Ever since Sigmund Freud invited his first patient to visit his office and lay down on his couch, clinicians have been forced to rely on what their clients tell them during their therapy sessions. But human memory is notoriously unreliable, and evidence suggests that people aren’t very good at remembering what they were doing, feeling, or thinking in the days or weeks since their last visit. Furthermore, life is lived in the trees, not the forest, which means that we just aren’t very good at seeing the larger patterns of our own behavior. Mobile Therapy allows people to easily and effortlessly share real-time information about our thoughts, feelings, and actions to our therapists, who can use this information to inform their treatment plans. “How have you been this week?” is a question that therapists need no longer ask because before their client sits down, they will already know the answer.
Consider an analogy in the world of medicine. Once upon a time, if your physician wanted information about your heart rhythm, he or she had to measure it in the hospital. But those measurements were of limited use because they didn’t tell the physician what your heart was doing under normal circumstances – as you ate, slept, walked up the stairs, argued with your spouse, and so on. That all changed in 1949 with the invention of telemetric cardiac monitoring by a scientist named Norman Holter. Today, if your physician is worried about your heart rhythms, he or she will send you home with a Holter Monitor attached to your belt, and this device will collect data about your cardiac functioning as you go about your daily activities. These data are invaluable and irreplaceable, and most physicians would not consider treating you without first collecting them. I think psychotherapy is about to enter the “Holter phase.” In the not too distant future, it will be unthinkable for therapists to treat clients without first collecting solid, real-time data about how and how well their client is functioning in his or her everyday life.
–Dr. Daniel Gilbert, professor of psychology at Harvard University and Senior Scientific Director of Mobile Therapy
HealthIT & mHealth: How did the team come up with the idea for Mobile Therapy?
Jacques Habra: I’m a serial entrepreneur and I often lecture at colleges and universities about what it takes to be an entrepreneur. One of the main things to be successful, productive and happy is to “know yourself.” You need to know your strengths, weaknesses, capacity, and patterns. The original idea was to build an app to allow for the average person to know themselves better. The smartphone can collect a tremendous amount of data and various environment variables on what someone is doing, where they spend their time, and how different locations and activities make them feel. Then, the goal was to provide real objectionable data to help them understand what they like and what they don’t like, when they are most likely to be successful, and when they should take a break. When we started to develop that product we realized that we had a really powerful psychology tool; we realized that giving the average person that information about themselves isn’t necessarily going to transfer to change. In order to change you really need an expert, in this case a clinical psychologist or medical professional to really embrace the treatment and help you as an individual to make actionable adjustments in your life to manage through the problems and opportunities that the system helps you discover.
HealthIT & mHealth: How does the patient typically interact with the SelfEcho app?
Habra: Throughout the day and based on geographical movements, the user is prompted to answer questions, with a frequency from one to ten times a day. The questions are always customized around the client. The client will get a notification that says “Time for a SelfEcho check-in”. The client can either dismiss the notification or complete the check-in. It takes about a minute to do a full check-in, which consists of a few questions followed by a Facebook-like status update of what you are doing, where you are and who you are with. The system knows your most common locations, most popular activities, most common people you interact with in order to allow for rapid input. This allows the clinician from various establishments, one of which is WhiteSands Tampa, to experience all of details of the check-ins in very meaningful psychological terms.
HealthIT & mHealth: What type of data does the Self Echo app collect on the patient?
Habra: Sixty percent of the data we are tracking is active data provided by the individual through momentary experience sampling surveys and about forty percent is passive data, that does not require end-user input. Linguistic analysis provides data to the Mobile Therapy system passively. SelfEcho is the only company in America that has a license to the LIWC System system out of the University of Texas in the field of psychotherapy. The LIWC system allows the app to extract emotional sentiment based on the words that patients use in emails or social media broadcasts. Our software analyzes the text and provides a score around things like positivity, negativity, social connectedness, and authenticity. It’s important to note that the Mobile Therapy platform in no way reads emails and no emails are downloaded. The LIWC system only numerically scores the content.
HealthIT & mHealth: Does the app collect accelerometer data from smart phones?
