Tech Trends 2023: What to Watch out for This Year in Digital and Telemental Health
The COVID-19 public health emergency (PHE), and attendant regulatory flexibilities, have rapidly expanded the role of technology in accessing care while adding stressors for most of us. As a result, telemental health has emerged as a key component of health care practice and policy. As we look toward the expected end of the PHE in 2023, we wonder: what happens next?
The key word in health care technology right now is change: of legal and regulatory frameworks, of financial strategies and reimbursement, and of user and provider capabilities and preferences. Some trends to look out for over the next year include digital access, advanced technology, and data collection.
You may have heard the term “digital divide” used to describe the inequitable distribution of access to technology, including internet-capable devices like phones, tablets, and computers; internet connectivity; and cultural and linguistic appropriateness of digital resources like apps. With many healthcare services moving online, the health equity implications of digital access become all the more urgent. Without clear approaches to improve equitable access to and understanding of technology, digitally-enabled care could entrench existing inequities rather than address them.
In 2023, look out for: opportunities to improve access to technology, including grants and programs to install broadband and improve internet access; software and online resources with broader user bases in mind, including language and disability accessibility; and frequent change in digital services and offerings as companies, clinicians, and patients identify what works and what needs to be improved.
Artificial intelligence (AI) and machine learning technologies will have a growing role in healthcare, including the use of natural language processing to interpret clinical data at scale, deep learning algorithms to predict treatment outcomes, and robotic triage. In mental health, this may look like AI-supported diagnosis and precision treatment, symptom monitoring, and even chatbots to provide CBT or triage support to patients with mental illness.
If this sounds a little “2001: A Space Odyssey” to you – or maybe even a little “Brave New World” – that’s okay! While AI is likely here to stay, AI systems are only as good as the data put into them. This means that AI technologies should be approached with caution from ethical and practical perspectives since they run the risk of reflecting biased or low-quality care or making assumptions without adequate data. Further, given the importance of the therapeutic relationship in mental health care, robots are unlikely to take over these key roles anytime soon. Currently, there are no FDA-approved AI tools for mental health in early 2023, but research is progressing rapidly.
You may have heard of “RPM” – which can stand for remote patient monitoring or remote physiologic monitoring, depending on whom you ask – but have you heard of remote therapeutic monitoring (RTM)? RTM and RPM are both types of digital symptom tracking. Remote physiologic monitoring is typically done through connected devices that capture objective patient behaviors or characteristics (e.g., steps walked or hours slept, blood pressure, or heart rate). Importantly, this typically excludes self-report data (e.g., mood and medication adherence).
Remote therapeutic monitoring, by contrast, offers a pathway to tracking self-report and non-physiologic data, including items relevant to psychiatric care (e.g., mood, medication adherence, and treatment response). RTM holds promise for measurement-based care, offering an approach for regular tracking of indicators like PHQ-9 and GAD-7. Recognizing this potential, the Centers for Medicare & Medicaid Services (CMS) developed a code for RTM in CBT (98978) for the 2023 Medicare Physician Fee Schedule, although it’s not currently clear which devices or technologies might provide the intended service and the pricing will be set by Medicare Administrative Contractors (MACs). Look out for rapid developments in technology that could track mental health signs and symptoms to inform care in general and value-based care efforts in particular.