DocuMental: a step toward personal medicine in the field of mental health

Psychiatry is a field more prone to misdiagnosis and errors in the treatment of patients than other medical specialities. Dr Eduard Maron and his team have developed a digital decision support platform called DocuMental, which is based on international diagnostics criteria and treatment guidelines and helps to make evidence-based decisions in regard to mental health patients.

Maron came up with the idea for the digital decision-making tool back when he was a resident in psychiatry at Tartu University Hospital. Twelve years ago, the development of the digital decision tool was launched in conjunction with professor Veiko Vasar, and several pilot projects were conducted. The 2007 financial crisis and ensuring cash crunch put the brakes on the project, though. In 2015, Maron decided to go forward with his idea. “I was pretty sure that the whole world was full of such digital platforms, but it turned out there weren’t any like this one, and DocuMental still lacks competition in the field of psychiatry,“ he says.

DocuMental was registered in November 2016 and the first major pilot project took place in North Estonia Medical Centre, which was also the first hospital in Europe to start using DocuMental. In addition, DocuMental has been tried by other Estonian medical centres and the feedback has been positive – they realize that both doctors and patients need this kind of tool.

Currently the activity is limited to Esto-nia alone, but interest in the pilot project from outside the country is significant. Work is underway to bring DocuMental to other countries quite soon.

Diagnoses made based on evidence

DocuMental is a digital decision support platform based on international diagnostic criteria and treatment guidelines used in psychiatry, where the user documents the patient’s case history by checking boxes.

“The doctor doesn’t have to enter text during the appointment but can instead tick boxes beside preset choices with the option of adding a comment,” said Maron. Based on the indicators checked, the system suggests a diagnosis based on inter-national criteria. At the same time, decision support offers alternatives in addition to the main diagnosis, allowing the doc-tor the freedom to choose. If choosing the alternative diagnosis, the user must provide a reason for disagreeing with the main result from the platform. Maron said the doctors in the pilot project appreciated the flexibility of decision support because sometimes an international criterion specifies one thing but practice shows the opposite.

DocuMental: A step toward personal  medicine in the field of  mental health

Maron admits that doctors in psychiatry need to process a great deal of information to confirm a diagnosis and assign treatment. A doctor will scarcely be able to remember all of the criteria, symptoms, treatment guidelines and required groundwork unassisted. Maron said there was no stigma in that; human memory is not infallible even at the highest levels. “As a result, doctors develop certain standard preferred options and courses of action. This can lead to major problems,“ says Maron. He argues for the need for the decision support platform that helps doc-tors make an evidence-based decision in a short span of time.

Facts in favour of digital decision support

Maron says that besides those positively predisposed to digital decision support, some say the product we want to develop is not right because the art of psychiatry can never be replaced by machines and algorithms as the doctor knows best what diagnosis to assign and how to treat a person.

“Our counterarguments are very simple and based on evidence,” says Maron. Both psychiatry statistics and research papers have shown that many mistakes are made in practice. One of these is misdiagnosis. Maron said it has been proved that a hypothetical diagnosis is formed within the first minute in talking to a psychiatric patient, but statistics show that in psychiatry this diagnosis is generally false. For instance, 67% of patients with bipolar disorder were misdiagnosed.

Another problem is that quite many – up to 70% of patients with psychiatric disorders do not get the right medications. The reason could be the fact that the patient was misdiagnosed but also in the case of drug interactions. For example, if patients have an increased risk of diabetes or cardiovascular illnesses, the medications used in psychiatry could aggravate the risks, but doctors are not able to evaluate all of these aspects.”

Maron says that up to now psychiatry has focused on how doctors know the field, not proceeding from the patient’s needs, which constitutes the best possible approach, assistance and support. He admits that current means are insufficient to offer patients what they need.

A patient module is also planned to be developed

Regarding the future, Maron says much has been accomplished in standardizing DocuMental on international psychiatry diagnosis criteria and treatment guide-lines. The team has also been working actively  to  make  DocuMental  easily  accessible but secure for its users. “Looking further, our goal is for DocuMental to be an environment that keeps up with the times, where the newest information is available to users. In future, it is plan-ned to integrate DocuMental with other medical start-ups and decision support platforms, such as those used in cardiology and oncology, because there are many psychiatric patients who have cardiological and oncological diseases as well.

Looking further, our goal is for DocuMental to be an environment that keeps up with the times, where the newest information is available to users.

As healthcare is becoming more personalized and patient-centred, we are also developing a module for patients to use.” Maron admits that several acclaimed international partners have offered their assistance and knowledge to develop the patient module. The patient module would allow the doctor to get an overview of the patient’s condition even if the patient is not at the doctor’s office. The module is structured on questionnaires that the patient can complete in the comfort of their home. Maron calls it a totally new concept in the field of mental health, termed digital phenotyping.

The DocuMental team also wants to develop decision support for medications and treatment methods, which would generate the most suitable groundwork and treatment for patients based on a complete range of significant factors.

The psychiatrist emphasizes that the DocuMental decision support platform is the latest step toward personalized medicine – for each patient to be treated based on their specific needs.