Habra: Yes, we tie into third party APIs like the Apple Health Kit to provide physical metrics alongside the psychological metrics. However, most psychologists simply want access to the psychological metrics, which is plenty of additional data for them at this point.
HealthIT & mHealth: What types of questions do you ask patients to collect active data?
Habra: The questions are all customized around the specific diagnosis of the patient. The clinician can chose which questions to ask the patient and create custom questions and metrics. A patient will typically be asked five to six questions at a time that focus on psychological metrics like stress, anxiety, depression, guilt, social connectedness, fear, anger, or concentration just to name a few.
HealthIT & mHealth: What type of algorithms and formulas do you use to analyze data?
Habra: Everything we use is based on scientific research and most of our algorithms and formulas are based on American Psychological Research papers. Everything is vetted through our science team and they are the ones that are designing the questions, the weighting of questions and the potential clinical benefits of the individual client data.
HealthIT & mHealth: Does the app give feedback to the patient?
Habra: The patients have the right to all of their data under HIPAA, but most clinicians do not want their clients to see any data at all because they could misinterpret the data. This is one of the reasons our product is targeting the end-user through the clinician; the only way the end-user can access the data and reports is through the clinician. The clinician has a sense of what the data means and how to make the data actionable. For example, if the data is suggesting that the client is having a really good day and they are feeling despondent that would be very confusing for the patient. In addition, if data suggests that the patient is depressed and they are feeling great about themselves, they might get depressed because they are supposed to be feeling depressed.
HealthIT & mHealth: Have you found that psychologists have enough time in their workday to analyze all the data?
Habra: That is the entire business model right there and the answer is that we encourage the clinician to offer one of three different types of programs. Mobile Therapy increases the clinician’s practice revenue, so with Mobile Therapy, the clinician can actually make more money. The light version, which clinicians usually offer for free or a nominal charge of ten to twenty dollars per month would involve the clinician looking at the data for five minutes before and five minutes after the session. The next level up entails having the clinician reviewing the data thirty to sixty minutes between sessions with a recommended extra charge of fifty dollars per month. The third level is known as concierge psychology, which enables the clinician to provide care right at the moment the patient needs it. For example, if the app detects that the patient is suffering from a bout of depression or having a panic attack, the clinician can be notified instantly and send the patient a reminder to practice breathing techniques or contact the patient for a therapy call or visit. Mobile Therapy recommends that clinicians charge at least one-hundred and fifty dollars for concierge psychology, however some clinicians charge as much as two-thousand dollars a month. Despite recommended charges, clinicians can charge whatever fee works best for their practice.
HealthIT & mHealth: Do patient’s insurance pay for the Mobile Therapy Service?
Habra: We are meeting with lawmakers and heads of insurance companies at the end of the month in DC to continue the process of obtaining an insurance code for Mobile Therapy and are hoping for an insurance code in three to six months.
HealthIT & mHealth: Do you currently integrate with any electronic health records?
Habra: We have been approached by a few EHR and EMR companies and we are exploring integration right now. One of the most promising integrations is with Microsoft, Microsoft has a product that they use with a big clinical community. We definitely see partnering with EHRs and EMRs to be the next step
HealthIT & mHealth: Is the Self Echo app HIPAA compliant?
Habra: Everything is HIPAA compliant, which was no trivial task. Everything from the way the phone encrypts the data to how data is transmitted to the server and the dashboard itself to the way the database stores the data is all HIPPA compliant.
HealthIT & mHealth: Which mental illnesses are patients currently using the app for?
Habra: So far people really benefit in cases of depression, anxiety/stress, relationship conflicts, and recently PTSD.
HealthIT & mHealth: Has the app been proven useful for patients who typically do not feel comfortable speaking with therapists?
Habra: That is a big factor, but to be honest with you, the biggest issue is that people do not remember how they felt and what made them feel that way, positive or negative. Clients enjoy the app because it’s a way for them to provide more data to their therapists and thereby feel more invested in their therapy. Some clients report sharing more intimate thoughts through the app than they would in live session.