The mental health crisis is a global phenomenon now and can safely be considered as a pandemic for which we clearly are unprepared to defeat. Nidhi Goel, MD is a Medical Futurist. She believes that the need for technology is now necessary to assist delivery of care at a mass scale. Nidhi is the Founder and CEO of HealMed Solutions. “I envisioned and created an AI assisted Voice enabled digital assistant to help deliver mental health assessment and workflow automation platform for providers there by increasing efficiency and ability to immediately start patient engagement with their treatment journey.
FWM: Tell us about the mental health crisis globally.
WHO estimated 1 in 5 people suffering from mental illnesses before 2019. In USA, different surveys showed 40% adults reporting depression or anxiety in June 2020 and 60% in September. We can safely assume numbers are only rising exponentially due to COVID-19 isolation, grief due to increased sickness and deaths, work from home, increased childcare burden, virtual schools, unemployment, recent racial tensions and election polarization etc. And on the other hand the provider force is shrinking by the day to the extent that 60% of counties in the USA have 0 psychiatrists and 60% are due to retire in next few years. In 2019 60% adults and 80% children did not have access to mental health care. Appointment wait times are 2-6 months..40 Million adults went to ER to get mental health care and leave with frustrating experiences as ER’s are not well equipped to handle mental health issues. It’s a global challenge, In India we have 90% shortage of providers. We have only 3800 psychiatrists to care for 1.7 Billion population!! By WHO estimates highest rate of suicide in age group 15-29 is in India with one student committing suicide every hour!! 32 Crore students at risk.. How are we OK with that?
Japan suicide rates have shot up by 80% last year alone and more so in women.. They have more marginalized jobs, higher rates of unemployment and are the main caretaker of children. They do not even know how to ask for help.. They are becoming numb to suicide and if subway train is late its just another add on to the statistics of suicide that someone jumped in front of the train. Hong Kong has a 2 year wait for a 10 min visit. It is seen as a sign of weakness to ask for mental health help. Canada, UK you name it…all countries are struggling with a rise in mental illness disease burden and losing billions of dollars due to loss of productivity and sick days..
You get the picture…Mental health parity has increased mental health awareness but it has not kept up with access to care.
FWM: You are a double board-certified Psychiatrist based in New York City. What are some of the challenges people are suffering from and how are you helping?
Access to timely care is the biggest challenge. I have worked in Acute care setting, Long-term care setting, inpatient, out-patient, emergency rooms and also had a fancy boutique private practice for high-functioning people and challenges are consistent. Even if you have insurance the wait time to see a mental health provider is huge. 40% psychiatrist have cash pay practice today. From provider’s end, we spend 45-60 min in collecting history and then 30-60 minutes in charting the electronic medical record. So essentially each new patient takes 2 hours or more.
Our efficiency in current system due to EMR and other documentation is so poor that double time is spent on that then what should have been devoted to patient care. And that is precisely why we see a lack of physician’s led innovation as they are over-burdened with documentation burden or calling for pre-authorization. Most of the technology out there is designed by people outside of the health care system and instead of helping providers it has so far increased their burden. EMR is a good example of that and a lot of research has now shown it has not created any added benefit except creating a lot of challenges for providers where they are now looking at computers rather than in their patient’s eyes! Some call it “death by 4000 clicks a day”. Considering all these challenges, I envisioned and designed a technology HealMed Solutions that uses AI driven digital assistant to do mental health assessment and a platform that automates workflow for the providers by 80% thereby improving efficiency in the healthcare delivery system up to 5 X. This is my humble attempt to hopefully start a patient’s treatment engagement journey immediately and prevent provider burnout. Which is another crisis we are facing. Rate of suicide is going up in providers too.
FWM: “There is no way humanly we can bridge this chasm.” Expound on this idea.
As mentioned earlier, when this 60% provider force in USA retires within next 5 years and with the rate mental health disease burden is increasing there is no way we can create so many providers in such a short span of time. New output is simply not enough. Residency spots are not enough and it’s another 4 years of training required and then every state has different medical licensing and credentialing needs which itself is a big bottleneck taking months and very expensive. So even with telehealth options providers have to be licensed in different states to provide help.. Not sure why it can’t be that one person who is providing care in NYC is equally competent to provide care in NJ across the river.
FWM: How is the pandemic creating a crisis for healthcare providers?
Providers were already working above their capacity. Every Healthcare system is trying to hire a psychiatrist and have been for past few months with being able to.. since pandemic so many outpatient practices closed and people are trying to migrate to telehealth platforms. It has been a transition. Although tele health has been there for over a decade it has suddenly come to a forefront due to COVID isolation.. You probably heard about PPE shortage already.. Almost all providers are now beyond burnout if that’s a word or even possible. Suicide rates in them have gone up. They are worried about their loved ones, about their patients and about themselves and there is no reprieve in near sight.. Vaccination rollout is still sketchy for out patient providers in private practices. Patients are scared to go to physical offices and in the world of mental health, rapport building is very important which is a bit difficult when both provider and patient are wearing the mask. Telehealth gives a better option in that case. But it still has its own challenges including internet access and speed etc..
FWM: You are a Medical Futurist. What is needed to deliver care on a massive scale?
Leveraging technology in a meaningful manner is one of the options I feel can actually help providers in reducing their burnout and to increase their efficiency. Actually, allowing them to do what they do best which is medical decision making and delivering care rather than be a typist. Products that increase efficiency and automate data collection are needed. Ubiquitous internet access and almost universal adoption of smartphones has given tailwind to tele health/digital health. People are more comfortable interacting with human like voices such as Siri and Alexa and evidence also shows they are more open to discuss sensitive issues on app than to a human due to lack of real-time judgment. Also Cloud servers help scalability instantly globally. Lastly, it’s COVID safe!!
FWM: Tell us about HealMed Solutions. Why is your work so critical today?
HealMed Solutions is an expert system that leverages AI (Artificial intelligence or what I call Assistive intelligence) driven Voice enabled digital assistant to conduct comprehensive mental health interview with the person is a safe secure manner at their own pace and converts it into a transcript in the real time for providers to be able to access remotely on their computers and essentially converts it into an electronic health record. Providers can review dashboard based on color coded categorization of symptoms for abnormal or critical findings. So where a provider is currently seeing one new patient in 2 hours they can see 4-5 in the same time. Also it is very affordable and at a fraction of the cost. It is a simple, accessible and affordable tool to help “bridge the chasm” that I talk about. Not only Healthcare system which is at the core, other verticals like 911 call where today if it is for violence, either person is taken to a correctional facility or ER. HealMed can help with the triage process.
In the education system, when a child acts out and 911 is called. Child is taken to the ER where they wait and the guardian would come after work hours and then the child gets discharged at midnight or later. Even in Enterprise or corporate systems where employee Burnout is costing over $500 billion in lost revenue annually due to presenteeism or absenteeism. HealMed can help determine the necessity and help timely triage and engagement with treatment journeys.
We are also launching this in India as we speak.
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