Hello and welcome to everyone. I'm Dr. John Torres, the Director of Digital Psychiatry at Beth Israel Deaconess Medical Center and technology expert for SMI Advisor. I'm so pleased you're joining us for today's SMI Advisor webinar, Selecting Apps for Sears Mental Illness, how to evaluate apps and incorporate them into your practice. Next slide, please. SMI Advisor, also known as the Clinical Support System for Sears Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with Sears Mental Illness. Working with experts from across the SMI commission community, our interdisciplinary effort has been designed to help you get answers you need to care for your patients. Next slide, please. Today's webinar has been designated for one AMA PRA Category 1 credit for physicians, one continuing education credit for psychologists and one continuing education credit for social workers. Credit for partaking in today's webinar will be available until September 18th of this year, 2023. Next slide, please. Slides from the presentation today are available to download in the webinar chat. You can select a link to view them. Next slide, please. Captioning for today's presentation is also available. Click show captions at the bottom of your screen to enable. Click the arrows to select a view and the full transcript to open captions in a slide window. Next slide, please. Feel free to submit your questions at any time throughout the presentation by simply typing them into the question area found in the lower portion of your control panel. We'll try to reserve about 10 to 15 minutes at the end of the presentation for your questions and answers. Next slide, please. Now I'd like to introduce you to the faculty for today's webinar, Dr. Darlene King. Dr. Darlene King is a psychiatrist and works as a behavioral health physician and informaticist for Parkland Health in Dallas, Texas, where she explores the intersection of psychiatry and technology. She's a member of the American Medical Informatics Association and serves on the APA's app advisor panel where she helps evaluate apps for mobile mental health. She's also a member of the APA's Mental Health Information Technology Committee, which she actually chairs and where she contributes to numerous different digital mental health initiatives. So Dr. King, thank you so much for joining us. I'm going to hand it over to you. Thank you so much, Dr. Torres. I'm glad to be here today. And hi, everyone. So to start, I have no relationships or conflicts of interest related to this subject matter of the presentation. And here are the learning objectives for today. Hopefully by the end of this presentation, you will know more about mental health apps and how to incorporate them into your clinical practice if you choose to do so. So let's start off with just some questions. So you can open up your Q&A and type in how many smartphones you think there are in the world. And no cheating, just kind of off the top of your head, no chat GPT or Google, just think about if you could guess how many smartphones are there in the entire world. So you see billions, too many to count. Seven billion, six, so it's a 60 billion, one trillion. So there are about six billion smartphones in the world. And the total world population is around eight billion. How many smartphones do you think there are in the United States? 10 million, 3 billion, 400 million. There are about 200 million smartphones in the world. There are about 249 million smartphone users in the United States, which makes up about 73.7% of the total U.S. population. Now, the average smartphone owner uses how many apps per day? How many apps do you think they use per month? So in your answer, type how many you think they use per day and how many apps you think someone uses per month. Around six per day, around 15, 10 to 20, four a month, 10. Okay. So the average smartphone owner uses about nine apps per day and then about 30 apps per month. So some of you are really close. And last year, what do you think was the most downloaded non-gaming app in 2022? TikTok, Facebook, Instagram, Gmail. A lot of people got it. It was TikTok. So you can see on this graph the most downloaded non-gaming apps. So it was TikTok followed by Instagram. And this number of downloads is actually in the millions. So around 672 million people downloaded TikTok. And as you go down, I think the Spotify was at the bottom here. So for people who downloaded TikTok, how many times per day do you think they open the app? 20, 10, 8 times, 5 times, someone says 300 times per day. So the average user opens TikTok about 8 to 19 times per day. And they spend an average of 95 minutes per day in TikTok. So how many mental health apps would you say are out there? I see 100,000 in the hundreds. A bunch. Three. Well, there's a lot more than three. There are about 10,000 to 20,000 mental health apps that currently exist. And so if you think about mental health apps and you see, okay, there's around 10,000 to 20,000 of these mental health apps, how can I pick and how do I know which ones could actually be useful or safe to recommend to patients? And for patients, a lot of patients are, they would like to have an app that would be helpful to help them improve their sleep, improve their mood, help them exercise more, help keep track of certain goals, and encourage them to keep them up, drink more water. You know, all of these reasons on here are ways that people would like for apps to be helpful to them. And so right now, the two most common uses for mental health apps are for patients seeking self-help and then for apps that facilitate telehealth visits. So these are the two biggest categories that we see apps being used for. And so like I said, with so many apps to choose from, and so like I said, with so many apps to choose