Implementation of Cognitive Behavioral Therapy in e-Mental Health Apps: Literature Review.

BACKGROUND: To address the matter of limited resources for treating individuals with mental disorders, e-mental health has gained interest in recent years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions accompanied by cognitive behavioral therapy (CBT). OBJECTIVE: This study aims to identify the therapeutic aspects of CBT that have been implemented in existing mHealth apps and the technologies used. From these, we aim to derive research gaps that should be addressed in the future. METHODS: Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by 2 reviewers, who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively. RESULTS: Of the 530 retrieved citations, 34 (6.4%) studies were included in this review. mHealth apps for CBT exploit two groups of technologies: technologies that implement CBT techniques for cognitive restructuring, behavioral activation, and problem solving (exposure is not yet realized in mHealth apps) and technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enables patients to self-manage and self-monitor their mental state and access relevant information on their mental illness, which helps them cope with mental health problems and allows self-treatment. CONCLUSIONS: There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on the efficacy of the mHealth interventions and their side effects, including inequalities because of the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is also required to integrate and test psychological theories to improve the impact of mHealth and adherence to the e-mental health interventions.

Digital Health Intervention to Support Refugees in Switzerland.

Experiences of war and persecution often lead to mental health problems, resulting in post-traumatic stress disorders. In this work, we design a digital platform that aims at helping refugees coming to Switzerland by providing exercises for their mental health and information about daily life in Switzerland. In collaboration with the Swiss Red Cross (SRC), we collected requirements and developed a concept for information provision through in this platform. The architecture of a progressive web application (PWA) was identified as to best fulfill the given requirements. Based on the collected requirements mockups were created. In user interviews, we received feedback regarding the future system. We learned that the platform should include an avatar, which guides the user through the entire platform and asks questions. All texts should be accessible by a read-aloud function and exercises should be provided as videos. In summary, we learned that it is essential to involve the future user group in the development process since it is characterized by cultural diversity that has to be considered in the development and design. Enriched by this input, the next step is to realize the application in terms of a prototype.

Dashboard Visualization of Information for Emergency Medical Services.

In emergency situations, every minute counts. Therefore, staff of emergency medical services (EMS) require easily accessible sources of information to organize and coordinate their work as quickly as possible. Digital dashboards can visualize various information at a glance and have thus potential to meet this need. We developed in cooperation with the Emmental Hospital a prototype of a dashboard, which aims to improve organizational aspects of the EMS. METHOD: A literature search was conducted in PubMed, IEEE and ACM. The goal was to identify design principles for dashboards. Additionally, several interviews and meetings were held with the EMS staff of the Emmental Hospital and with those of another hospital. The aim was to identify requirements of the EMS staff towards such an organizational dashboard and to transform them into use cases. RESULTS: Considering the collected requirements and standards of dashboard design, a prototype of a dashboard was developed. It consists of several modules that show relevant information items such as news or traffic information. Due to this modular development, content is easily interchangeable. The most important information for the EMS is shown on the dashboard aiming at saving time for information gathering. CONCLUSION: A digital dashboard offers many advantages and optimization possibilities compared to an analog whiteboard. For example, such a dashboard can be connected to other systems and data can be automatically included. Although we developed our dashboard in cooperation with the EMS of a specific hospital, it can easily be applied and adjusted to other EMS. As a next step, we will perform usability tests with the prototype and start implementing the dashboard.

How to Motivate Children with Severe Disabilities to Adhere to Their Therapy?

Rehabilitation therapies after a serious accident or disease are usually repetitive and lengthy, requiring high motivation and adherence of the patients to achieve therapy goals. Moreover, the exercises are often painful leading to a decrease in motivation. Keeping motivation and adherence on a high level is even more challenging when the patient is a child or youth. In this paper, we address the question how to motivate this patient group to continuously attend therapy sessions and repeat the painful exercises. To address this issue, we developed the mobile application PAPP with integrated motivation concept that stimulates intrinsic and extrinsic motivation by corresponding features within the app. The intrinsic motivation is considered by means of gamification. An ice bear called "Teddy" and his journey to Spitzbergen is introduced and accompanies the patient journey. The extrinsic motivation is implemented by introducing the virtual currency "Papp-Taler" with integrated rewarding system. The usability test results show promising results. The app still requires extensions such as an external data storage to enable therapists and parents to monitor the progress. In future, it will be possible to use the app in a study to investigate whether it can motivate young patients to adhere to their therapy and whether that has a positive influence on the therapeutic outcome.

