[PPT] - reform (For the users: access and quality!! For the funder: sound PowerPoint Presentation

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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 Ian.hickie@sydney.edu.au

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The University of Sydney Page 2

UK UK Go Govt vt Of Offi fice ce f for

r Scienc

Science e 20 2008 08

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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

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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)

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Percentage distribution of YLD by mental disorders and nervous system disorders, Australia 1996

10 20 30 40 50 60 70 0-14 15-34 35-54 55-74 75+ Years of age Percent of total YLD Mental disorders Nervous system disorders

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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)

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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

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The University of Sydney Page 8

Recommendations

10/0 3/20 8

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The University of Sydney Page 9

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NATIONAL MENTAL HEALTH COMMISSION OUR RECOMMENDATIONS ON TECHNOLOGY

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The University of Sydney Page 10

$40m Co-operative Research Centre for Young People, Technology and Wellbeing

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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’.

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The University of Sydney Page 12

Mental Health eClinic: example dashboard of results

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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

nline alert

No suicidality High suicidality Low suicidality Email contact within 24 hrs Urgent Follow up and/or escalation required No further escalation required Clinical service

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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

Online

assessment (survey and ‘video visit’)

Stage

1a

(help-seeking

subjects with mild-moderate severity

f

symptoms)

Stage 1b+

(attenuated

syndromes)

headspace

appointment

Stage

1a

(help-seeking

subjects with mild-moderate severity

f

symptoms)

24 19 Stage 1b+

(attenuated

syndromes)

4

26

Comparisons of assigning to Stage 1b+ (attenuated

and actual syndromes), n=73

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The University of Sydney Page 15

Share plan (decision tool) wireframe - clinical support

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The University of Sydney Page 16

Configuring the MHeC for an inpatient unit

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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)

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The University of Sydney Page 18

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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

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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.

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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