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The University of Sydney Page 1
Using real-time data to drive
reform
(For the users: access and
quality!!
For the funder: sound
investments & accountability)
Prof Ian Hickie AM MD FRANZCP FASSA
FAHMS
Co-Director, Health and Policy
Brain and Mind Centre, USYD
The University of Sydney Page 2
UK Govt Office for Science 2008
The University of Sydney Page 3
Key Issues for early intervention with adolescents and
young adults
– 1. Improving the range of key outcomes– A. Maximising economic, educational and social
participation• OECD focus on ‘NEETs’ in the 18-25 (30) year old age group
– B. Reducing self-harm, accidents and suicidal behaviours• Requiring much more specific focus
– C. Preventing development of alcohol/substance misuse• Major community and personal issue
– D. Improving physical health outcomes• Cardiovascular (smoking) and metabolic risks
– E. Prevention of syndrome progression• The most contentious but perhaps the least important
3
The University of Sydney Page 4
Key Issues for the future
2. Developing more personalised care regimes
Major conceptual, biological and psychological challenge
Role of TRAJECTORIES AND STAGES of illness
Models of key pathophysiological pathways – NOT DX
(e.g. anxious, circadian, impaired development)
3. Delivering evidence-based and personalised care at scale
Designated services (Headspace +)
E-health developments (full range, not just existing services online)
4
The University of Sydney Page 5
Percentage distribution of YLD by mental disorders and nervous
system disorders, Australia 1996
0
10
20
30
40
50
60
70
0-14 15-34 35-54 55-74 75+
Years of age
Pe
rce
nt
of
tota
l Y
LD
Mental disorders
Nervous system disorders
The University of Sydney Page 6
Uberization of (Mental) Health Care!!
– Access: Demand is driven by the user with their own personal technology, in their own time frame, at their convenience
– Empowering: Consumer has choice – often use both and go on comparing
– Availability of Service: Particularly attractive in areas where current demand is not met by highly-regulated systems and where current services focus on high-profit areas
– Cost: Reduces upfront direct and indirect costs compared with traditional services
– Quality of Service: comparable or exceeds current offerings
– Accountable: Each interaction is rated by the USER for quality: the system removes underperforming operators
– i.e. Doesn’t require any more ‘enquiries’ into the regulated (self-regulated) industry – the existing industry either adapts or ends (by improving quality and/or reducing costs)
The University of Sydney Page 7
Economics: Planning economies vs Smart Regulations
and continuous measurement of outcomes
– Health Care is part of the real economy!!
– In Australia: mixed economy, chaotic, live and changing!!
– Role of Govt: Yet more plans????
– Alternative view:
– 1. Regular Reporting: independent, annual, meaningful– Role of National Mental Health Commission (2012- )
– 2. Smart Regulation:– Anti-competitive practices, quality controls, user-focused
– 3. Continuous, real-time and targeted outcome data collection– Big new systems: New personal technologies
– Input: Needs Driven into every system
– Outputs: Experiences of care and functional outcomes
The University of Sydney Page 8
Recommendations
10/0
3/20
8
The University of Sydney Page 99
NATIONAL MENTAL HEALTH COMMISSION
OUR RECOMMENDATIONS ON TECHNOLOGY
The University of Sydney Page 10
$40m Co-operative Research Centre for Young
People, Technology and Wellbeing
1
0
The University of Sydney Page 11
Project Synergy Online Ecosystem
Currently, the integrated Synergy Online Ecosystem includes:
1. HAPPINESS CENTRAL (HC) – developed by The University of Sydney’s Brain and Mind Centre in collaboration with Young and Well CRC, end-users identify their current needs (eg. managing stress) and through the use of smart algorithms and interoperable apps and etools, develop a personalised ‘wellbeing plan’;
2. ReachOut.com Next Step (RONS) – developed by ReachOut.com Australia, The University of Melbourne and 13 youth service partners in collaboration with Young and Well CRC, RONS is a web-based tool that uses creative algorithms designed to help end-users work out what’s going on, find free and paid support services, as well as suggest practical tips for immediate help; and,
3. Mental Health eClinic (MHeC) – developed by The University of Sydney’s Brain and Mind Centre in collaboration with Young and Well CRC, the MHeC is a real-time primary care clinic that offers end-users immediate online assessment, as well as timely support and programs, via a ‘video-visit’ with a health professional and ‘share plan’.