Creating Individualized Education Material for Diabetes Patients Using the eDiabetes Platform.

Diabetes mellitus (DM) is a chronic disease that affects many people in Switzerland and around the world. Once diagnosed, a patient has to continuously monitor blood glucose, manage medications or inject insulin. Technical skills and competencies as well as knowledge on disease management have to be acquired right after being diagnosed. Diabetes consultants support patients in this process and provide educational material. While the process of generating patient-tailored material is currently complex and time consuming, in future, the eDiabetes platform can help. The platform developed in cooperation with the consulting section of the Swiss Diabetes Society offers the opportunity to create individual patient information and instructions to teach technical skills and knowledge on diabetes. Further, an integrated forum allows exchanging information and discussing issues regarding diabetes counselling on a secure platform. Usability tests showed that eDiabetes is easy to use and provides benefits for diabetes consultants and patients.

Facilitating the Information Exchange Using a Modular Electronic Discharge Summary.

BACKGROUND: Discharge summaries are a standard communication tool delivering important clinical information from inpatient to ambulatory care. To ensure a high quality, correctness and completeness, the generation process is time consuming. It requires also contributions of multiple persons. This is problematic since the primary care provider needs the information from the discharge summary for continuing the intended treatment. To address this challenge, we developed a concept for exchanging a modular electronic discharge summary. METHODS: Through a literature review and interviews with multiple stakeholders, we analysed existing processes and derived requirements for an improved communication of the discharge summary. RESULTS: In this paper, we suggest a concept of a modular electronic discharge summary that is exchanged through the electronic patient dossier in CDA CH level 2 documents. Until 2020, all Swiss hospitals are obliged to connect to the electronic patient dossier. Our concept allows to access already completed modules of the discharge summary from the primary care side, before the entire report is entirely finalised. The data is automatically merged with the local patient record on the physician side and prepared for data integration into the practice information system. CONCLUSION: Our concept offers the opportunity not only to improve the information exchange between hospital and primary care, but it also provides a potential use case and demonstrates a benefit of the electronic patient dossier for primary care providers who are so far not obliged to connect to the patient dossier in Switzerland.

A First Standardized Swiss Electronic Maternity Record.

BACKGROUND: During the nine months of pregnancy, women have to regularly visit several physicians for continuous monitoring of the health and development of the fetus and mother. Comprehensive examination results of different types are generated in this process; documentation and data transmission standards are still unavailable or not in use. Relevant information is collected in a paper-based maternity record carried by the pregnant women. OBJECTIVES: To improve availability and transmission of data, we aim at developing a first prototype for an electronic maternity record for Switzerland. METHODS: By analyzing the documentation workflow during pregnancy, we determined a maternity record data set. Further, we collected requirements towards a digital maternity record. As data exchange format, the Swiss specific exchange format SMEEX (swiss medical data exchange) was exploited. Feedback from 27 potential users was collected to identify further improvements. RESULTS: The relevant data is extracted from the primary care information system as SMEEX file, stored in a database and made available in a web and a mobile application, developed as prototypes of an electronic maternity record. CONCLUSION: The user confirmed the usefulness of the system and provided multiple suggestions for an extension. An electronical maternity record as developed in this work could be in future linked to the electronic patient record.

Improving Patient Safety with a Mobile Application for Patients with Peripherally Inserted Central Venous Catheters (PICC).

Peripherally inserted central venous catheters (PICCs) are of growing interest because they allow intravenous therapies up to several months. The appropriate management of the PICCs is crucial to minimize complications and largely depends on the right information for everyone who cares for the patient. To reach this goal we develop the mobile application "PICC App" to provide the necessary information for all involved persons in the outpatient setting. We expect to be able to report about the PICC App and the results of the usability evaluation with pilot users.

A Novel Approach to Teach Medical Informatics.

The Bern University of Applied Sciences established the first Swiss Bachelor of Science in Medical Informatics. We demonstrate the specifics of the new curriculum that was based on requirements analysis and includes seminars and live case studies to enable problem-solving abilities.