar AR, Kumar M, et al. Cross cultural and global uses of a digital mental health app: results of focus groups with clinicians, patients and family members in India and the United States. Global Mental Health. 2021;8:e30. doi:10.1017/gmh.2021.28
Rauseo-Ricupero N, Henson P, Agate-Mays M, Torous J. Case studies from the digital clinic: integrating digital phenotyping and clinical practice into today's world. Int Rev Psychiatry. 2021 Jun;33(4):394-403. doi: 10.1080/09540261.2020.1859465. Epub 2021 Apr 1. PMID: 33792463.
Rodriguez-Villa, E., Rauseo-Ricupero, N., Camacho, E., et al. The digital clinic: Implementing technology and augmenting care for mental health. General Hospital Psychiatry 2020. See Article.
Torous, J., Jän Myrick, K., Rauseo-Ricupero, N., et al. Digital Mental Health and COVID-19: Using technology today to accelerate the curve on access and quality tomorrow. JMIR Mental Health. 2020. See Article.
Naslund JA, Gonsalves PP, Gruebner O, Pendse SR, Smith SL, Sharma A, Raviola G. Digital Innovations for Global Mental Health: Opportunities for Data Science, Task Sharing, and Early Intervention. Curr Treat Options Psychiatry. 2019 Dec;6(4):337-351. doi: 10.1007/s40501-019-00186-8. Epub 2019 Sep 7. PMID: 32457823; PMCID: PMC7250369.
Chen, K., Lane, E., Burns, J., Macrynikola, N., Chang, S., & Torous, J. (2024). The Digital Navigator: Standardizing Human Technology Support in App-Integrated Clinical Care. Telemedicine and E-Health, 30(7), e1963–e1970. https://doi.org/10.1089/tmj.2024.0023
Chen, K., Huang, J.J. & Torous, J. Hybrid care in mental health: a framework for understanding care, research, and future opportunities. NPP—Digit Psychiatry Neurosci 2, 16 (2024). https://doi.org/10.1038/s44277-024-00016-7
Burns J, Chen K, Flathers M, Currey D, Macrynikola N, Vaidyam A, Langholm C, Barnett I, Byun A, Lane E, Torous J
Transforming Digital Phenotyping Raw Data Into Actionable Biomarkers, Quality Metrics, and Data Visualizations Using Cortex Software Package: Tutorial. J Med Internet Res 2024;26:e58502. URL: https://www.jmir.org/2024/1/e58502. DOI: 10.2196/58502
Rodriguez-Villa E, Rozatkar AR, Kumar M, et al. Cross cultural and global uses of a digital mental health app: results of focus groups with clinicians, patients and family members in India and the United States. Global Mental Health. 2021;8:e30. doi:10.1017/gmh.2021.28
Rauseo-Ricupero N, Henson P, Agate-Mays M, Torous J. Case studies from the digital clinic: integrating digital phenotyping and clinical practice into today's world. Int Rev Psychiatry. 2021 Jun;33(4):394-403. doi: 10.1080/09540261.2020.1859465. Epub 2021 Apr 1. PMID: 33792463.
Rodriguez-Villa, E., Rauseo-Ricupero, N., Camacho, E., et al. The digital clinic: Implementing technology and augmenting care for mental health. General Hospital Psychiatry 2020. See Article.
Torous, J., Jän Myrick, K., Rauseo-Ricupero, N., et al. Digital Mental Health and COVID-19: Using technology today to accelerate the curve on access and quality tomorrow. JMIR Mental Health. 2020. See Article.
Naslund JA, Gonsalves PP, Gruebner O, Pendse SR, Smith SL, Sharma A, Raviola G. Digital Innovations for Global Mental Health: Opportunities for Data Science, Task Sharing, and Early Intervention. Curr Treat Options Psychiatry. 2019 Dec;6(4):337-351. doi: 10.1007/s40501-019-00186-8. Epub 2019 Sep 7. PMID: 32457823; PMCID: PMC7250369.