A recent decision by the Centers for Medicare and Medicaid Services to start covering preventive screening for depression and alcohol abuse is paving the way for wider use of a mobile app that helps primary care physicians find signs of mental illness that might otherwise be missed.
As part of healthcare reform efforts, CMS said in October that it would pay for annual screenings for both conditions. The news followed by just a few months the release of a $2.99 iPhone app called mym3, a screening tool that walks clinicians and consumers through a 27-item questionnaire in about three minutes to look for not only depression but also anxiety, bipolar disorder and post-traumatic stress disorder.
"This one's unique because it screens for four different disorders at once," suggests psychiatrist Dr. Steve Daviss, CMIO of the app's developer, Bethesda, Md.-based M-3 Information.
The mym3 app actually incorporates three components: the consumer-focused depressioncheck screening tool; a Web-based version for physicians called M3 Clinician; and My Mood Monitor, which lets patients track their moods over time and share that information with their doctors.
The screening test assigns a score that, according to the company, "reflects the patient's overall need for treatment, measures functional impairment, and explores alcohol and substance abuse." It has proven to be surprisingly accurate. M-3 Information reports that a trial at the University of North Carolina showed that a score of 33 or higher corresponded to a 90 percent likelihood a patient had a diagnosable mental illness, while a score below 30 indicated a 10 percent likelihood.
The same UNC researchers, funded by M-3 Information, discussed the efficacy of the four-illness screening test in a paper that appeared in the Annals of Family Medicine in March 2010. The accuracy of the My Mood Monitor checklist "equals that of currently used single-disorder screening instruments and has the additional benefit of combining them into a 1-page tool," the study concluded.
Daviss calls the M3 screener "mostly a primary care tool," since primary care physicians manage more than half of all depression cases in the U.S., despite the fact that this country tends to put less emphasis on primary care than other industrialized nations. "But follow-up maybe is not as frequent as some in the mental health field would like," says Daviss, chair of the department of psychiatry at Baltimore Washington Medical Center in Glen Burnie, Md., and of the American Psychiatric Association's Committee on Electronic Health Records.
"Some docs set [mym3] up on an iPad in their office," Daviss reports. Physicians also use iPads to let patients fill out the self-assessment while in the waiting room, or patients can choose to take the screening test on their own smartphones or PCs.
The depressioncheck app gets more than 500 downloads a day, and sometimes as many as 1,000, according to Daviss. More than 700 people have left ratings on iTunes. "The fact that it has so many ratings really says something," Daviss says.
M3 Clinician users can send reports to a database in the cloud. Much like the questionnaire is a form of clinical decision support, the database functions like an EHR component since clinicians can see a list of all their patients. Daviss said M3 is working with the Department of Veterans Affairs and EHR vendor NextGen Healthcare Information Systems to integrate with their technology. The consumer and clinician apps are compatible with Microsoft HealthVault, too, but PHRs not tethered to a specific EHR product have tiny user bases so far.
Daviss is just starting to use the technology in his own, hospital-based practice, providing mental health consulting for physicians treating patients who, for example, were admitted for chest pains. Baltimore Washington Medical Center is just starting a test in an outpatient clinic.
M-3 Information is applying for a Logical Observation Identifiers Names and Codes (LOINC) code so data could come directly from a lab, Daviss says, and major lab companies are anxious to participate in all forms of health information exchange. Quest Diagnostics has an HIE subsidiary, MedPlus, for example. And just as cholesterol test results are broken down into components with easy-to-interpret values, Daviss believes physicians will want the M3 mental health scores, which have subscores for each of the four conditions. "Primary care docs are very attuned to looking at numbers," Daviss notes.
The reimbursement money -- generally $16 to $70 per screening, depending on the payer -- doesn't hurt, either. "Insurance companies … are incentivized to get these patients screened and diagnosed and treated on an outpatient basis," says Daviss. A single hospitalization resulting from an undiagnosed mental illness can, of course, cost thousands of dollars.