Prescription Digital Therapeutics: The Future of Digital Health Solutions

Prescription Digital Therapeutics: The Future of Digital Health Solutions

by Ree AI Health Tech Med Tech

The global market for prescription digital therapeutics (PDT) is expected to grow to $17.16 billion by 2030. This growth is mainly due to the affordability of digital health technology for both healthcare providers and patients, as well as the increasing use of smartphones in both developed and developing countries.

In this article, we’ll describe PDT, its applications, benefits, and challenges.

Contents

What Are Prescription Digital Therapeutics?

Prescription digital therapeutics (PDTs) are a new class of medical interventions that leverage software to treat, manage, or prevent diseases and disorders. Unlike typical health apps, PDTs require a prescription from a healthcare provider and are subject to rigorous regulatory scrutiny.

According to the U.S. Food and Drug Administration (FDA), prescription digital therapeutics are medical devices, also called Software as a Medical Device (SaMD). The FDA review of prescription digital therapeutics is the same as the process the FDA uses to review medical devices. 

Definition and key characteristics of PDTs

PDTs are software-based treatments delivered through mobile devices, designed to address the behavioral and psychological aspects of various health conditions. These digital tools are developed based on scientific evidence and aim to provide therapeutic benefits comparable to traditional medical treatments (Phan et al., 2023). 

Source: Avalere

Examples of prescription digital therapeutics developers

This chart from Blue Matter Consulting (2023) lists 154 PDT companies.

Source: Blue Matter

How PDTs differ from wellness apps and other digital health tools

While wellness apps focus on general health and fitness, PDTs are designed to treat specific medical conditions. PDTs undergo clinical trials, and are subject to stringent regulatory processes to ensure they meet high standards of safety and effectiveness. This regulatory oversight differentiates PDTs from other digital health tools, which may not require such rigorous evaluation.

The PDT regulatory framework 

The FDA plays a critical role in the approval of PDTs. These therapeutics must demonstrate clinical efficacy and safety through rigorous trials before receiving FDA clearance. This process ensures that PDTs meet the same standards as traditional pharmaceuticals, providing healthcare providers and patients with confidence in their use (Phan et al., 2023).

The Science Behind Prescription Digital Therapeutics

PDTs are grounded in scientific research and evidence-based practices to ensure their effectiveness in treating various health conditions.

Evidence-based approaches used in PDTs

PDTs incorporate evidence-based approaches to help patients change their behaviors and manage symptoms effectively, such as: 

For instance, CBT-based PDTs can help identify and change negative thought patterns, improving mental health outcomes. A study on a PDT for opioid use disorder found it improved retention in treatment by 76% at 12 weeks compared to treatment as usual (Brezing & Brixner, 2022). 

Clinical trials and efficacy studies supporting PDTs

Lab worker

Clinical trials are essential for validating the efficacy of PDTs. These studies assess the therapeutic outcomes of PDTs compared to traditional treatments. 

For example, trials have shown PDTs can be effective in managing substance use disorders and chronic insomnia, providing real-world evidence of their clinical benefits (Brezing & Brixner, 2022).

Applications of Prescription Digital Therapeutics

PDTs offer promising solutions across a range of medical conditions, providing tailored interventions for diverse patient needs.

Mental health conditions

Therapist and patient talking on couch

PDTs are increasingly used to treat mental health disorders such as depression, anxiety, schizophrenia, and post-traumatic stress disorder (PTSD). In a randomized controlled trial, a PDT for depression reduced symptoms by 45.6% compared to 17.4% with usual treatment (Phan et al., 2023).

These digital tools provide accessible and scalable interventions, often with CBT techniques to help patients manage symptoms and improve their quality of life.

Chronic diseases

For chronic conditions like diabetes and hypertension, PDTs offer personalized management strategies. They enable continuous monitoring and data analysis, facilitating timely adjustments to treatment plans and improving patient outcomes (Phan et al., 2023).

A PDT for type 2 diabetes led to a 1.1% reduction in HbA1c levels after 6 months in a clinical trial (Phan et al., 2023).

Substance use disorders and addiction treatment

Woman sitting with hands clasped

PDTs are particularly effective in treating substance use disorders, offering structured programs that support recovery. They provide patients with tools to manage cravings and develop healthier coping mechanisms, contributing to sustained recovery. 

