> Our EHR also automates administrative tasks such as collecting intake forms and getting reimbursement from insurance companies.

Sounds good on paper but I am not sure if I would want processes that heavily collect psychometric data and automate insurance to coexist in the same company. It is a matter of a flip of a switch (e.g. repealing of ACA) before insurance companies might legally have access to that psychometric data, with sweet profits left to this company. Even though right now they are in HIPAA land, since that data probably doesn’t qualify as therapists notes, it won’t have the same protections.

My second issue is overfocus on treatments like ketamine, psychedelics etc. I get that they target treatment resistant population, but maybe having this additional psychometric data would have rendered more conventional treatments efficacious to begin with? Or this would be a therapy modality in itself? (Pervasive technology) Or maybe it is going to be completely neutral because the extra effort required from therapist to analyze and interpret this data is not going to be worth it, or the AI won’t match the sophistication of the problems? Biomarkers for mental ails is indeed the holy grail, but the signal to noise ratio with what we have without getting invasive is pretty low.

Sounds like right now the focus of the compnay is pretty diffuse waiting to pivot on whatever proves most profitable, which is perfectly fine. Hopefully it will end up being something useful to the humanity too.

> Our EHR enables doctors to measure how patients are doing in between appointments via an integrated patient mobile app to drive personalized, improved clinical decision-making. For example, we can use data science to automatically detect symptom exacerbation or improvement (from patient-reported outcomes or functional metrics such as activity levels) and get them in for treatments at the right time.

The problem with patient-reported outcomes or other metrics, is that you are relying on the patient. This trap already exists for the vast majority of people suffering from mental health issues in the United States: in order to conquer your issues you basically need to not have them in the first place. Navigating (maybe battling) insurance, out-of-pocket bills, finding doctors who will take you seriously, and so forth, is really taxing, and when you are already struggling it can be Too Much.

I saw, second-hand, some of the surveys that Stanford sent to their disabled patient, which I would suspect would be used in the same way. The surveys are tiring, exhausting, and frustrating. It's frustrating to be asked the same questions over and over again while you tread water, and have to admit the same shitty answers, whether it's pain or depression or any other miserable symptom.

I am curious what you are doing here that is wholly different from what most institutions are already doing.

Thank you for bringing up this great point - yes, agreed that patient-reported outcomes can be sometimes challenging even though this is the standard of "objective" measurement for mental healthcare! Part of our whole goal is to find additional objective measurements that don't need to rely solely on the patient's reporting. For example, how one uses their phone (have they left the house? are they socializing and in touch with others? etc.) could be telling. By combining different streams of information we can relieve patients, clinicians, researchers of just relying on the types of surveys you talk about to give a more objective view of the patient. We don't know of anyone else taking this comprehensive approach.

This is concerning for people suffering from disabilities and on long term medical leaves, and also where a private disability insurance provider (or even social security!) is paying the patient.

Most disability corps only care about maximizing revenue, and will look for any excuse (legal or not) to cut off a client. Often times they require full access to medical records, so what sort of information is in this records can be, for lack of a better term, life or death.

If a whether or not a patient left the house might be tracked and eventually accessed by an insurance agent, I would be extremely hesitant to use this product, and I know private disability insurance advisors that would be very afraid of this sort of thing, on behalf of their clients.

The real achievement here is how you were able to convince clinics to try your software. The biggest problem in healthcare is inertia. It is not that the tools don't exist but people in this field don't like change. I run a telemedicine startup Tangerine Health https://www.tangerinehealth.co/ and we want to approach self funded companies and their independent Third Party Administrators to provide a subscription base business model and it's so hard to meet the decision makers. We know employees will be more satisfied with on demand and unlimited services and save the company so much money.

Thank you for your note - so real! Your work looks really important. Interestingly with self-ensured employers you may want to try their HR/benefits departments rather than anything healthcare related. A lot of bigger companies will also use benefits brokers/consultants like Mercer, Willis Towers Watson, and more. Best of luck and let us know if we can be helpful to you too :)

thanks for the info!

Have you reached out to benefits brokers? I've found that they're usually easier to get in touch with.

Not yet will try thanks for the advice!

