Empowering the Digital Therapeutic Relationship: Virtual Clinics for Digital Health Interventions

Abstract

As “digital phenotyping” and monitoring technologies begin to unleash the potential of data insights for mental health care, we propose here a complementary concept of the “digital therapeutic relationship” to unleash the power of the patient-provider alliance in clinical care. In millions of clinics today, care decisions are made on a daily basis in the context of a relationship honed through professional training to be respectful, protective, and empowering of patients. Now as clinical care evolves toward online and especially mobile platforms, it is critical to not ignore the digital therapeutic relationship and instead to realize that supporting it will require new and innovative means of care delivery. Here, we propose that technology can be harnessed to facilitate, augment, and expand these relationships directly, and identify virtual clinics as the currently missing but necessary environment to unleash the true potential of digital medicine. Introduction On paper, digital health tools like smartphone apps appear to be the ideal solution to the current mental health crisis. Depression is now the leading cause of disability worldwide, and mental health disorders impact one in four people globally, yet current and projected future access to care and treatment remain inadequate. Today’s limited access to clinical care stands in contrast to the ubiquity of smartphones, heterogeneity in care delivery in contrast to standardized protocols of apps, and snapshot diagnostic assessments in contrast to continuous longitudinal monitoring by phone sensors. Digital phenotyping, the moment-by-moment quantification of individual-level human behavior and physiology in situ using data from smartphones and other personal digital devices1 offers a new window into understanding and addressing the real-world lived experience of illness. Yet the reality of digital health services like apps is different—uptake is low in clinics and engagement remains poor among the public.2,3 Searching for the cause of this striking disparity has proven difficult because it is neither tangible nor a fault in apps, clinicians, or patients. Rather we propose that a failure to address the digital interaction between patients and clinicians—the digital therapeutic relationship—and resulting lack of support for this new relationship limits the true potential of digital care.