San Francisco-based startup Iodine is touting its depression-focused mobile app, Start, as the first app developed with Apple’s CareKit to be integrated into clinical practice in mental health. The news signifies a milestone for CareKit, a platform for developers to build iOS apps that help people better manage health conditions.
Wednesday, Iodine announced that it is teaming up with TMS Health Solutions, a network of psychiatric service providers in Northern California, to make Start a part of depression treatment at TMS, which specializes in transcranial magnetic stimulation.
“They’re our clinical partner to demonstrate how we close the loop with patient-generated data,” Iodine CEO and Co-founder Thomas Goetz said.
The idea is to provide better management and monitoring of patients starting on antidepressants.
Goetz cited the 2006 National Institute of Mental Health trial called STAR*D (Sequenced Treatment Alternatives to Relieve Depression), which found that it generally takes 6-9 months for a new patient to find an effective treatment for clinical depression. “We want to help people understand that the first 2-4 weeks, there may be side effects and ups and downs,” Goetz said.
“Antidepressants, out of the gate, they work one-third of the time,” Goetz explained. That statistic comes from a 2005 study published in the Journal of the American Board of Family Medicine.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
With the usual method of trial and error, patients often are on their own, out “in the wild,” Goetz said. The CareKit-developed Start helps providers check in with people who are adjusting to new medications.
The app generates progress reports at regular intervals. “The user can see right away if they’re getting better or not,” Goetz said.
It also can help physicians determine if the patient needs a medication switch by providing a window into the patient experience outside the clinic. (The app doesn’t have FDA clearance, so it can’t be offered as a diagnostic system.) “We want to be the arbiter of real-world success or failure,” Goetz said.
TMS Health Solutions practice chose e-fax integration of PDFs from Start because faxes fit better with the practice’s workflow — sadly, typical of healthcare even in 2016. “We could have done EHR integration,” Goetz said.
Even with low-tech faxes, providers get what Goetz called a “digital lab value” on each patient, and that’s important to TMS. “They are all about measurement-based care,” he said.
Primary care physicians do the majority of antidepressant prescribing, but rarely administer the PHQ-9 survey, the depression module of the Patient Health Questionnaire. Goetz said that only about 20 percent of psychiatrists practice measurement-based care. The Start app incorporates the test.
Since Iodine released the Start app in August 2015, 46 percent of users have reported positive results with their treatment after six weeks, according to data from the company. Four weeks into treatment, they have averaged an improvement of nearly 6 points on the 27-point PHQ-9 test.
Image: Iodine