This looks really cool! Very impressed that you have navigated HIPPA compliance and come so far since Spring 2020. As others have said, innovating in health care is so difficult because organizations are afraid of change and the consequences of fines. Also, healthcare workers can be very tech-adverse, many who have been forced to adapt to telehealth programs due to COVID-19 hate working with the technology and want to go back to the old way. Too many older people in the licensed positions.

As a data scientist excited about the potential of psychedelic therapies, I like that you are helping bring rigor to the space. I imagine supplementing clinical data with feedback from daily in-app experience sampling could help validate or invalidate new therapies. Keen to follow along and possibly get involved in the future.

We need more startups like this that aim to help people and save lives, not another tech-centric b2b saas. Very exciting to see Silicon Valley begin to realize the potential of psychedelic medicine for mental health care.

Out of curisoty, how have you implemented the security/hipaa compliance?

> We care deeply about patient and clinician privacy as well. Our platform is HIPAA-compliant and protected by end-to-end encryption. We work with independent third parties to verify our compliance and security. Patients own their health data and have the right to all of it. Any analysis we do is always on anonymized and aggregated information and never traceable back to an individual or clinic. We openly state that our mission to advance new treatments to the patients and doctors we work with and have found that the whole field is motivated to help - everyone realizes it’s an all-hands-on-deck movement.

do you have further infos?

We've appointed a Chief Security Officer within our startup that oversees security and HIPAA compliance. We work with Vanta (W18) to ensure compliance (they have automation software and compliance dashboards) and have a third-party auditor as well. I am happy to have our engineering team to tell you more if you wanted to learn! Feel free to message lucia@osmind.org

Congrats on taking your first major steps on your journey.

As an outsider who doesn’t know either of you I get concerned by:

>Jimmy and I met at Stanford in a healthcare IT class at Stanford last year where I wrapped up my MBA and Jimmy is on leave from medical school

It sets a red flag this being a MBA project, especially given neither of you have worked as a professional mental healthcare worker.

I don’t know either of you, but just sharing my initial honest impression based on your post.

There is a lot of stuff above about the size of the market and your technology, but not enough about why you’re so driven to solve this problem.

Hope you find this honest feedback helpful. (Edit format)

Thank you for your honest feedback :) This wasn’t actually just a school project. Jimmy and I met in the class and stayed in touch. One of the many things we bonded over was our shared mental health journey. From growing up in households where it’s highly stigmatized to dealing with our own struggles during college and beyond, we realized we both had a drive to do something based on our and our loved ones’ patient journeys. We are lucky to work with a number of advisors who are some of the most respected academics and practitioners in psychiatry such as Dr. Charles DeBattista and Dr. Alison McInnes. We know we have a lot to learn and are excited to continue to bring in these perspectives. I am super grateful you’ve pointed out what your perception is! I would be happy to address any additional concerns or take any other feedback :) thank you so much! lucia@osmind.org

Sound like really amazing software. Best of luck!

One area where such tool could be extremely helpful is using supplements(and their lower side effects profile) where appropriate in order to minimize drug use.

Which supplements have proven safe and effective for treating mental health conditions in large scale randomized controlled trials?

There's a problem here: it doesnt make financial sense to do those studies on a supplement, without strong parents.

That doesn't mean they aren't helpful, and some psychiatrists already use them.

And in particular, when were talking about vitamins, minerals that the body naturally gets , the risk profile is quite good.

That's a separate problem. Individual psychiatrists can experiment with unproven treatments, within reasonable bounds. But it wouldn't be appropriate for an EHR vendor like Osmind to make treatment recommendations without a solid foundation in evidence-based medicine.

I am personally interested in this domain and would like to share something I have been thinking about:

If a platform could separate my personally identifiable bits from my measurement data stream and if I participate in sending anonymous track of my health -

- at a large scale, there would be enough data to derive patterns and then insights (like you mention)

- I could take the generated insights and apply them as overlay on top of my own personal data again

In theory my personal bits never leave my app. But I contribute to a larger data driven improvement of health.