The University of Sydney Page 12
Mental Health eClinic: example dashboard of results
The University of Sydney Page 13
Priority case and suicidal escalation I
The process used to prioritise cases and determine appropriate suicidal escalation for
those at significant risk.
Initial assessment
Suicidality algorithm
Individuals data reviewed by clinical team
Synergy Online system
Figure 1. Suicidality escalation protocol
No action Real time online alert
No suicidality High suicidalityLow suicidality
Email contact within 24 hrs
Urgent Follow up and/or escalation
required
No further escalation required
Clinical service
The University of Sydney Page 14
Cells representing concordance are highlighted in bold red font
Actual agreement 50/73 – unweighted observed kappa = 0.40
Note: maximum possible unweighted kappa (given observed marginal frequencies) = 0.61
Onlineassessment(surveyand‘videovisit’)
Stage1a(help-seekingsubjectswith
mild-moderateseverityofsymptoms)
Stage1b+(attenuatedsyndromes)
he
ad
spa
cea
pp
oin
tme
nt
Stage1a(help-seekingsubjectswith
mild-moderateseverityofsymptoms)24 19
Stage1b+(attenuatedsyndromes)
4 26
Comparisons of assigning to Stage 1b+ (attenuated
and actual syndromes), n=73
The University of Sydney Page 15
Share plan (decision tool) wireframe - clinical support
The University of Sydney Page 16
Configuring the MHeC for an inpatient unit
1
6
The University of Sydney Page 17
The proposition
– “ ..In five years from now every teenager thinking of suicide, will be able to access high quality, personalised care and social support, facilitated by innovative technologies”
– (the reality: it will require sustainable investment, community and setting based engagement, smart effective tech systems operating at scale, well-
informed and tech-competent clinicians)
1
7
The University of Sydney Page 18
The University of Sydney Page 19
Project Synergy Moves to USYD Innovation Hub
1. Turnbull Govt commitment to $30m over three years to implement
Project Synergy
1. National partnerships Model with health services agencies
2. Professor Jane Burns appointed to Faculty of Health Science and
BMC to lead the project
1. First three trials completed – next six planned
2. International partners – Canada and South America
3. SYD supports the next CRC bid for mental wealth and technology
– to be decided in Nov 2016
4. Key opportunity to bring together major centres with content
knowledge, tech skills, data and analytic capacity at USYD and
health system partners – extensions into early child development
and community-based ageing studies
The University of Sydney Page 20
HOW READY ARE YOU FOR CHANGE???
– USERS: Already have the technology in their pockets.
– Those with the financial capacity are already headed to alternatives
– Very keen to exercise the evaluation options
– Keen supporters of integration into practice
– Serious roles in co-design, deployment and evaluation
– Providers: Highly ambivalent.
– Some distinctly hostile: “An add-on at best”
– Investors:
– Ready to go!!
– Need the right technology-user-provider relationships
– Govts: High level officials already headed there.
– NZ and Aus examples.
Questions – Ian Hickie and Jono Nicholas
• What is the chance that e-mental health can transform both access to and quality of mental health care in your country?
• How could e-mental health services be optimally maintained in your country?
• What are the sources of greatest resistance to the uptake of e-mental health in your country
• On a scale of 1-10 (where 1= totally unprepared & 10 = fully prepared) how well prepared is your country, region or service for technology disruption?
• What is ONE opportunity to maximise the benefits of technology for your country?
• What is ONE innovative idea to foster international collaboration and drive mental health reform through technology?
