In my last blog, I wrote about the impact of the private sector including tele-medicine strategies and social media on youth suicide. This week I’d like to talk a little more about innovations in technology that have an impact on youth suicide as well as their implications for data and privacy.
Technology has been used more in mental health over the last two decades. There are apps for tracking mental health and new medications that use technology to show medication compliance.
I was able to listen to a presentation by a drug representative at one of my clinical sites last year for the drug Abilify MyCite. Abilify is used in children and adults. It is approved for children and adolescents for some disorders and used off label as well. Abilify is a medication approved for the treatment of schizophrenia and bipolar one disorder (FDA, 2017). Abilify MyCite was recently approved by the FDA and it is the first pill to have a sensor that can track the patient’s medication compliance by signaling to a wearable patch that the medication was ingested (FDA, 2017). The data collected can be transferred to a phone app and the patient can choose to allow their provider or family members to have access to the data. This is a great opportunity for patients who are court ordered to be able to show their compliance with medications. The patch also has the ability to track the patient’s activity level with a pedometer and the time spent resting using a sensor that can track whether the patient is lying down (AbilifyMyCite, 2020). Within the app the patient can also track their mood, how well they rested and why they missed their pill, if applicable (AbilifyMyCite, 2020).
This is an innovative new technology that has many positive and negative implications. This would be a great way to help patients remember to take their medications and be more aware of their mood. This could help decrease suicide by increasing compliance and helping patients be aware of when they may need to schedule an appointment with their provider. When I first learned of this medication I wondered how this changes the provider’s liability if they have access to this information. If the provider has access to the information and can see that the patient is not taking their medication, is extra active, and not sleeping, are they ethically and legally responsible for reaching out to the patient? Or perhaps the patient is not taking the medication at all and they have been resting too often, could this be a sign that the patient’s mental health is deteriorating and should the provider send help? Apps that track mood can be wonderful for patients. However, if providers have access to this information the amount of data would be overwhelming. Luckily, this medication and mood tracking apps are voluntary for patients so it is their choice to opt in to using them. Although, some are concerned that insurance companies may provide incentives for patients to use medications with sensors and that is too much like coercion to use the medication (Belluck, 2017). Parents may want their children to take this medication as a way to make sure they are being med compliant and this may feel like a breach of trust to the child. This may be just the beginning of this type of technology for medication tracking, so it is important to be aware of the ethical and legal implications so we are prepared for the future.
AbilifyMyCite. (2020). What is the ABILIFY MYCITE system? Retrieved from https://www.abilifymycite.com/about
Belluck, P. (2017). First digital pill approved to worries about biomedical ‘Big Brother.’ Retrieved from https://www.nytimes.com/2017/11/13/health/digital-pill-fda.html
FDA. (2017). FDA approve pill with sensor that digitally tracks if patients have ingested their medication. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-pill-sensor-digitally-tracks-if-patients-have-ingested-their-medication
Child and Adolescent Suicide in Arizona 
Mykaila,
The Abilify Mycite product seems like a leap forward in terms of caring for patients with psychiatric conditions. It sounds like it might give patients more freedom to live life on their own terms but keep them accountable and keep providers informed. Considering the impact that sleep and activity can have on mental health, it is also really cool that the app can track that information. I think the concerns that you bring up about the technology are valid. Providers are always dealing with ever-increasing amounts of data. It seems like adding this type of technology to a care regimen may almost constitute a type of “alert fatigue”. Hopefully time will tell whether this is something that is beneficial for patients and providers alike.
Evan Eisenberg, BSN, RN, ASU DNP Student
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You found an interesting technology innovation with the Abilify app. I was most interested in the concept of data privacy provided by the app because of the implications of mental health and privacy. Apparently, Otsuka America Pharmaceuticals provides data encryption at an acceptable level (2020). With the higher level of data privacy expectations for mental health records, and the legal protection surrounding a pharmaceutical company, I think you’ve found a very interesting example of a private company that has found a way to provide data security at a level to satisfy their lawyers. This is no small feat.
You mentioned a concern about the liability of healthcare providers caring for patients who use the app but may not be compliant with the therapy. In the current healthcare environment, I frequently see poor coordination between healthcare providers and their patients. I think we will always see patients who are none compliant or partially compliant, and this is a patient’s right. Technology is a tool, and I hope we continue to see it as such; and also, that a person’s rights and choices are always their own. The value-add I see being offered by the Abilify app is the person can track their medication compliance, activity level, and mood; and they will have data to help them understand what works for them and what doesn’t.
References
Otsuka American Pharmaceuticals. (2020). What is the AbilifyMyCite System? Retrieved from AbilifyMyCite: https://www.abilifymycite.com/about
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“Technology is a good servant but a dangerous master.” — Christian Lous Lange
One prescient truth about our contemporary reality is that technology or its permuted advances are continually exhibiting and exerting increasing levels of influence throughout many areas and domains of our social, physical, and metaphysical lives. An area directly subject to this encroachment by technology is the domain of healthcare services delivery both from a physical and mental health perspective. While this blog post initially discussed, from a thoughtful and reflective viewpoint, the many positive aspects that technology might offer in delivering better quality and wider-access to patient care, it may also fail to adequately address the potential adverse outcomes that may arise with the interaction and further integration of technology into the realm of healthcare service delivery.
Specifically, responding to the example provided here about the Abilify MyCite patch, some might regard this technological advancement as unacceptably dystopian in its possibilities for adverse outcomes to outweigh the potential benefits associated with this innovation. Of the approximate $2 trillion spent each year on health care in the U.S., it is surprising that, of the total amount spent annually, only ten (10) percent is attributable to medications, two (2) percent goes to diagnostic tests, and the remaining allocation (nearly 85 percent) applied in the forms of direct patient care for the ill and healthcare-related administrative costs (Wallach, 2015). Reasonably acceptable is the premise that “the prevention of illness has the greatest impact on reducing health care costs and patient expenditures” (Wallach, 2015).
However, much as previously alluded to, the danger arises when we begin to consider the critical ethical and legal implications of all future applications of technology rather than the immediate intentional uses or design conceptions. For instance, the example provided discusses that “[this] patch can track the patient’s activity level with a pedometer and other patient behaviors as well as other potentially relevant patient information such as mood, sleep duration, rest levels attained, and missed dosages in the prescribed dosing regimen” (AbilifyMyCite, 2020; Hartman, 2020). What is not immediately apparent is whether the device (patch) produces other readily identifiable patient data such as GPS location, real-time positioning, travel tracking, or other types of geotagging or metadata sources? Tracking patient compliance and medication adherence data is also a cause for concern. Where does this type of data gathering end up in transfer or who has access to such compliance data (e.g., restricted access only to healthcare providers and professionals or other third-parties like court systems, law enforcement agencies, or pharmaceutical manufacturers)? It is likely that patients may agree to some level of data disclosure but then place limitations on other levels. The previous discussion also states that some of the features are available as opt-in from the patient-user experience perspective, but that may only partially reflect the overall risk of such an innovation in that it fails to account for whether metadata gathering is subject to opt-in or direct patient consent.
Overall, it sounds like this innovation exhibits extraordinary potential and capacity for ensuring the consistency of mental health treatment. But it remains unclear if those possible benefits outweigh the risks to patients.
References:
Wallach, W. (2015). A dangerous master: How to keep technology from slipping beyond our control. Philadelphia, PA: Basic Books/Perseus Books Group.
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