Thank you for this!! We so appreciate that you are aligned with the approach. We would love to find interesting ways to return the insights back directly to patients. For example, if you're taking XYZ medication, how do your responses compare to the national average? What other interesting correlations can we make to help you better understand your health? It may be a ways off, but definitely something we're thinking about :)

Yes, that would be really cool. A while back I was thinking about something similar, when I was working on a social network for cancer patients. What if we can connect people by symptoms, medicine they are taking or their side effects, the doctor or facility they are visiting. Connect people to help them get through whatever they are experiencing, but also collect anonymous data to see patterns and offer suggestions.

I would like to think of some of these issues deeply. I don't work in this domain but interested due to personal and family reasons.

Let's stay in touch somewhere if you want.

Yes please, we would really love that! Can you shoot me a note at lucia@osmind.org? Thank you :)

How do you convince doctors to use your software? I see the benefit for patients but what’s in it for doctors? If they give crappy care they still get paid.

Really great question! Two things: 1. We have found doctors to actually want to try to do the right thing for patients in this space. Oftentimes they are seeing people who have tried 10+ SSRIs and experienced mental health conditions for decades. These patients are suffering immensely and doctors want to help 2. Our software also helps streamline administrative tasks for doctors, such as scheduling, dealing with insurance, etc. So there is a financial/time-saving benefit for them as well

Wow, great idea! Nice to know you are taking care of so many people. Are you planning to use data from wearables?

Thank you! Yes, we are planning on using wearables data as well. For example, many of our clinicians want to know how people are sleeping or if they are leaving the house, which both can be highly correlated with mental health conditions.

> Any analysis we do is always on anonymized and aggregated information and never traceable back to an individual or clinic.

Google says your records are "anonymized" when they drop the last octet of your IP address. What do you mean when you say "anonymized"?

Thank you for the question! We do more than just redact records by erasing names and all demographic information. We actually remove specific pieces of information from all records, such as medications, lab results, diagnoses, etc. and put those into separate files that contain similar information from numerous other records. Thus the only thing researchers see are spreadsheets with a bunch of numbers, medications, and dates that include information from, at minimum, thousands of anonymous contributors around the world who have joined forces to advance science and healing. As a result, the information is totally anonymous. We realize there can be concerns that data in general can never be totally anonymized, but a combination of our rigorous de-identification process, aggregation across (at minimum) thousands of people across the world, and strict laws forbidding any attempt by researchers to re-identify data make it extraordinarily difficult if not virtually impossible to trace data back to any individual or clinic.

I think this idea has a lot of potential, does Osmind incorporate sleep data?

Thank you, we hope so too! Yes, we are planning on using sleep data from wearables or one's phone as well given many of our clinicians have requested it. It would be very interesting to see how that correlates to specific mental health conditions

This sounds great on paper!

I'm curious - how does your data consider racial biases when it comes to mental health?

Additionally, does your data take in consideration social determinants of health and health inequalities?

Thank you!

Thank you for bringing up the issues around racial biases when it comes to mental health. We hope to address this in multiple ways: 1) trying to incorporate objective forms of information such as digital and biological data that theoretically should be less biased 2) giving back to the community by supporting providers who serve underrepresented communities (we provide our software for free or significantly discounted to these community practices and are working with a number of them already)

And yes, we aim to incorporate various types of demographic information including social determinants of health.

Beware the trap of distinguishing "objective" measures/data in a space that almost by definition concerns itself with subjective experience. I also would question any assumption that such data is less prone to racial issues -- see for example volumes of literature on inequities in healthcare access and treatment.

It's great to be using quantitative measures, and almost a necessity, but as someone in this area who has done clinical work as well as research, I can say from personal experience EHR in mental healthcare has fumbled repeatedly with handling the complexities of behavioral information.

Good to see attention in this area though.

Very necessary product. Have you thought about approaches for helping researchers run studies with de-identified but linked data?

Thank you! Yes, after rigorous deanonymization we aim to support academic studies that look to research standards of care, efficacies of treatment paradigms, and public health measures. These collaborations can help develop better procedures for treatment resistance

This is a great approach. Does your data analysis go beyond TRD?

Yes! While we are focused on treatment-resistant mental health conditions because these patients need the most help, we plan to expand more broadly across mental health. We envision a world where everyone can find the right treatment for them the first time around (rather than having to go through a painful trial and error process) and end all suffering.

What an amazing product!! Keep the hustle guys!!