One of the most vexing risks of the digital mental health space is that of efficacy and safety amid an overwhelming number of choices. I have been heartened to discover an emergent subcategory of services which play a similar role in the digital therapeutics ecosystems, as drug formularies play in the drug therapeutics space. I refer to these services as digital health formularies and am open to alternatives.

I have heard of 4 players, PsyberGuideRx.HealthXealth, and AppScript. (I appreciate being informed of others.) Three of these players have come out of provider organization incubators where teams started out to develop an(other) app and realized that the better need fill was for tools to provide decision support regarding existing apps. The fourth was created by IQVIA, the global healthcare market research, and clinical research organization.

What They Have In Common?

What these services generally have in common is that they curate digital health apps, programs, wearables, etc. Additionally, 3 of the 4, provide a user interface that automates the ability to: a) prescribe an app, b) track app use, and c) close the loop of patient/client entered app data back into the patient’s electronic medical record. This really is a fabulous utility which addresses app efficacy/safety, delivery and real-world data capture challenges that had not been addressed previously even as we recognize its a risky gap in the solutions environment.

Their Risks?

Similar to most health information tech services used by healthcare clinicians and their provider organizations, these services may have potential for data privacy breaches. This risk would manifest if therapeutic searches and prescriptions were exposed, putting patients at reputational risk, and especially given the stigmatized nature of mental disorders.

Another risk is related to their representativeness of curated solutions which can reflect one of two points: a) that time and investment on the part of these services will correct this, and by extension improve their offerings, or b) that the majority of digital health services are not worth rating owing to a too general lack of efficacy proof and privacy compliance. I think there is some truth in both these points.

One thing we can expect is that digital health firms, especially in the therapeutics subsector, will be as assertive and strategic in their dealings with these formularies, as drug and device companies are with their respective formularies.

What Uniquely Differentiates Them?

Now let’s take a look at what is uniquely different about each service.

PsyberGuide, A Project of One Mind, is a non-profit website managed at the University of California, Irvine. PsyberGuide is uniquely differentiated in its focus on consumers versus healthcare systems, and exclusively on mental health apps. It provides unbiased reviews focused on various mental health apps. Its experts review apps based on: a) credibility (how likely is it that it will work?), b) user experience (how easy and engaging is it to use?), and c) transparency of privacy practices (is the apps privacy policy readily available to users and does it contain certain key pieces of information regarding data storage, encryption, deletion, etc?), in particular. As a non-profit, in addition to reviewing digital mental health apps, PsyberGuide aims to help people to use technology to live a mentally healthier life. As to cost, this service is freely available to any who wants to use it.

Rx.Health, born at Mt Sinai Health System, curates digital tools, including digital therapeutics, into procedure- and disease-specific digital toolkits. Rx.Health contains 200,000+ apps that are implemented as specialty-specific do-it-yourself starter sets which can be customized by healthcare organization customers at implementation. Aside from its toolkits, its unique differentiation is its coverage of education and care plans in addition to apps.

Its services are free to consumers, though not to the healthcare systems that use them. Their customer focus is health systems, payors, accountable care organizations, pharma, and clinical research organizations, which include Mt Sinai Health System, InfuCare Rx, SBH Health System (Bronx), Crohn’s and Colitis Canada and Advantia Health.

Xealth, born at Providence St. Joseph Health (Seattle), is differentiated in its closed-loop monitoring and analysis capabilities. It allows physicians and care teams, to monitor patient’s digital health solution engagement, via their eMR interface, and by extension, to measure outcomes and effectiveness of prescribed solutions which they claim include +253,000 content, apps & services, and +38,000 connected medical devices.

Their customer focus includes health systems inclusive of Providence St Joseph Health, Duke Health, UPMC, Hennepin Healthcare, Baylor, Scott & White Health, Froedtert & Medical College of Wisconsin. They are looking to expand to pharma, device and supply chain in the future.

Its services are not directly available to consumers except through the patient portals of the health systems that use them.

AppScript, launched in 2013, is developed by IQVIA, the global healthcare market research and clinical research organization. The key differentiation for this service is: a) its Customer Relationship Marketing function for health apps which follows up with reminders to fill the app Rx and measures for retained app use, b) its ability to be white labeled in alignment with different health systems and c) its ability to conduct real-world studies. (They also have quite a nice report on digital health apps that speaks to the variety of insights that can be derived from AppScript data.)

Their customer focus is on the top 50 U.S. integrated health systems. It has also been deployed in the U.K. and U.A.E. In a discussion I had with them, they took pains to clarify that they are not a formulary in the traditional sense, but rather a curation, ePrescribing, and studies recruitment & “paper-less” execution platform, nor do they decide on app selection for health systems’ formularies.

Cost-wise, this service can be used free for basic functionality, and requires a subscription for additional services.

I am sure that we will see other offerings in this space. I have heard that there is a solution like this being developed in Asia, and if you hear of others in the market, anywhere in the world, I appreciate your alerting me.

Again, it is good to see services like these who are working to make sense of the unintended chaos that emergent solutions sectors, like digital mental health, naturally manifest. Further, they are facilitating and smoothing the path to adoption and insight for these tools, a net positive for patients, practitioners, and payors.

Risks considered, there is a need to also keep an eye on how they manage the data they are collecting. Time gives us time to keep an eye on this.

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Be well.

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