from, where do you begin? Well, where we're going to start is in better understanding what types of apps are out there. So when we dig into the patient self-help category, how can we break down these different categories? So there is a difference between what's called a health and wellness app, what's called a medical app, and what are FDA-approved apps. So if we start with health and wellness apps, these are known as general wellness products. They're usually considered a low safety risk, and they're typically apps that are intended for self-help or to promote healthy behaviors. They're usually not subject to FDA regulation. So this could be an app that reminds someone to take their medication. It could be an app that tracks their GPS, and if a patient is struggling with addiction, it could say, hey, you're going near a part of town that you've said has been problematic for you. Maybe think about going in a different direction. These also include like Fitbit apps and apps that help with exercise. But they're not medical apps. They're not apps that, when we look at the medical app category, are apps which are intended to be used by patients in coordination with the mental health professional. These would be apps that help patients maintain behavioral coping skills, such as an app that says that it provides some cognitive behavioral therapy. Apps that also just provide educational information, so providing information about, say, schizophrenia or about major depressive disorder. When you open the app, it has a lot of different pages of information that someone can look at and learn more about their diagnosis. Many of these medical apps are not directly regulated due to regulatory enforcement discretion. And then we have FDA-approved apps, and I'll talk about the regulatory enforcement discretion in a minute. So then we go to FDA-approved apps, and with this, these are where you hear the term software as a medical device. And these are digital tools to help diagnose, cure, and treat a disease. These are apps that require software that meets the definition of a medical device, where the function of that software, if it goes wrong, it could actually pose a risk to a patient. And then these require FDA approval. But when we look through the current regulatory pathway, it can be a bit confusing, as there is not a clear regulatory system for apps. And apps really get to decide if they themselves qualify as a medical device. And in one sense, you could have an app that says, we are just a health and wellness app, and they are helping a patient with sleep, for instance. And they say, you know, we provide a service and we can track sleep, but we're not going to offer any kinds of clinical recommendations. We're just going to help you track your sleep, and you can make your own decisions off of that. And they may take that and start as a health and wellness app, but then as they collect more and more data and they develop the app more and more, they may decide, okay, I think we're at a point where we have data where we can then transition to as a medical device. And so, within this process, there is like an innovation versus regulatory give and take, where currently, it's more helpful for certain products to be able to innovate, but we don't have as much regulation. So, for instance, when COVID-19 happened, the FDA noted it would allow apps, or more formally, software as medical device, to make medical claims without data if they were related to psychiatric disorders and were seeking a lower risk approval. The FDA at first had plans for a pre-certification process, but as they further explored that, it became a bit more tricky to implement, and they said that they were abandoning that process. So, currently, the approval process is a bit unclear. But it is helpful to know that right now, with FDA-approved apps, even if an app says it's FDA-approved, the data that was used to make that app FDA-approved, it's not always quality data. So, that's why it's important to be able to evaluate an app yourself, look at it, and we're going to go through the app evaluation process so that if you have an app, regardless of what type it is, you can discern whether you think it's a quality app or not that would benefit someone. Now, even though the United States does not have a clear pathway, other countries have started to have clear pathways. So, one example of this is in Germany, where they have a process called DIGA, and it is where they have a fast track with regulatory and reimbursement pathway wrapped into one. So, if the app is approved, it also is approved for reimbursement there. And so, this is a graph of that process and how an app goes through the pre-certification requirements. In general, these apps, they have to meet some pre-specified requirements related to safety, functionality, quality, data protection, data security, in order to be eligible for the review. So, they have to meet a certain benchmark. Once they do, then they can be reviewed. And then another interesting part of this is that it allows the use of real-world data. So, data that would come from, say, monitoring sleep, it's data that's captured outside of a randomized controlled trial, which is normally how we, normally how the FDA tests things and approves things. But this process utilizes real-world data and real-world evidence, which allows for technologies to be approved faster. But there's still no, like, international standards on the best practices for using real-world evidence. And so, it's going to be interesting in the coming years to learn more about what new methods and techniques for analyzing this data are going to emerge. So, one thing, and before we jump into evaluating apps, it's always important to talk to your patient and see what their level of digital