IconoPsych Care, LLC is working toward commercialization of web-based mental health services which integrate the practice of video telepsychiatry with electronic medical record keeping. This research and development effort is in response to three problems: 1) the shortage of mental health providers available in rural areas , 3) stigma related to seeking mental health services, 3) the need for medical recordkeeping technology that enables improved communication between patients and mental health practitioners. Despite large rural mental health needs, very few rural communities have access to mental health services in their area. Over half of the counties in the United States have no psychiatrists, psychologists or social workers. Rural residents travel much longer distances to obtain health care services. Otherwise, rural communities must pay high costs for mental health professionals to travel to their local clinics. IconoPsych is positioned to be the first company to offer an "online clinic" video conference portal for mental health. Several large studies have found telepsychiatry and telecounseling by videoconference equivalent in outcome and patient satisfaction to face-to-face encounters. IconoPsych is pairing the videoconference functionality with an electronic health record, embedding the teleconferencer within the patient's electronic chart. Such a set-up will enable processes that promise to improve quality and efficiency of care, even in the context of traditional face-to-face mental health clinic visits. The patient is able to complete online questionnaires prior to the visit, e.g., from home. Questionnaire answers are formatted for use by the clinician, conveying the patient's history in a comprehensive and accurate fashion. Also, the clinician may post information for online access by the patient, facilitating understanding of the treatment plan and continuity of care. IconoPsych's "completely portable" online portal is to be called HomePsych. Although one or both parties are likely to connect from a clinic or community center, the patient and doctor could connect from their respective homes, given a high speed internet connection and web cam is available. If patients are given the option of seeing a psychiatrist from home, the risk of being seen entering a mental clinic is eliminated. This would allow patients to overcome the stigma barrier to seeking help. OBJECTIVES: IconoPsych Care LLC has developed the prototype for an online portal for collaboration between mental health professionals and consumers. This product, HomePsych, features online videoconferencing (telepsych) embedded in a record keeping and practice management system for psychiatrists and counselors. Specific Phase II objectives include: 1. Establish safety and quality of the current product from a technical standpoint. 1a. Install an SSL security certificate and subject the software system to independent analysis for security and HIPAA compliance. (9/08); 1b. Subject the software system to independent usability testing. This will be conducted by the Information Experience Laboratory at University of Missouri-Columbia. (9/08); 2a. Modify the system as needed prior to live testing. This will include fixing bugs and implementing usability improvements recommended by the Information Experience Lab and mental health practitioners. (10/08 - 2/09); 2b. Beta test the system in live clinical situations involving 6 to 10 early adopter mental health test sites. IconoPsych will collect and analyze qualitative and quantitative feedback from beta testers. Data collection will involve not only perceptions through survey questions, but also tabulations of usage and technical support requests, automated software error reports, etc. (3/09 - 7/09); 2c. Modify the program as needed based on feedback from beta test. It is expected that practitioners will request addition of basic electronic medical (EMR) record functionality. Additional personal health record (PHR) functionality may be added, as requested by consumers. EMR and PHR functionality will be implemented under supervision of engineer(s) experienced in open standards for medical informatics technologies, to enable interoperability with other systems, e.g., importing of medical test results (if such functionality is requested by beta testers). (5/09 - 11/09); 3. Revise preliminary cost and revenue projections based on detailed analysis of target market(s), expenses and pricing. 3a. Analyze specific targets for marketing efforts. Based on beta tester feedback and market analysis, IconoPsych will determine whether to focus primary marketing efforts on private mental health practitioners, group practices and/or institutions. (3/09 - 5/09); 3b. Determine pricing and margins based on analysis of competing or complementary strategies, e.g., initiation fees, monthly subscription fees, commission off of billing through the system, usage fees, etc. (6/09 - 8/09) ; 4a. Ensure adequate availability of capital for launch. The HomePsych venture requires $400,000 in startup capital for product and market validation and scale up. This will be raised in conjunction with IconoPsych's experienced business development partners. (9/08 - 4/09); 5: Prepare to launch the product to market. Necessary support structures will be in place, including administrative and customer support. Marketing, customer support, tech support, travel and other expenses are to be financed by investor funds (11/09 - 12/09). APPROACH: 1. Prior to Phase II, IconoPsych will survey potential practitioner users individually and in a focus group to determine the most desired additional features. This project will involve asking potential users to create narrative describing the ideal telemedicine and medical informatics systems. 2. Dr. Hummos will obtain an independent evaluation to assure compliance with the Heath Information Portability and Accountability Act and other high security standards 3. The Information Experience Lab (IE Lab) will conduct a usability study. The evaluation for Phase II will include evaluations of potential users in a focus group or individual settings to evaluate ease of use. A second expert review from the IE lab will evaluate quality of the system from a technical standpoint. IE lab will assure formalized consent of subjects and assure protection of human subjects. Subjects will include at least two mental health providers and two non-providers who will play the role of patients. Volunteers will be found by IconoPsych Care, and will be unfamiliar with the system prior to the testing. 4. Dr. Cafer and Dr. Hummos will work with software development contractor to implement changes recommended by the security and usability consults described above. 5. By month five, IconoPsych will have followed up on leads from Phase I paper and online surveys to enlist 6 to 10 early adopter mental health test sites. 6. Funds provided by this grant will be used to collect and analyze both qualitative and quantitative data. Qualitative data will be reviewed in total, with no need for complex theoretical synthesis, simply because there will be no more than ten test sites. Quantitative data analysis will involve straightforward univariate and graphical analysis of specific variables. In this Phase II project, quantitative data collected will involve not only perceptions through survey questions (as did Phase I), but tabulations of usage and technical support requests, automated software error reports, etc. Each of these five sites will be paid $1200 for participating in this part of the study. Through the HomePsych patient portal, patients will be given the opportunity to give anonymous feedback on their experience. 7. Dr. Cafer and Dr. Hummos will work with software development contractor to implement changes recommended by patients and providers during the live beta test. 8. Conferring with The Incubation Factory, Michael Schrader MBA will construct a report comparing these markets, analyzing them in relation to the HomePsych product, and issue a formal recommendation of where marketing efforts are to be focused. 9. The Incubation Factory (TIF) will orchestrate get-to-market acceleration through a 2 year process which will begin when the specified capital is raised, which matches TIF's sweat equity contribution. 10. Using the product and planning from the past 13 months, release the product to paid users, supported by The Incubation Factory's infrastructure
