Ok Computer

Dr Joanna Hudson works in the Health Psychology Section of the Psychology Department at the Institute of Psychiatry, Psychology, & Neuroscience, King’s College London. She was one of 30 Fellows on the 2019-20 NHS Digital Pioneer Fellowship delivered by DigitalHealth.London. Here she writes for us about how the band Radiohead inspired her thinking about we use digital health products. 

In 1997, the British band Radiohead named their album OK Computer. It was reported (NME, 2017), that the album title reflected concerns about the limits of technology, especially its lack of human connection and intelligence. Fast forward 22 years with the growth of artificial intelligence and the digital health sector more of us are turning to technology to ask, “Computer am I ok?”.

As a psychologist, this type of human behaviour fascinates me. Inspired by Radiohead, I love thinking through the different ways people use a digital health product and studying how and why they use it (or not). This is called stakeholder mapping and engagement. Understanding human behaviour plays a vital role in improving the likelihood that digital interventions are implemented in health care so that their potential benefits are achieved. This is one to the topics discussed on the DigitalHealth.London Fellowship Programme I found most engaging. The team I work in at the Psychology Department at the Institute of Psychiatry, Psychology, and Neuroscience; King’s College London have recently written a chapter on digital health stakeholder engagement in the Handbook of Behavior Change (see compass-ltc.org research page for more information).

The successful implementation of digital health technologies involves a wide range of stakeholders each with their own motivations and desired outcomes from the use of the technology. To give an example of stakeholder mapping I’d like to share with you and outline the stakeholders involved in COMPASS: Navigating your long-term condition, the digital health project I work on. COMPASS is a therapist supported, digital, cognitive-behavioural therapy (CBT) program developed to treat depression and/or anxiety in the context of physical long-term conditions (LTCs).

People with physical LTCs are at higher risk of depression and/or anxiety. They often have poorer health outcomes. The downstream effects of this can cost the NHS more money. They are also less likely to access psychological services; if they do, then the types of treatments offered may not optimally manage their emotional health needs alongside their physical LTCs. COMPASS aims to tackle these challenges.
Below is a list of our stakeholders and a snapshot of their contributions and motivations for being involved in the project:

• Clinical-Academic development team: The core team includes: Professor Rona Moss-Morris who pioneered COMPASS, Dr Katrin Hulme, and me. We are all motivated to provide better access to evidence-based psychological care for people with LTCs.

• COMPASS patient development team: Our amazing team of 19 patients are core to developing COMPASS. They make sure COMPASS is relevant and acceptable to patients. For example, they selected the name COMPASS to reflect the need to adapt to LTC challenges.

• NHS therapists: Therapists guide patients through COMPASS. They provide the human input alongside the patient self-guided platform. Therapists told us a priority for them is ensuring that COMPASS alerts them urgently if a patient is at risk of suicide. Dr Abi Wroe and Dr Kate Rimes are part of the COMPASS team. They provide clinical input and supervision to COMPASS therapists.

• Mayden: Mayden provides a system (IAPTus) to collect patient health outcomes. Our work with therapists told us that COMPASS needs to be inter-operable with IAPTus. Fiona at Mayden has patiently walked us through this process – thank you!

• SPIKA software: SPIKA are our tech team who program COMPASS. They “translate” our needs into a digital delivery format. We especially thank Fathima at SPIKA for being our interpreter!

• Non-mental health trained professionals: We need non-mental health care professionals to refer LTC patients experiencing depression and/or anxiety to COMPASS. They told us a priority is having a clear referral pathway into COMPASS.

• King’s Health Partners (KHP): COMPASS is funded by KHP Mind and Body Programme. They understand the need to evolve and adapt our planned work in response to stakeholder findings. This insight is down to Kate Lillywhite one of the Mind and Body Programme leads.

• NHS commissioners: We need to understand the priorities of commissioners who can get COMPASS into the NHS. This is new territory for our team but vital to ensuring COMPASS remains available to patients. We are currently implementing in two NHS Trusts.

• Investors: We need investment and commercial expertise to help COMPASS sustain and grow when our grant funding ends. King’s Commercialisation Institute is supporting us to create a business plan and secure investment so that COMPASS can be scaled. They are also funding more feasibility work to look at real world use in two more NHS Trusts.

This list helps us map out who is involved and what we can achieve together. For me, the human relationships that surround digital health products are key to their success.

Like the concerns reflected in Radiohead’s album title, I agree there are limits to the processing and emotional intelligence of tech. But if we recognise this, plan for it, and section off “who” (including the computer) is responsible for “what” then the scope for digital health is huge. The true value of digital health for increasing and sustaining access to integrated mental and physical health care is highlighted by the current COVID-19 pandemic. Online CBT programs, like COMPASS, allow patients to either gain or sustain access to much needed health care without risking their own health or the health of their therapist.
If you see yourself as one of the COMPASS stakeholders listed above, then we would love to hear your thoughts and perspective. Or if you’ve read this blog and you think your perspective has been missed as a stakeholder then please get in touch (contact details below).

If you would like to be updated about COMPASS and our linked digital health research streams, then please visit the link below or follow our team on the below Twitter handles for real-time updates:

• compass-ltc.org
• @JoHudson13
• @RonaMossMorris
• @KatrinHulme

Contact us at: Compass-ltc@kcl.ac.uk