literacy is. So, for instance, I had a patient who, she clearly had a smartphone, and in our EMR, it showed that she had access to the EMR app. But when I asked her about it, she said, oh, yeah, but I don't, I can't use it because my app, my phone actually doesn't have any more storage. So, even though she had a smartphone, her phone was packed full of pictures that she took, and she didn't have any other, she didn't have any computer. Her phone was pretty much her only source of connection. And so, learning that about her, we realized, you know, helping her improve her digital literacy was key. Also, helping her with resources to maybe be able to get a computer, something she can use at home to be able to offload those pictures so that she could then utilize her smartphone and more effectively. So, when you're assessing a patient's digital literacy, we can think of literacy in two main ways. So, the first is like traditional literacy, which is what we usually think of reading and writing. Then media and information. Information literacy is when someone sees information, can they, how do they take that information and create new knowledge from it? And then media literacy is, do they know how to access videos, audios, books, articles, websites, in order to gain more knowledge? And so, all of this in the context of digital literacy is, do they know how to access a computer or the internet? And it can be as basic as the questionnaire that you see on the right of using a mobile device. Do they know how to turn it on and off? Do they know how to charge it? And so, this questionnaire is from the mobile device proficiency questionnaire, which goes through a lot more details from being able to turn it on and off to be able to access more complicated things. But overall, assessing digital literacy helps you know the degree to which an individual can obtain process and understand communication and in the healthcare environment, how they can understand health-related information that's needed to make health decisions. And so, this is really necessary if you want to help someone with accessing apps. And if they're not at this point, helping provide some ways and means for them to get there. And near the end of the presentation, we'll go into a potential strategy for improving digital literacy in patients. So, another thing to consider before you recommend an app. So, like the patient that I mentioned, her cell phone was her one means of connecting to the internet. And that can be common. And some patients may have limited data plans. They may have a pay-as-you-go type of text messaging. And so, they may be more limited in terms of using the smartphone than you would think. And so, asking them those questions can be helpful to choosing an app that would fit with them the best. And when we think about apps, we see there's a great potential to reduce mental health disparities among marginalized communities because in theory, they can expand access to care. They can decrease costs, reduce transportation challenges, and provide care in a more private and de-stigmatizing way, but when we look at the apps that are out there, there aren't that many that were specifically designed for people in marginalized communities. A lot of them were designed with the majority population in mind. It can be hard to find apps that are geared towards certain languages, and so there can be a lack of attention to unique experiences of marginalized individuals which could then compromise the effectiveness of apps in these populations. And so if you have a patient who would benefit from an app that would be more culturally or linguistically tailored, it's helpful to explore that with them and see if you can find an app that would meet those criteria. And so now we get to how do we evaluate an app. And so this is the APA app evaluation model. So the idea of this is that you can take this model and you can apply it across different technologies, not just apps, because the basic ideas are very similar. But it's in a hierarchical pyramid shape, which means that you start at the bottom and if the app meets that criteria, then you then go to the next level. But if the app does not meet the level one, level two criteria, then you don't proceed up the pyramid. And so we start with level one. So and another thing to know about this model is that it was developed by looking at all the different evaluation models at the time. And when it was developed, I believe, by Dr. Torres' lab around 2014, there were a lot of different models out there. But there was a problem because the criteria was a mix of objective and subjective criteria. And so what his lab did was they took all those models, and they then said, okay, let's try to get the most objective criteria down so that anybody can go through this process and get similar results. And so this is what this APA app evaluation model is built for. It's to be able to be translated to multiple technologies and apps and have somebody, different people, rate an app and have very similar outcomes in terms of that app. So if we go to level one, this is access and background info. So this is very basic information about an app. It is, all right, we have a patient who is interested in an app to help with their depression. So what does this app do? Does this app, is it helpful for depression? Also, who made this app? Is it developed by somebody or a company that is credible? Do they identify who developed this app? Are there any conflicts of interest? Does this app claim to be medical? Are there any additional or hidden costs? And so this is, you're scoping out an app. You're looking at it from like a 10,000 foot view and saying, does this look like an app I can trust? Because there are some apps that you look at and they seem a bit sketchy. And