Trina Histon recently took on a new challenge at Woebot Health, the company behind a chatbot for mental healthcare, after nearly 25 years at Kaiser Permanente.
In his new position as vice president of clinical product strategy, Histon will be responsible for figuring out how to use Woebot in actual medical settings. She worked at Kaiser for a long time in the past, and one of her responsibilities there was formulating a strategy for getting doctors to prescribe digital mental health apps to their patients.
Histon sat down with MobiHealthNews to talk about the future of digital mental health tools for more severe conditions and how apps can be integrated into the provider workflow.
MobiHealthNews: If you’re a healthcare provider or a patient, what do you think some of the most significant barriers are to incorporating digital tools into clinical care?
Trina Histon: The beginning of this work in Kaiser Permanente was a time of discovery for me. At the time — and this wasn’t too long ago, but due to the pandemic, time has flown by — I believe there was a desire within Kaiser Permanente to incorporate digital tools into care delivery as a standard.
Just how do you accomplish this, then? How does success manifest itself? Which tool is the best? We at KP had this pressing inquiry because we are a research-driven company. Does the clinical community accept and trust these tools as effective? You’re well aware of how numerous apps can be found in the App Store. If you’re a consumer, how do you tell quality from bad? You are taking it into the trusting relationship that exists between a doctor and a patient.
But I also believe that workflow is the lynchpin upon which the success or failure of even the best apps hinges. Have you thought about the care setting? Using human-centered design, Kaiser Permanente conducted in-depth interviews with a select group of clinicians to gain a thorough understanding of the care setting, including the types of patients they saw, the resources at their disposal, and the clinicians’ openness to incorporating digital tools, given that the vast majority of people now own smartphones and are willing to make use of such technologies.
Therefore, it’s important to put yourself in the clinician’s shoes and learn how they spend their time. What would the ideal electronic medical record referral look like? This will also vary slightly depending on whether you’re a family practitioner, therapist, psychologist, or psychiatrist.
This was done in great detail, and afterward, a prototype of the best possible workflow and referral was created, along with tear-off prescription pads. Therefore, from a clinical standpoint, you could say, “Please begin with this lesson. Here are the total weekly minutes and frequency requirements.” Also, having compassion for the frail human beings seeking care, who have likely been holding back for a long time out of fear of being judged or rejected. The challenge is how to design for simplicity in the referral’s acceptance.
The responsibility for a positive user experience within the healthcare system falls squarely on Woebot Health once a patient enters the system. It’s possible they’ll never figure out how to open the door to your website if it wasn’t designed with their needs in mind.
MHN: You were expanding this process to include more primary care physicians and other specialties after the year 2020, right? How did they manage such a rapid expansion?
Histon: If there was a silver lining to the pandemic, it was that the healthcare industry, which is notoriously risk-averse, managed to innovate as much as it had in the previous decade in just a single year. In practise, much of our arsenal was developed with in-person meetings in mind. When it comes to patient education materials, it’s clear that a lot of the work could be done through encrypted text or email. However, we quickly shifted our focus to providing care via the internet.
As a result, we shifted the majority of the processes and methods of delivery to this digital medium, making extensive use of QR codes. Then, during a video consultation, you could simply hold up your phone to access your preferred app through the Kaiser door. We also had to test how those QR codes would look on various devices with varying video capabilities to ensure they would be usable.
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Plus, top-level executives were calling me to say, “Hey, we need to talk.” “The people who come to see me are under a great deal of emotional and mental strain. I was wondering if I could also get one of these.” As a result, I should expect a call from a high-up on Mondays. We’d collaborate with the team there. On Sunday night, they would go for a live sprint. Therefore, the ability was present in a matter of days.
We designed it in such a way that it could be expanded to include whatever set of clinical services a given organisation required, be it primary care, obstetrics and gynaecology, or family medicine. Next, we collaborated with primary care physicians during the pilot phase to create some brief, six-minute video in which one doctor explains, “Here’s how I do it in my practise,” and then proceeds to walk the viewer through the process. Because we had already collaborated with these medical professionals during the pilot phase, this informative piece could be completed in record time.
In the Mental Health Network, many digital resources focus on less severe mental health issues. What are your thoughts on providing more intensive care for those who need it?
Histon: My mood has been generally depressed and anxious for the past seven to ten years. The digital mental health field will continue to develop and mature, and I expect that to include more approaches to treating severe mental illness.
And I believe that you will see more and more activity in that space in the next one to three years, because there is a desire. I’d like to think that we’ve overcome at least some of the scepticism that was initially present. There are still sceptics, and that’s fine, but I think there’s a growing recognition that these methods are useful.
I believe the next step for Woebot Health, in collaboration with health systems, is to determine how to more thoroughly embed these tools into the care continuum. How can we determine more precisely who would benefit from them? How long will this be going on? On whose behalf? When do you know it’s time to shake things up? And that, in my opinion, is where we should be going.