A couple of examples:

  • Research with 1,758 patients using a PDT for substance use disorder showed 64.1% abstinence at 12 months (Brezing & Brixner, 2022).
  • A PDT for alcohol use disorder resulted in 63% of patients reducing heavy drinking days compared to 32% receiving standard treatment (Rassi-Cruz et al., 2022).

Neurological disorders

Conditions such as ADHD and insomnia can benefit from PDTs, which offer targeted interventions to manage symptoms and improve daily functioning. For instance, PDTs for insomnia often include sleep hygiene education and relaxation techniques to enhance sleep quality.

Benefits of Prescription Digital Therapeutics

PDTs offer numerous advantages that enhance patient care and healthcare delivery.

Improved accessibility to treatment

PDTs make healthcare more accessible by providing treatments that can be delivered remotely via mobile devices. This is particularly beneficial for individuals in underserved areas or those with mobility challenges, ensuring they receive timely care.

Personalized and adaptive interventions

PDTs can be tailored to individual patient needs, offering adaptive interventions that evolve based on real-time data. This personalization enhances treatment effectiveness and patient satisfaction (Phan et al., 2023).

Real-time data collection and analysis

The ability to collect and analyze data in real-time allows healthcare providers to monitor patient progress continuously. PDTs can collect patient data continuously, providing 1440 data points per day compared to 1-4 from traditional in-person visits. This facilitates early detection of issues and enables proactive adjustments to treatment plans, improving overall outcomes (Phan et al., 2023).

Reduced healthcare costs

By providing effective and scalable interventions, PDTs have the potential to reduce healthcare costs. They can decrease the need for in-person visits and hospitalizations, making them a cost-effective alternative to traditional treatments. For example, an economic analysis estimated PDTs could save $2,150 per patient per year for opioid use disorder treatment (Brezing & Brixner, 2022).

Challenges and Limitations of PDTs

Despite their benefits, PDTs face several challenges that must be addressed to maximize their potential.

Doctor showing a patient an app in green

Federal regulation lags behind software development

Digital therapeutics (DTx) are mobile medical apps that use new tech like artificial intelligence (AI) and virtual reality (VR). They’re always changing, with new versions coming out every few months, which makes them hard to regulate. 

DTx Products 2015-2021 with Regulatory Status

A problem with a DTx app could hurt someone’s health, so to keep DTx safe for consumers without stopping progress, software companies need to self-regulate–find ways to reduce risks and follow ethical rules on their own to help patients and build trust with their doctors.

One way to self-regulate is to involve clinicians in app development. Doctors know what patients need and can spot potential problems. But surprisingly, most health apps are made without input from medical experts. A study found only 20% of health apps included input from health professionals during development (Rassi-Cruz et al., 2022). 

Data privacy and security concerns

The collection and storage of sensitive health data raise significant privacy and security concerns. Ensuring robust data protection measures is crucial to maintaining patient trust and compliance with regulations (Phan et al., 2023).

Integration with existing healthcare systems

Integrating PDTs into existing healthcare infrastructures can be complex. Seamless integration is necessary to ensure that PDTs complement traditional treatments and fit within the broader healthcare ecosystem.

Patient adherence and engagement

Black man using his blood pressure monitor at home

Maintaining patient engagement with PDTs can be challenging. 

For example, take mental health apps that use CBT or provide feedback through wearables like smartwatches. While helpful, these apps often aren’t covered by insurance, and patients may pay out-of-pocket. They often give up if they don’t see quick results. 

Ensuring that patients adhere to prescribed digital therapies is essential for achieving desired outcomes, requiring strategies to enhance motivation and commitment. Pharmacists can help by encouraging patients to stick with the apps and complete all modules (Pharmacy Times, 2024).

Reimbursement and insurance coverage issues

Securing reimbursement for PDTs remains a hurdle, as insurance companies may be hesitant to cover these relatively new treatments. Establishing clear guidelines and demonstrating cost-effectiveness may help overcome this barrier.