so you wouldn't want, it would fail level one and you wouldn't go forward. And one of the things to think about is if the app's been updated in the last 180 days, because if an app doesn't get updated regularly, there's a chance that it could stop working or you may be at risk of some like viral, like a virus. Now the second level is in privacy and security. So when you think about privacy and security is, is there a transparent privacy policy that's clear and accessible before you use the app? Do they describe how they use protected health information? Is the information that they collect identified or anonymous? Can you opt out of the data collection? Does the app explain security systems? Does the app collect, use or transmit sensitive data? And does the app talk about third parties and share data with third parties? I think one of the biggest things with privacy policies nowadays is there they show up and you have to click accept if you want to use the app, but a lot of times there may be language in there that you may not understand or really even think about. And I think one of the key words would be third parties. And so an app could have very clear language and say, you know, we are not sharing data, but we do communicate with third parties or you may go to third party experiences within this app. And that is keyword for information is getting shared along that route. And so when you think about certain apps, how is information flowing back and forth? And is it clear? And can you understand it when you read a policy of privacy policy for app evaluation? It is important to read a policy of privacy policy because that is the only way you're going to be able to know what those information flows are. And this is an important thing because there are a lot of privacy concerns with certain mental health apps where the Washington Post had a reporter who wrote about a study where the researcher contacted different data brokers and said that they would like to purchase mental health data. And so they were actually able to purchase different sets of mental health data that was obtained through some of these information flow processes. And this included the names, home addresses of people, and their diagnoses. You could see if they have bipolar disorder, PTSD. Another was selling a database featuring thousands of aggregated mental health records. And so this is something to watch out for. Treatment-focused apps that host sensitive health-related data, particularly data related to mental health and substance use disorder conditions, they do need to be held to HIPAA data privacy. But I think it's important when you talk to patients or you think about recommending an app that you let them know that even though you're recommending an app, that app is not a part of their official health care. And the same confidentiality rules don't necessarily apply. And to be mindful of that. And here are some other pretty egregious data protection mistakes where the FTC did step in and regulated these companies. But it was only after some pretty bad mistakes, such as the Crisis Text Line. They were a suicide hotline that was sharing data to another company. GoodRx was fined for sending consumer health data to Google or Facebook. And then there was another app called Patients Like Me that was involved in this. And so this is a pretty egregious app called Patients Like Me that was involved in a patient data scraping scandal where patients were putting their health information in there and it was using that data and aggregating it. So if you're evaluating an app and it fulfills level one and level two, then you can go on to level three. Now, one thing I will say before I go to level three, with level two is that I think this is also something that can be. Everybody is different in their level of concern with privacy and security. And so if you're talking to a patient, they may not really care if their data gets sold or not. And so if that's the case, they have a lower threshold for level two. You could keep that in mind. So I think part of this is it can be customized to an individual's preferences. But still knowing how data is being used in an app is important. And then level three, this is the app evidence based. And does it appear to do what it claims to do? So if it is saying this app helps with CBT, then it's saying that it's not doing it. Is it doing that? Is it providing kind of behavioral therapy? Some apps say they're based on CBT. And if they use that language, it doesn't necessarily mean that they're applying cognitive behavioral therapy, but they're utilizing techniques that have been shown and verified outside of the app where the app itself may not be validated and verified. That's something to keep in mind. Is the app content correct, well written and relevant? What sources and references are being supported? And this is where some apps, they can be dangerous if they don't have the right information. There have been some instances where an app treating bipolar disorder has said to, if you feel that you're becoming manic, drink a shot of liquor and that'll help with your mania. And other times there, it might say, don't worry friends and family about mania because they don't want to hear about it. And so there have been instances of an app telling people that, and that's not the safest app to use. So if you have an app in front of you, if you have an app in front of you that's saying that it's helping with certain disorders, you actually going through the app yourself and verifying it, looking at what advice and tips it's giving may be worthwhile to make sure that it is safe because you don't know what all is in there unless you go through it yourself. Also looking at the evidence behind certain apps, who supported their research, who