HTN recently caught up with James Reed, consultant forensic psychiatrist and physician executive at InterSystems, to chat about recent projects and key opportunities for digital transformation and technology in the mental health space.
Along with his work in the NHS, James’s role at InterSystems involves working as part of the clinical executive team in areas of the business where there is a need for clinical input, including work with prospective and existing customers, clinical safety, usability, and to support the business as a subject matter expert.
Contextually, James noted that mental health services have never had a higher profile, and there is a much greater public awareness than there has ever been of the importance of mental wellbeing and the impact of mental illness. This has in turn led to an increasing demand for mental health services which have (along with the rest of the NHS) been put under significant pressure. The charity Mind states one in four people will experience mental health problems of some kind each year in England, and one in six people report experiencing a common mental health problem (like anxiety and depression) in any given week in England.
Over the years, the delivery of mental health has moved from large hospitals into a community-based model. This has brought benefits in terms of bringing care closer to patients, but also challenges, as care is delivered in numerous settings and it can be difficult to make information broadly available.
Technology has an important role to play, both in terms of supporting individuals in maintaining good mental fitness, but also in enabling mental health services to deliver high quality care to those with mental illness and other mental disorders.
Identifying key opportunities for digital mental health care
With a growing interest in the concept of maintaining mental fitness and wellbeing in a similar manner to physical fitness, we have seen the development of an enormous number of apps and self-help services becoming available, which provide access to advice, support and forms of treatment. These can help people remain mentally well, and also allow mild symptoms of some illnesses to be effectively treated. However, once needs become more complex, this will need intervention from mental health services.
“Mental health services are in an interesting position, because from a digital point of view they’ve led the way,” James reflected. “In England, there are about 50 mental health trusts. All of them have electronic systems of some sort, many of which have been in place for a long time.”
There are positive implications for this, James considered, as it means that in some respects the initial work has been done – at least in terms of the move from paper records to digital systems. The key driver for this has been that the nature of mental health services these days has moved from the single, large psychiatric hospitals format, to care being based in multiple, smaller, community locations. Often in a chronic condition, someone needing mental health services will present in different locations, so digital systems are essential to ensure crucial care information is available to those that need it, wherever they happen to be.
Now that EPRs and electronic prescribing are largely in place, the next challenge is making maximum use of the technology. “You can use electronic systems in the same way as paper records, and that’s OK to a point; but it’s not making the most of what you’ve got. It’s about thinking differently in terms of what that technology enables you to do. We have a wealth of information at our fingertips with many of these systems, how we use it to help improve the health of our patients is up to us. I think you have to come at it from a different angle, think of what you would like and then see how the technology can fulfil that.”
This could be a case of using workflows in a more efficient way, or exploring new opportunities such as artificial intelligence, James continued.
“AI has the potential to help resolve one of the biggest problems in mental health – the sheer volume of information, unstructured narrative, and long reports which mental health services have to process. When we’re dealing with patients, we often have 10 – 15 years’ worth of electronic records to go through; that makes mental health services more complex. I’m excited about the possibility of using AI to help us make sense of these records, to look for the key clinical insights in of all the noise. For example, information about a negative reaction to a drug that might have been given 11 years ago could easily be missed if it were buried in a note somewhere. If AI can find that nugget of information it could result in a different treatment approach and a better outcome.”
The role of technology in supporting patients
With regards to the role of technology in supporting patients, James first raised the challenge of patient engagement. “It can be difficult, as due to the nature of mental illness, patients may not engage with treatment, with services and so on. Simple things like patient portals and the NHS App are helping, by even just reminding people when their appointments are.”
This is already an improvement on 10 years ago, when a lot less people owned a smartphone, James pointed out. “Now, the numbers of people with access to technology like that are much higher. That means it is becoming less of a barrier for our patients.”
Waiting list management is another area in which James sees potential for tech and digital to make a difference, noting how tools such as chatbots can be used to move people through the list with more speed, help support with rapid triaging, and help ensure people are seen in the right place at the right time by signposting.
Coming back to AI, James shared the view that AI could be a real help in resolving long waits for mental health services. “Patients can spend two years on a waiting list for an issue that could have been dealt with long before the appointment, which is not simply a waste of the patient’s time but delays like this could also negatively impact on their clinical condition. I think there’s a lot we can do with technology to ease that kind of thing.”
With particular focus on patients with mild to moderate mental health issues, there are also opportunities for technology to help encourage self-management, James continued. “In some cases that’s already happening, like digital and online therapies for mild to moderate depression, for example, which can be accessed by anybody at any time. A lot of the time, it’s just a case of providing the right resources, and pointing people in the right direction. A lot of these tools are out there right now, but not necessarily very well curated.”
Digital projects in the mental health space
James shared some details on different projects he has been involved in during his time at InterSystems, including a longstanding project originating in Birmingham and relating to the sharing of mental health data between providers.
”Sharing mental health data is much more commonly done these days”, said James, “but when we started that project back in 2017, sharing mental health information was seen as technically and politically a very difficult topic. We proceeded anyway, because there was a clear need in Birmingham on the back of a very serious incident involving a homicide which identified that key information about the individuals mental health had been known by particular organisations, but wasn’t shared.”
