There’s An App for That: Integrating Devices and Gadgets into Clinical Practice

Hanover, NH—Health apps for smartphones are nothing new. There are a plethora of devices and gadgets available to help us manage our own health and wellness—fitness apps tracking diet and exercise are the most common. And health-care providers are increasingly using sophisticated technology-based medical applications to help patients manage chronic illnesses. Recently, there has also been an increase in applications designed to address behavioral health, including substance abuse and mental illness.

Lisa Marsch
Lisa Marsch, PhD, director of the Center for Technology and Behavioral Health, and colleagues are leading the way in not only developing evidence-based tools that target behavioral health and serious mental health issues, but also in evaluating the science behind the tools.

Just because these apps exist, doesn't mean they work, notes Sarah E. Lord, PhD, an assistant professor of psychiatry at Dartmouth's Geisel School of Medicine. "There are a lot of apps being developed for depression, PTSD (post traumatic stress disorder), and all sorts of symptom management for a variety of other behavioral health conditions, and we're not sure that the majority of them has a clear evidence base," she says.

"It's also clear than even when you have a website or mobile application that has strong empirical support, it doesn't mean that people are going to use it," Lord adds. "There is much to learn about effective dissemination and implementation of empirically-supported tools for health care."

Mobile health technology's rapid advance raises many questions, including accessibility, privacy, technology literacy, effectiveness, and dissemination and implementation.

Academic and entrepreneurial, Dartmouth's Center for Technology and Behavioral Health (CTBH), under the auspices of Geisel's Psychiatric Research Center, is taking a hard look at these questions and at the science driving innovation. Lisa Marsch, PhD, director of the center, and colleagues are leading the way in not only developing evidence-based tools that target behavioral health and serious mental health issues, but in evaluating the science behind the tools for efficacy and how to best integrate technology-based interventions into practice.

A direct comparison between technology-based therapeutic care (mobile apps, Internet-based treatments) and traditional care reveals comparable outcomes—in some cases comparable to highly trained clinicians delivering the same interventions. The intention is not about replacing clinicians with these tools, but in providing around the clock access to therapeutic support, Marsch says.

"There are a number of effective behavioral treatments for both addiction and for mental health issues and there are also a number of challenges to delivering those interventions in any widespread way," she adds. "It's not about specific populations, but about creating tools that bring value to whatever the population is."

With strong partnerships at Dartmouth and with researchers at partner institutions, such as Cornell University, Columbia University Medical Center, University of Wisconsin-Madison and Feinberg School of Medicine, CTBH has generated important new projects involving various stages of research ranging from prototypes to evaluating tools for acceptability, usability and feasibility. They also conduct large multi-site studies looking at cost-effectiveness and implementation research for technology-based tools with an eye toward functionality on the clinical end.

"The Center for Technology and Behavioral Health is a national center of excellence housed within Geisel that ensures that science drives the optimal development, evaluation, and implementation of technology-based therapeutic systems," says Dean Chip Souba. "It distinguishes Geisel as a leader in harnessing technology to deliver effective, personalized, integrated, and wide-reaching approaches to transform health and wellness."

Using technology-based therapeutic tools can help patients manage certain aspects of their care, but the flip side of self-management is making sure patients understand the power of technology. They need to be informed about the information these devices are collecting—information, which in some cases they may not be interested in sharing.

David Kotz, a professor of computer science at Dartmouth, has teamed up with Marsch on a project investigating how to optimize privacy and security when using these technology-based tools.

Other CTBH's projects includes wearable sensors, a smartphone system for schizophrenia self-management, tools to manage substance abuse, and a web-based repository of evidence-based tools that people can easily access.

"The scientific reach of the CTBH is broad—toward the development of new, highly effective, and cost efficient ways of delivering health care to large groups of patients," says Alan Green, MD, chair of the department of psychiatry. "Lisa Marsch and her colleagues are at the leading edge of developing and using technology to improve the lives of people with mental illness and substance abuse."

"There's this explosion in devices and gadgets related to mobile health, but we view these tools as just that. Understanding what it is about using these tools and understanding the principles driving behavior change that persists despite the technology of the moment, is not about a particular platform," Marsch says. "It's about the functionality toward the clinical end."

Technology-based interventions could have a transformative affect on health care service delivery in the future, but "there's still a lot to learn about how to best achieve the goal of effective tools that really work—in what context, in what payer system, and in what audience of stakeholders," Marsch concludes.

To learn more about the CTBH, please visit their website at