went through, did it go through certain clinical studies and what evidence was gained from that. And also if there were some clinical studies, how looking at the quality of those clinical studies. Now, the fourth level is when you're using an app, is it easy to use? Does it seem to be engaging? Does the app and its features align with your needs and priorities? Is it customizable? Can you find what you need to find? And this is where if you recommend an app to someone, but it's very difficult to use, it's not engaging their not going to use it. And it's been shown that people will download an app and they may use it a lot in the first few days and then they just don't ever open it again. And so there is this idea of how do you increase engagement of an app and encourage people to use an app when they do download it. And so if an app is easy to use, patients are going to be more likely to use it. Level five is data integration. And this is, this here looks ahead to thinking about as we have more interoperability. So if there are apps that are built for physician-provider-patient interactions, does the app facilitate that? Does the app allow for patients to send their data to their provider? Does the app share their data with an EMR or other data tools? And when it shares that, is it in a secure way? And is the app, does it lead to any positive behavior change or skill acquisition and can you track kind of that behavior change over time? And does this app improve the therapeutic alliance between patient and provider? And does this app improve the therapeutic alliance between patient and provider? So then another, just to wrap up the app evaluation model, there are some other considerations to think about. And it could be, you know, what are the benefits that we'd expect from using an app? And does this seem like this app is going to be helpful? Another thing to think about is just because a patient has a smartphone, it doesn't mean that they use that smartphone in the way you would expect. So I know Dr. Torres's lab was doing a study where they gathered data from patients' smartphones through an app, but the patients actually were trading their smartphones with other, letting other people borrow their smartphones. And so the digital phenotyping data, which was supposed to maybe be tracking their sleep patterns, was way off because it was being collected from different people when the patients were letting others borrow their phone. And so it could be also helpful to ask patients about how they use their smartphone or what their smartphone does to help them and better understand and characterize the app. And then the other part is thinking about having an informed consent process. If you want to recommend apps in a way that, just like medication, we know that medication has risks and benefits, so do apps. And one of them is privacy concerns. So being open with patients about that. And also not having patients feel pressured to using an app. Saying, I'm recommending this app, but it's up to you if you want to use it or not, and making that clear to them. And then, like I said earlier, evaluating the app before you're recommending it. That can be helpful. And so if you can think about the app evaluation process we just went through, there were five levels, and each step takes some time to go through all the questions and go through all the questions and go through an app and really fully evaluate it. And you may be thinking, this is all great, but I have a really large patient panel. I'm very busy. How do I fit that in to my clinical day? How do I get all this information and evaluate apps? And so this is a website that is very helpful, and it's what's called an evaluation hub, where it's a website that contains already done evaluations on about 600 apps. And it allows you to go through and filter on what you're looking for in terms of apps. And so you're able to decide what features you want to include or what features you don't. And so it could be helpful if you're talking to a patient and they want a certain app, you can quickly go through this website and pull up some apps that may be helpful. And so what we're going to do now is I have a few clinical case scenarios that we can go through that actually use this website. So if you want to pull up the website on your own, and I'm going to go to this case scenario, and we can take a few minutes to actually use the website and find out what app would work. So here's our first case scenario. And we have a patient who's experiencing depressive symptoms. They potentially have a mood disorder. They're interested in using an app for mindfulness. In their spare time, they also enjoy writing in a journal. They would prefer to have an app where they could connect with someone such as a therapist. The digital navigator asked them if they have any privacy concerns. The patient feels strongly about having an app that meets HIPAA. I will talk about a digital navigator in a minute once we go through our case scenario. Because you might be wondering where that comes from. All right. So once you're able to go to MindApps.org and see if you find an app, you can write your answer in the Q&A. And I'm going to go to the next slide so that you can see the key words that are helpful here. Yeah. And I'm reading one of the a comment from one of our attendees saying, you know, privacy and security policies and notifications are very cumbersome to read. And a lot of people just click accept without ever reading a word of the pages that the team wrote to protect themselves, not their users. And yeah, I think that that is a big issue of having privacy policies that we just click through if we really want to use the service. And how much of it do we actually accept? All right. Now people are saying so let's