Can One Small Town Doc Change The Way We Diagnose Mental Health Conditions?

When it comes to health and tech innovation, people have spent years talking about how Gen Z and Millennials – along with their Silicon Valley startups – are going to disrupt the health ecosystem. Those “in the know” have been fond of claiming they are going to be the next Uber or AirBnB of health. And everyone is scrambling to be at the forefront of “personalized medicine.” But the truth is, our most basic health needs and care requirements have been known for a long time. With mental health being at the core of both better health and better care.

Despite nearly one in five U.S. adults living with a mental illness (about 45 million people), and mental disorders being reported as the most costly medical condition in the U.S. (with spending at an estimated $201 billion a decade ago) Americans tend to separate mental and physical health from one another. But after more than 20 years of specializing in child and adolescent psychiatry and more than 70 clinical trials as a primary investigator, Dr. Nelson Handal is among the voices in public health advocating that mental and physical well-being are intrinsically tied.

That’s why in the small town of Dothan, Alabama, Dr. Handal and his team have quietly set out to do research, see patients, and use the ever-growing clinical data points of patient history and experience to create an online portal for physicians, mental health professionals and patients to do assessments, standardize questions, compare results, and develop treatment plans based on individual needs.

Actions Speak Louder Than Words

In place of buzzwords and flashy slogans, CliniCom has slowly and steadily, over more than a decade, built a database of more than 35,000 patient assessments. Using those as the basis, algorithms to assess potential conditions and severity were created for patients to do at-home assessments before ever setting foot in a doctor’s office. The team claims this saves significant time and money for both doctors and patients by allowing a remote, honest, unbiased assessment of patient psychiatric information based on standardized questionnaires, DSM-5 criteria, community benchmarks, and expert opinions in real-time. Further, it can suggest multiple psychiatric conditions alone or together (comorbidity).

While the results are not an official diagnosis, CliniCom asserts that it can comprehensively screen for 52 mental health conditions using 26 possible chief and secondary complaints. According to Dr. Handal, it also provides an, “analysis of suicide and violence risk, and warns of possible traumatic brain injury, if applicable.”

In July of 2018, CliniCom published the results of a study to determine the specificity and reproducibility of its software to appropriately diagnose five prevalent disorders including: Attention Deficit and Hyperactivity Disorder (ADHD), Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Obsessive Compulsive Disorder (OCD), and Social Phobia. The online tool was, “Overall 78% concordant in diagnosing the same disorder during a test-retest analysis. When subjects exhibited two, three, or four disorders, the tool was less consistent in diagnosing the same set of disorders during the test-retest analysis (53% concordant). However, if evaluated as individual disorders within subjects, the more persistent disorders had a higher rate of concordance: MDD (83%), ADHD (81%), and OCD (68%).”

The conclusion is that the algorithms used by CliniCom in its online assessment tools are pretty reliable in determining both a patient’s type of psychiatric illness and the severity among common psychiatric illnesses. Thus, potentially cutting down on the number of clinical visits for diagnosis, bringing access to remote patients more easily, and providing assessments in languages that are often neglected in traditional care settings.

Hope Beyond Hype

In September of 2018, CliniCom was accepted in the App Developer program with Epic Systems Corporation, the largest EHR provider for hospitals in the world. Given that hospitals using Epic’s software hold 64% of U.S. medical records and 2.5% of patient medical records worldwide – not to mention Epic’s decision to roll out a behavioral health module – and the coming months could prove very prosperous for CliniCom’s ever-growing database. With each new entry providing deeper and richer information about mental health.

While they avoided public announcement and grand claims in the press, CliniCom has now been made readily available to all large hospital and health providers using Epic software, the behavioral health module is designed to also be used by smaller psychiatric practices. Even better, it can be used in a range of languages, incorporating patients who speak Spanish, Portuguese, and Italian.

According to Dr. Handal, “We are very serious about our research and global reach in helping people with mental health disorders.” And his team in Alabama believe that through pending and ongoing partnerships with the University of Alabama, and health departments and agencies in Puerto Rico and Italy, as well as inclusion in Epic’s system, the coming year will prove just how valuable an ever-learning system like CliniCom can be for those wanting to access mental health tools in real time anywhere in the world.