News > Details
09/22/2009 - Medullan's September Newsletter With Featured Client: Veritas Health Solutions (VHS)
In this issue, Medullan is pleased to feature Veritas Health Solutions (VHS) and our joint efforts in developing a solution to help adolescents with depression. In March 2009, VHS received an SBIR grant to develop a Technology Enabled System for the Treatment of Adolescent Depression (TESTAD) worked closely with VHS to develop this innovative treatment administration and management system that will make optimal adolescent depression care significantly more accessible and affordable to larger segments of the population. This prototype will be tested in the field this fall.
Medullan congratulates the VHS leadership team for their hard work and passion in integrating technology and healthcare to improve the quality and accessibility of behavioral healthcare.
Interview with the Leadership Team from Veritas Health Solutions
- Please describe VHS and its vision.
- What is TESTAD?
- What are the challenges faced in the treatment for adolescent depression that drove the need for a solution like TESTAD?
- Has the TESTAD (or telephone-based) solution model ever been used in the treatment of psychological disorders?
- Are there any risks involved in this type of remote treatment where the clinician is unable to observe the patient or detect changes in mood?
- How does this solution change the current patient/clinician relationship?
- Why did you select Medullan and what role did they play?
Please describe VHS and its vision
Founded in 1997, Veritas Health Solutions LLC (VHS) is a behavioral and mental health research firm with a mission and vision that emphasizes the development and implementation of clinical and system innovations that seek to improve the quality of behavioral health care in primary care populations. VHS's vision is to be the innovation leader in the development of technology-supported, evidence-based behavioral interventions, tools, and methods for the integration of behavioral health into primary care. VHS programs leverage technology to increase patients’ active participation in their own care. The company designs and delivers patient-centered automated or semi-automated systems that integrate behavioral health into primary and specialty care processes for use with patients with chronic medical conditions or psychiatric disorders. TESTAD is one of our current products being developed in collaboration with Medullan.
TESTAD stands for Technology Enabled System for the Treatment of Adolescent Depression. It is a system that uses real-time structured interviews of patients in combination with clinical data from their medical records and risk-stratifying models based upon clinical complexity and severity to guide care managers in the delivery of tailored interventions in their oversight of the care of depressed adolescents in the pediatric primary care setting.
The national shortage of child psychiatrists is a major public health problem. Most adolescent depression first presents in the pediatrician's office, yet pediatricians are caught between a rock and a hard place: they worry about the risk of suicide -- an increasing risk in the adolescent population -- and the scary FDA-mandated "black box warning" that alerts pediatricians to the risk that SSRI antidepressants may potentially increase suicidality. Then, the waiting time to get a child an appointment to see a child psychiatrist is often unacceptably long, so what can the pediatrician do?
Clinicians use the telephone for delivering care routinely in mental health and general medical settings. For example, when a patient calls in a crisis and needs counseling over the phone or medication. But I think what you mean to ask is whether care is delivered over the phone routinely in ways that would ordinarily be provided face-to-face. The answer is yes. This occurs in two ways. One is the use of structured or “manualized” telephone-based psychotherapy or “talk therapy.” For example cognitive behavior therapy, or CBT, can be delivered over the phone by specially trained nurses. The other telephonic approach is the use of automated, computer-based systems that provide interactive, tailored behavioral treatment delivered over the phone. Both these approaches have been evaluated and telephonic care for depression in adults has been shown to be clinically effective in studies conducted in the U.S., Great Britain and Australia. However, to our knowledge, the use of computer-assisted telephone interviewing (CATI) or other technology-supported care have not been studied previously in adolescent populations or pediatric primary care settings. The TESTAD provides an alternative to address the manpower shortage faced by our broken clinical system. TESTAD also addresses issues related to access to specialty care, quality improvement, patient safety, patient adherence, evidence-based medicine, and dissemination of best practices.
First of all, TESTAD has the potential to improve patient safety if it increases access to care that would otherwise be unavailable while at the same time enabling limited health care resources to be used more appropriately for those who need care the most. That said, quality and safety standards require that a patient be known to the clinician or practice from a prior face-to-face evaluation. TESTAD is not a substitute for care but is a method to augment standard clinical care. In that sense, the TESTAD program improves care by collecting additional information often not available for guiding treatment such as interval history symptom reports that can be tracked in between standard office visits. This additional monitoring will alert the care manager to patients whose depression recovery progress is lagging. It may also detect adverse drug reactions, the emergence of suicidal thoughts or urges, use of alcohol or drugs, and other factors that could complicate the successful treatment of a depressed adolescent. The system will generate alerts that will be reviewed by the care manager and referred to the clinician when warranted.
How does this solution change the current patient/clinician relationship?
The use of TESTAD is expected to strengthen the team approach to depression management by facilitating collaborative care. Currently, adolescents with depression are often referred by pediatricians to child psychiatrists. This can be problematic as they are scarce and often have long waiting lists. The pediatrician is left with worrisome responsibility while waiting for a behavioral health specialist to take on the care of the patient. Collaborative care is a better model but practices need additional support, including depression care managers and decision support tools. Studies have shown convincingly that when a case manager is introduced into a collaborative care program for the population-based management of adult depression, the presence of the care manager is associated with better clinical outcomes. The more challenging patients can be quickly identified and referred, making better use of specialist referral resources, and the less complex patients can be managed more effectively in the primary care setting with the added expertise that the system can impart to the clinical team through its capacity to provide decision support, patient monitoring, adherence monitoring, and tailored recommendations for supported self-care. We anticipate that TESTAD will lead to more satisfied patients, families, nurses, and pediatricians.
In a nutshell, TESTAD is expected to be one of a suite of products offering decision support tools for clinical systems to use in supported self-care programs for patients and families.
Why did you select Medullan and what role did they play?
As a behavioral telehealth company, our long suits are the behavioral health and health services research domains. We know a great deal about how to integrate behavioral health into primary care and about health system innovation and drivers of change. However, we value a partnership with a company like Medullan that has significant technology assets in the healthcare space. We have known the principals in Medullan for several years and have been impressed with their experience, intelligence, and commitment to the use of cutting edge technologies to improve health care. They have been outstanding collaborators in every way and a delight to work with. The VHS team is impressed by the professionalism and high standards the Medullan team brings to the partnership. We look forward to ongoing and future collaborations.