go through here. And now I'm going to walk you guys through how to find the answer. So, we're going to go through to the supported conditions, it was depressive disorder and mood disorder. We're going to look up. They wanted it to meet HIPAA. So that is under privacy. We're going to filter on journaling and mindfulness. Since that was a feature they wanted. They also wanted to be able to connect with a therapist, maybe have some peer support coach therapist connection and so this brings up an app called Simbello. And so on the website you see different screenshots of the app. And then here it is this is the evaluation that you can look at and you can see when this evaluation was done. And it can be a quick way to see a patient asks you about an app you can come here and see if it's there, do a quick read through, or if you are are trying to find an app that may help a patient with some extra support in between appointments. You could also look on here and find one that you think would be helpful. And this is a good way to have a starting point. So, if you want to start with this to filter out some apps that may not be worth digging deeper into you use this and then you have maybe two or three apps you really want to consider, then you can do a deeper yourself into more of the nuances, looking more at the evidence or the privacy considerations. And so that could be a good strategy that you use when finding apps to try to sift through all of the ones that are out there. All right. So now let's go to case scenario. So this is another case scenario. We'll do this one more time. So, find an app to recommend to this patient. This patient owns an Android smartphone and has been diagnosed with bipolar disorder. They would like an app to track their mood. They would like to see whether their medication is helpful and be better able to anticipate if they may develop symptoms of mania or depression. So finding an app where they own their own data would be ideal, as they want to keep their mood logs private. nkivit.org is where commissioners see our compliance standards reports. And again, the website is mindapps.org. And this is what the Evaluation hub that we're using. And this Evaluation hub is built off the AP App Evaluation model. And so if you come across those other hubs, look into how do they evaluate their apps, and how often that information is updated. All right, so I see one answer so far. So let's go on. So here we can pick the platform. So we pick Android. We're going to go to bipolar disorder. The features we want would be mood tracking. And we're going to go to mood tracking. We're going to go to bipolar disorder. The features we want would be mood tracking. And we want to own our own data. And that brings us to this app. Where again we can read more about it. We can look at different screenshots. And then here is the evaluation. We see that it was updated, June, pretty recently. And there's also older evaluations, too, if you want to click through those you can. So in one of the scenarios you saw the term digital navigator. And this is an idea of having someone whose focus is on app evaluation. And this could be someone who specifically hired for this role or it can be someone who has an interest in this, and they're able to devote some extra time to helping patients with apps. And so the digital navigator ideally would be someone who has this role and that's what the clinic hires them to do. Where they evaluate apps, they keep a database of apps that are recommended. They use an evaluation hub to carry out these evaluations. And then they meet with patients. They assess a patient's digital literacy. They help patients get up to speed to where they can utilize apps. They provide technical support for patients. And then they also work with clinicians to recommend apps. And in the meantime, we have the clinicians talking to the patient, going over their goals of treatment, utilizing apps. And if you're utilizing an app that's tracking mood, that data can then go to the digital navigator who keeps up with the panel of data to help aid treatment, continue to provide help and assistance to the patient and the clinician. And so this could be a good strategy of implementing apps into a clinical space when there is limited time available. And then finally, there may be a question of, well, this is all great, but how do we pay for it? Or how do we get reimbursed for it? And you know, the answer to that is not very simple. It's still very cloudy and needs clarification. And so what we know right now is in 2023, there is a remote therapeutic monitoring, which offers a CPT code. And this code does allow our practitioner to bill for the use of cognitive behavioral therapy device. But this value and payment for this code is established by Medicare administrative contractors, and it can vary nationally. And then some other details on this is the app must monitor a patient for at least 16 days per month and be used for at least 20 minutes per month by the patient. And then the practitioner must check in with the patient during that one month period. And only one practitioner may bill the RTM code per 30 day period. So if that patient might be getting home health and another device is providing RTM, then those would conflict. Only one could be billed during that 30 day period. So in conclusion, evaluation hubs like MyNavs.org can facilitate app selection. Consider training digital navigators for your clinic who carry out regular app evaluations and promote the use of apps within patient care. And overall, we need more advocacy for better reimbursement models. And then utilize the AP app evaluation model if you're curious about an app and are unable to find it in an evaluation hub. And that's all I have. Thank you so much for your time. Thank