The technology to build mobile health (mHealth) apps to manage mental disorders is increasingly commonplace, yet their integration into clinical care has lagged. To gain an understanding of how to incorporate a patient-provider mHealth platform into the clinical care of rural patients with complex psychiatric conditions, the Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT) team created and deployed a smartphone app.

The app is designed to provide a patient interface with the UW’s clinician-facing tool, the Care Management Tracking System (CMTS). The app allows patients to self-monitor and report symptoms to their care manager by completing rating scales for depression (PHQ-9), mania (SPIRIT mania scale), PTSD (PTSD Checklist for DSM-5, PCL-5), and medication adherence. They can see a graph of their scores to track their own weekly progress over time and it offers psychoeducational materials about their condition, psychiatric medications, and tips for managing common side effects. The app is also customizable with a Reach Out for Help module to make phone calls directly to supportive, self-programmed contacts such as friends, family, or care providers. Since it’s directly integrated with CMTS, care managers can register patients and manage accounts through CMTS and easily view data that patients enter into the SPIRIT app.

A new paper published in the Journal of Medical Internet Research from Amy Bauer, MD, Sarah Hodsdon, Jared Bechtel, and John Fortney, PhD, reports early findings of their ongoing study. Early feedback from patients indicates that the SPIRIT app earns high scores for usability among active users. A majority of the initial patients using the SPIRIT app are self-monitoring symptoms on a biweekly basis over a period of several months, which are intervals that are clinically meaningful for supporting measurement-based care. The SPIRIT app team employed a human-centered design process based on the Principles for Digital Development, a set of best practice guidelines for mobile design. Based on the SPIRIT experience, the team proposes to extend this framework with five additional principles: design for public health impact, add value for all users, test the product and the process, acknowledge disruption, and anticipate variability. These principles can inform future efforts to improve health care quality and outcomes by integrating mobile tools into clinical care pathways in rural practice settings.