Q&A: Integrating Digital Health Applications into Clinical Care

After nearly 25 years with Kaiser Permanente, Trina Histon recently took on a new challenge at Woebot Health, a company that developed a chatbot for mental health care.

Histon’s new role as VP of Clinical Product Strategy will focus on integrating Woebot into clinical care. She previously spent several years at Kaiser developing a process for transferring digital mental health applications from clinicians to the hands of patients.

Histon sat down with MobiHealthNews to discuss the incorporation of apps into the provider workflow and the future of digital mental health tools for more severe conditions.

MobiHealthNews: What are some of the main challenges you have faced in integrating digital tools into clinical care, both from a provider and patient perspective?

Trina Histon: I characterize the early days of this work at Kaiser Permanente as a kind of age of discovery. At the time – and it wasn’t that long ago, but with the pandemic, time was doing funny things – I’d say there was interest at Kaiser Permanente in adding digital tools to become the standard of care.

So how do you do it? What does good look like? What is a good tool? This was a big question that we had at the KP as an evidence-based organization. Are clinicians confident that these tools are good? You know that there are millions of apps in the App Store. So how do you, as a consumer, know what’s good? And then you bring it into this sacred space between doctor and patient.

And then I think the other part where great apps can live or die is in the workflow. Did you take into account the context of care? So the process that we used at Kaiser Permanente, backed by a human-centered design, was to go deep into the context of treatment with a small group of clinicians: the patients they saw, what they had in their arsenal today what is their susceptibility. was to add a digital layer, given that most people have smartphones and are ready to use apps and use them. So I really understand from a clinician’s point of view how they are wasting their time. What might an optimal direction look like in an electronic health record? And it will be a little different if you are a primary care physician and not a therapist, psychologist, or even a psychiatrist.

Doing it this deep and then prototyping optimal flow and doing that direction by making prescription pads that look like tear pads. So, as a doctor, you can say, “I want you to start with this module. I want you to practice so many minutes a week, so many times a week.” And at the same time, understanding the people who are asking for help, who feel very vulnerable, who have probably waited a long time to talk about this issue. How do we design to make it easy for them to get that referral?

So once you enter the healthcare system, we at Woebot Health will guide that person through that user experience. But if you haven’t designed optimally to lead them to that front door, they may never know how to find the handle and get in, so to speak.

MHN: Many of these processes were developed before the pandemic, and then as 2020 rolled around, you started rolling them out to more primary care providers and other professionals. What was this sudden scaling process like?

Histon: If anything, the positive side of the pandemic has been that healthcare — which is a fairly risk-averse industry — has indeed innovated for a decade in a year. The reality on the ground was that we had built a large set of tools for in-person visits. Patient Education Materials Obviously, a lot can be done with a text message or a secure message. But then we had to move very quickly to virtual care.

Therefore, we have switched many streams and much of how the patient will receive them to this virtual modality using many QR codes. Thus, during a video visit, you can pick up your phone and thus open the Kaiser door to the desired application. And then we had to make sure that these QR codes would be displayed depending on the different kinds of video opportunities that the participant would have.

The other part was that senior executives called me and said, “Please, people are very, very tense and anxious when they come to me. Can I get that too?” Basically, I can get a call from a senior executive on Monday, we’ll work with the team in that region, they’ll do a sprint, and it’ll be live on Sunday night. So just a week later, the opportunity arose.

So what was nice about the way we built it was that you could take it and then build it and either provide a specific clinical suite – be it primary care, OB/GYN or family medicine – a subset of applications, or you could give them all depending on what they wanted. And then, working with the primary care physicians we partnered with in the pilot, we developed a very quick training for physicians, like a short six-minute video to say, “This is how I do it in my practice,” and walk them through the workflow. . So again, since we were piloting with these doctors, it was very quick to change this educational part.

MHN: Many digital tools focus on less acute mental health issues. What do you think about stepping up care for people with more severe illnesses?

Histon: I think the last seven to ten years have been mostly depression and anxiety. So I think that’s what we’re going to see more and more of, an evolution and maturation in digital mental health, including more solutions for severe mental illness.

And I think that in the next year or three you will see more and more movements in this space, because there is a desire. I would like to think that we may have overcome some of the high levels of skepticism. You still have people who are skeptical, and that’s okay, but I think there’s a higher acceptance that these tools have a place.

And I think the work we’re going to do now – with Woebot Health in partnership with health systems – is how do we deepen these tools in the healthcare delivery path? How can we more insightfully understand who they are best suited for? How long, for whom? And then, when do you need to change things up a bit? And I feel like this is the way forward.