you so much for such a wonderful presentation, Dr. King. So before we shift to the Q&A, I want to take a moment to let you know that SMI Advisor is accessible also from Apropos, your mobile device. So you can use the SMI Advisor mobile app to access resources, education and upcoming events. You can complete even mental health weighting scales like you see there and submit questions directly to our team of SMI experts. You can download it at smiadvisor.org app. So we have a couple minutes for Q&A, and I think we have some exciting questions that are in the answer. And I think one of them that we covered is you kind of you discussed a little bit in terms of the privacy policies, as you said, no one has time to read them. But I do want to ask you, as you're trying to make sure that people click through them, what are some ways that you think clinicians and those listening can kind of make a better decision about that really complex legal miniature mouse print? It's very, it's difficult. I think going through and reading and looking, learning what are some key words to look out for. I think it's really important for clinicians, third parties, read more carefully in that area to try to better understand what, how they may use information and data. Yeah, I thought your example of on MindApps what to look for was nice. You can click through those buttons. Another question says can apps interface with electronic health records? What are the pros and cons of being able to connect, say, this app data to electronic health records? So I guess can it be done and is it a good thing or a bad thing? Well, I think there are some apps that allow that functionality, but you have to be careful. Because I think there was one app, it was the PatientsLikeMe app that allowed it to connect to their electronic medical record, but then the app or the company had access to that data. And they weren't, and so I don't know if a patient really fully understood that and wanted that to happen. So that's something to be mindful of. The related question is do apps, someone's basically saying what do apps offer in terms of emergency features or how do you kind of know that this app isn't going to, how can you be confident it may protect your patient or not cause harm? Yeah, that's a, that is a very important thing to look at when you are considering an app to help with crisis situations. And I would say, check out the app yourself and see how they handle crises. Some apps don't, and they give a disclaimer saying that they don't. Other apps are specifically for like crisis situations, but ultimately I think it comes down to you and the patient making a safety plan and being comfortable with that safety plan. That makes sense. So kind of calibrating the risk and looking, it sounds like with someone else that you've won. I'm trying to read this question. It says, would I suggest that the client use the MindApp website or would I want to use it with the client? Is this something you're suggesting maybe to give to people to find apps themselves and bring it to you or do you use it collaboratively with them? I think you can do either. If you feel like a patient has a high digital literacy, they could go through it themselves and evaluate apps. I think the more people who know how to evaluate apps and how to use these tools, the better. That makes sense. I'm also seeing, they're not questions, just comments saying thank you and this was very enjoyed by people, so I'm not sure. Welcome comments. I'm searching out for the questions as well that people have. Some people, another question again, you kind of touched on payment. Do you view it as feasible that clinicians or those using apps should expect to be paid for them today or not from what you told us about those potential codes? Well, I don't think that right now reimbursement is easy. I think it would, if it is possible, it has to be set up in a way that, because there isn't like a set defined guideline right now, you have to maybe talk with your Mac and set that up. What do you think, Dr. Torres? I think so too. I think it's going to happen, but probably I think what you suggested too, it's not going to happen today. And one shouldn't build a practice expecting that apps will, that part will be reimbursed of the care at this point right now. So I think if anyone has any last questions, do put them in the chat, but I think you covered so many wonderful topics. So I think let's actually move on to the next slide. So a couple more things to wrap up as we move on. So if there are more topics covered in this webinar that you'd like to discuss with colleagues, you can post a question or comment on the SMI Advisor Roundtable Topic Discussion Board. This is an easy way to network and share ideas of other clinicians who partook in the webinar. So this could mean sharing ideas of apps that you'd like, maybe apps that you think people should avoid, ones that you have questions on. These are really topics, I think as Dr. King said, that really work with the community, kind of helping us assess it together. And if you have questions about the webinar or any other topic related to evidence-based care for SMI, you can get answers in one business day from any of our SMI Advisor national experts on these topics. So this service is available to all mental health clinicians, peer support specialists, administrators, and anyone else in the mental health field who works with individuals who have SMI. It's completely free, and it's of course confidential. Maybe we'll jump to the next slide. So SMI Advisor offers so many evidence-based resources and guidelines specific to telemedicine and SMI, such as the fact sheet, Myths vs. Technology for SMI, which I think is a really fun one. We help build it and kind of helps dispel some notions, such