Has mental health harnessed the digital revolution?

In their editorial, Hollis et al ¹ focus on the third of three digital revolutions – access to real-time patient data (‘connected health’) – but also highlight the benefits of the first two revolutions – unlocking value in electronic medical records and new forms of access that allow patients direct control.

How far have the first two digital revolutions embedded benefits for patient care in mental health? The first revolution (word-processing, from the 1960s) allowed people with little training to prepare, edit and duplicate high-quality documents. The second comes with the internet: ability to access, transmit, share and edit these documents. From these two revolutions, what can patients (and carers and professionals) expect as the outputs of the mental health IT system?

A basic expectation is that, before every face to-face clinical encounter, the IT system can easily deliver an accurate background history, account of recent treatment, and up-to-date care plan. (This list could be extended to include a summary history, complete history, and non-stigmatising vulnerability and risk history.) The safety of these documents is assured by accessibility (so that they are used and reviewed often) and accuracy (confirmed by patients and carers). They must be easily readable, to be safely understood, and actually used (as unread documents do not convey information).

The quality of these ‘output’ documents must convey respect for patients, carers and professionals and the interactions between them. For patients and carers, documents summarising core parts of their present or past lives must carry real-world acceptability in appearance and structure. Clinical staff able to take pride in their documentation (being clear, respectful, accurate and useful) will welcome sharing them with patients, carers and other professionals. Finally (as in the ordinary world) the IT system should save time for professionals (and patients and carers), freeing up treatment time.

Simple IT technology can deliver this for professionals, patients and carers. Hollis et al ¹ note that mental health patients' use of technology is similar to the general UK population, with three-quarters of adults accessing the internet daily, half via a smart phone. I have only anecdotal knowledge of how far mental health IT is delivering the benefits of the first two revolutions.

Hollis et al ¹ summarise key challenges for the third revolution in connected health:

‘first, ensuring that patients and their needs remain at the centre of technology development and implementation; second, rapidly increasing the evidence base for the clinical effectiveness of digital technology; third, ensuring that the opportunity provided by data sharing between patients, carers and clinicians does not threaten privacy and undermine public trust. Finally, patients, clinicians and NHS commissioners require an agreed framework to evaluate the core features of new technologies including usability, content, safety, clinical- and cost-effectiveness’.

These still apply with equal force to the first two digital revolutions.