Against a sea change in real-world practice of technology in psychiatry, John Torous, MD, MBI, shares what clinicians can expect next.
The year 2020 brought many unexpected changes that including a dramatic uptake in the use of telepsychiatry and digital mental health tools like smartphone apps. While numbers continue to pour in, early reports suggest that before COVID-19 perhaps only 20% of clinicians were using telehealth platforms and that number rose to roughly 80% in the wake of COVID-19.1 Change was not limited to just video visits, and interest in mental health apps and other asynchronous technologies has also expanded.2 Against this background, what can we expect for 2021?
As video-visits and telepsychiatry becomes more common in care, integrating digital data from smartphones and wearables will become even more important. Both clinicians and patients will want to use devices that are able to synchronize data with electronics medical records. The era of stand-alone apps and wearables will not come to an end in 2021, but the popularity of such isolated products will begin to wane.
The increased use of telehealth in 2020 also highlighted the fact that not everyone has access to high-speed internet or a device that will allow them to partake in digital care.3 Beyond devices, ensuring training and resources to help all people build digital literacy skills (for example connecting to video visits) will be important for ensuring that the expansion of digital health actually increases access to care to those who need it the most.
Despite the appeal of chatbots, evidence for their actual utility in clinical care setting remained limited in 2020.4 While there will of course be research advances in 2021, waiting on chatbots to emerge as a driving force in clinical care is likely premature for next year.
Digital health tools like apps can be effective treatments—but their Achilles Heel remained low user engagement throughout 2020. Continued evidence supports that having a human in the loop including clinicians, community members, and peer supporters can make a huge difference in continued engagement. In 2021, expect innovations in hybrid uses of digital health where there is more human support. New care models like digital clinics that support live visits (video or in-person) but also integrate new technologies like apps will boom.
While memory of Cambridge Analytica in 2018 may have faded, a series of notable health care ransomware attacks in 2020 have put privacy and data security back in center stage. Technology platforms that do not protect user data will find less uptake and market share in 2021. If you are interested in mental health apps, you can visit our division’s app evaluation website to learn about privacy features on apps you may be using today.
Entering 2021, the state of the world and demands on and for digital health will remain in a state of flux. With changes in payment models, health care regulation, and COVID-19 itself—no one truly knows what 2021 will bring.
1. Reilly SE, Zane KL, McCuddy WT, et al. Mental Health Practitioners’ Immediate Practical Response During the COVID-19 Pandemic: Observational Questionnaire Study. JMIR Ment Health. 2020;7(10):e21237.
2. Torous J, Myrick KJ, Rauseo-Ricupero N, Firth J. Digital mental health and COVID-19: Using technology today to accelerate the curve on access and quality tomorrow. JMIR Ment Health. 2020;7(3):e18848.
3. Roberts ET, Mehrotra A. Assessment of disparities in digital access among Medicare beneficiaries and implications for telemedicine. JAMA Intern Med. 2020;180:1386-1389.
4. Vaidyam AN, Linggonegoro D, Torous J. Changes to the Psychiatric Chatbot Landscape: A Systematic Review of Conversational Agents in Serious Mental Illness: Changements du paysage psychiatrique des chatbots: une revue systématique des agents conversationnels dans la maladie mentale sérieuse. Can J Psychiatry. 2020;Oct 16:0706743720966429.