as say, do patients with schizophrenia want to use technology? Yes, of course they do. So I think it's one that you can actually access for free. We have many other of these fact sheets that you can find on smiadvisor.org. There's a lot of exciting information. I think we actually also have the largest telehealth library of videos on mobile health that you can of course watch for completely free as well. So one of many featured resources to discuss. Maybe we'll jump to the next slide. So to claim credit for partaking in today's webinar, you need to have met the requisite threshold for your profession. After the webinar ends, please click Next to complete the program evaluation. The system then verifies your attendance for you to claim credit. This may take up to one hour and can vary based on your location, regional and national web traffic, and Zoom. So be patient with it, but we will ensure that you get your credit. And our last and final slide. So please consider joining us on July 28 as Kaylee Mullins presents Managing Hoarding Behavior and Hoarding Behavior in People with SMI. This is again another completely free webinar on July 28 at 12 p.m. Eastern. Thank you for joining us. Thank you of course for Dr. King and thank you of course for the APA SMI Advisor staff for making it happen behind the scenes. So until next time everyone and take care. Thank you for participating in today's free course from SMI Advisor. We know that you may have additional questions on this topic and SMI Advisor is here to help. Education is only one of the free resources that SMI Advisor offers. Let's briefly review all SMI Advisor has to offer on this topic and many others. We'll start at the SMI Advisor website and show you how you can use our free and evidence-based resources. SMI Advisor's mission is to advance the use of a person-centered approach to care that ensures people who have serious mental illness find the treatment and support they need. We offer several services specifically for clinicians. This includes access to education, consultations, and more. These services help you make evidence-based treatment decisions. Click on consult request and submit questions to our national experts on bipolar disorder, major depression, and schizophrenia. Receive guidance within one business day. It only takes two minutes to submit a question and it is completely confidential and free to use. This service is available to all mental health clinicians, peer specialists, and mental health administrators. Ask us about psychopharmacology, recovery supports, patient and family engagement, comorbidities, and more. You can visit our online knowledge base to find hundreds of evidence-based answers and resources on serious mental illness. All content in our knowledge base is reviewed by our team of national experts from the American Psychiatric Association, Harvard, Emory, NAMI, University of Texas at Austin, and more. Browse by key topics or search for a specific keyword in the search bar. Access our free education catalog to find more than 100 free courses on topics related to serious mental illness. You can search the education catalog by topic, format, or credit type to find courses that fit your needs. SMI Advisor also offers live webinars each month that let you learn about evidence-based practices and participate in live Q&A with faculty. Check out our education catalog often to find new courses and earn continuing education credits. For individuals, families, friends, people who have questions, or people who care for someone with serious mental illness, SMI Advisor offers access to resources and answers from our national network of experts. The individuals and families section of our website contains an array of evidence-based resources on a variety of topics. This is a great place to refer individuals in your care for information about their conditions. They can choose from a list of important questions that individuals who have SMI typically ask. SMI Advisor worked with experts from the National Alliance on Mental Illness to develop these important questions and many of the resources in this section. Watch videos on important topics around SMI, such as what to know about a new diagnosis. They can also find dozens of fact sheets, infographics, and links to other important resources. To access even more evidence-based resources for individuals and families, visit our online knowledge base. All content in our knowledge base is reviewed by our team of national experts from the American Psychiatric Association, Mental Health America, and the American Psychiatric Association. Browse by key topics and select View All to uncover a list of resources on each topic. SMI Advisor offers a smartphone app that lets you access all of the same features on our website. SMI Advisor offers a smartphone app that lets you access all of the same features on our website in an easy-to-use, mobile-friendly format. You can download the app for both Apple and Android devices. Submit questions. Browse courses. And access clinical rating scales that you can use in your practice with individuals who have SMI. SMI Advisor also created My Mental Health Crisis Plan, a smartphone app that helps individuals in your care to create a crisis plan. The app is available on both Apple and Android devices. It helps people prepare in case of a mental health crisis. They can make their treatment preferences known and specify who should be contacted and who should make decisions on their behalf. The app even guides individuals through the process to turn their crisis plan into a psychiatric advance directive. Thank you for your interest in SMI Advisor. Access our free education, consultations, and more on smiadvisor.org at any time.

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