At the time, this was a “pioneering” system, James said, bringing together mental health data from four separate geographical areas and four different trusts. It ultimately “paved the way” for a much larger scale data and information sharing system: a shared care record which “incorporates pretty much everything, not only in Birmingham and Solihull, but in the two neighbouring areas of Coventry and Warwickshire, and Hereford and Worcestershire”.
James also raised a project in the Republic of Ireland, where the National Forensic Mental Health Service built a brand new hospital to provide secure mental health services, and chose InterSystems to provide their electronic health record.
“That’s been a great success.,” he said, ” We’ve been able to show that it is possible to deliver a good standard of care in a specialist setting, using our software. As a psychiatrist I’m really pleased to see the company’s products supporting good mental health care delivery.”
Achieving true digital transformation in mental health services
On what the NHS needs in order to facilitate true digital transformation within mental health services, James reiterated his earlier thought that putting in the infrastructure, the basic systems, and the foundations for digital transformation are important first steps; but far from being the complete solution.
“The difficult bit is thinking differently about our services now we’ve got all this infrastructure,” James considered, “and how we can use this in an innovative way to deliver our services differently – because the current model is under pressure. We saw glimpses of that during the pandemic, when there was a big shift to online consultations. They’re not for everybody but they certainly have their place, and I think we need to do more work to understand which groups of patients benefit most from that approach.”
A willingness to embrace some of the emerging technologies and innovations being introduced is also important, James said, but there’s still a lot of work to do. “No-one still quite knows at what stage you should use an AI system in clinical care, how to test those things out, how to use them. To some extent we’ll have to be willing to take a leap of faith, and start using things in situations where we think there will be a benefit, because otherwise we risk being left behind.”
Looking back on the history of medicine, James elaborated: “There have been times when big innovations have been seen as bold and perhaps a bit risky; but sometimes if we don’t take those risks we’re never going to drive things forward. My hope is that with the right level of assurance we might be able to deploy some of these technologies.”
James raised some examples of potential uses for AI, including assisting with triaging patients so they don’t have to wait so long, or using it to summarise clinical consultations and reduce the amount of administrative time spent there. “The technological capability is there if we’re willing to embrace it,” he said. Acknowledging that it is understandable that clinicians and patients would be hesitant around adopting something new, James added: “But the only way we’re going to know is by starting to cautiously test this stuff.”
When it comes to summarising notes, he continued, it is natural that busy humans with intense workloads will make mistakes – or they may not have time to pick up the task at all. “If you’re trying to see a patient in A&E and you’ve got just 10 minutes, you’re not going to be able to read three volumes of notes; whereas if you’ve got an AI summary you can quickly review, even if it makes a few mistakes, it’s probably better than not doing it at all. However, we need to remember that it has been generated by AI and treat the conclusions with care.”
James likens the space that healthcare technology is in now to the 1930s onwards, “when synthetic chemistry was quite new, and labs were making substances all the time. Things were quickly moving into clinical settings, and we discovered numerous drugs in a very short space of time. That was a period of great innovation, and I feel we have the potential for that again now. But the areas I see the real big benefits for are in the slightly risky territory, or the more patient-exposed areas. But that’s where we can maybe save clinicians half an hour per patient, which would be massive.”
He emphasised that it is integral not to lose sight of the patient in all of this. “If a patient could be sent a summary straight out of a consultation, translated into their language, perhaps simplified to make it more understandable, that would be huge. At the moment, they go home and they might get a letter in the post a month later, which might be understandable to them, or it might not; and that’s not helpful, particularly if you’re maybe suffering with depression and you struggle to retain information. If you get it straight away there’s a much better chance of it being useful.”
Overcoming challenges and hesitancies around innovation in the NHS
Looking again to history for comparisons, James referenced the way the pharmaceutical industry had developed, and that the fast pace of development in the 1950s was followed by some well-publicised problems.
“That led on to increasing regulation of the pharmaceutical industry,” he said, “which was clearly a good thing; but what it means is that now to develop a new drug is very expensive and can take a long time to get to market.
“I think it would be a shame if we end up with such a high degree of regulation for technologies like AI that it becomes very difficult to progress anything. We need to find a way of building confidence, and get a reasonable assurance mechanism in place. We also need to recognise that these systems allow us to do things that we otherwise wouldn’t do at all, and risk of doing nothing must also be considered.”
Ultimately, from his NHS perspective, it would be “brilliant to be able to use AI to search through the reams and reams of data that many patients have, and pick out or summarise a few key pieces of information. For example, perhaps the patient tried a certain drug some years ago and it didn’t work. It would be so good to be able to know that, especially at a point of crisis, when you don’t have the time to read very much.”
Looking ahead
Regarding InterSystems’ plans for the next three years or so in mental health, James said: “We’re always looking for new ways in which our products can be used, and we’re definitely interested in exploring what opportunities there are in the mental health world. There’s also a lot of talk about ICSs doing more whole-system procurements, so it would be really interesting to provide a solution for a whole ICS area.”
The company is also looking to build on the work in Ireland. “We’re keen to pursue further opportunities in mental health settings, because fundamentally mental health services are not really so different from any kind of health services and deserve the best quality software available.”
On a personal level, James said that he is enjoying working for InterSystems, and shared that he is keen to ensure that mental health data is included in projects like the Shared Care Records. “I think that historically, at least, mental health has often been overlooked; but it’s starting to get better now.”
We’d like to thank James for his time, and for sharing his insights with us.