The Future of Prescription Digital Therapeutics

The future of PDTs is promising, with advancements in technology and expanding applications poised to enhance their impact on healthcare.

overlay with doctor and pill bottle

Emerging technologies such as artificial intelligence and machine learning are set to revolutionize PDTs. These innovations can enhance personalization and predictive capabilities, improving treatment outcomes and patient experiences.

Potential for combination therapies

Combining PDTs with traditional treatments offers a holistic approach to healthcare. This synergy can enhance therapeutic outcomes by addressing multiple aspects of a patient’s condition, providing comprehensive care (Phan et al., 2023).

Expanding applications in preventive care and wellness

PDTs hold potential for preventive care by identifying and addressing health risks early. Their application in wellness can promote healthier lifestyles and prevent the onset of chronic diseases, contributing to improved public health.

Conclusion

In digital health, PDTs offer promising avenues for improving patient outcomes, increasing access to care, and potentially reducing healthcare costs. While challenges remain, the growing body of evidence supporting PDTs suggests that they will play an increasingly important role in the future of healthcare delivery. 

As patients, healthcare providers, and policymakers alike embrace these innovative tools, we can look forward to a more personalized, accessible, and effective approach to managing a wide range of health conditions.

References

Bashran, E. (2024). Prescription Digital Therapeutics: Devices. HealthAffairs. Retrieved from

https://www.healthaffairs.org/doi/10.1377/hlthaff.2024.00159

Brezing, C. A., & Brixner, D. I. (2022). The Rise of Prescription Digital Therapeutics In Behavioral Health. Journal of Behavioral Health; 11(4), 1-10. doi: 10.1007/s12325-022-02320-0 

Global Prescription Digital Therapeutics (PDTx) Market – Industry Trends and Forecast to 2030. (2023). Data Bridge Market Research. Retrieved from https://www.databridgemarketresearch.com/reports/global-prescription-digital-therapeutics-dtx-market

Liesch, J., Volgina, D. Nessim, C., Murphy, D., & Samson, C. (2023). Blue Matter Consulting. Retrieved from https://bluematterconsulting.com/prescription-digital-therapeutics-us-market-outlook-2023/

Phan, P., Mitragotri, S., & Zhao, Z. (2023). Digital therapeutics in the clinic. Bioengineering & Translational Medicine; 8(4), e10536. doi:10.1002/btm2.10536. 

Prescription Digital Therapeutics Bring New Treatments to Healthcare. (2021). Avalere Health. Retrieved from https://avalere.com/insights/prescription-digital-therapeutics-bring-new-treatments-to-healthcare

Prescription Digital Therapeutics for Mental Health: Effectiveness, Challenges, and Future Trends. (2024). Pharmacy Times. Retrieved from https://www.pharmacytimes.com/view/prescription-digital-therapeutics-for-mental-health-effectiveness-challenges-and-future-trends

Rassi-Cruz, M., Valente, F., & Caniza, M. V. (2022). Digital therapeutics and the need for regulation: How to develop products that are innovative, patient-centric and safe. Diabetology & Metabolic Syndrome; 14. doi.org/10.1186/s13098-022-00818-9 

Wang, C. Lee, C. & Shin, H. (2023). Digital therapeutics from bench to bedside. npj Digital Medicine; 6(1), 1-10. doi.org/10.1038/s41746-023-00777-z

Health App Gamification: Making Your Wellness Journey Fun

Health App Gamification: Making Your Wellness Journey Fun

by Ree AI Health Tech Med Tech

Did you know that 71% of people using fitness apps abandon them within 3 months? These apps may lack health app gamification – health trackers with fun, competitive elements to keep us motivated and on track with our goals. 

In this article, we’ll discuss how gamification is making health apps more engaging, effective, and enjoyable.

Contents

What is Health App Gamification?

Definition of gamification in the context of health apps

Gamification aims to make a website or app fun and motivate people to use it. This is done by employing elements from successful popular games and classical principles of human behavior. 

In health apps, gamification in health apps involves incorporating game-like elements into non-gaming contexts to enhance user engagement and motivation. 

This strategy approach uses the fun and competitive aspects of games to promote healthier habits. By integrating features like points, badges, and leaderboards, health apps aim to make achieving wellness goals more enjoyable and rewarding.

Elements of gamified health apps

Source: Pragmatic Coders

Mechanics are gamified elements in the app that users can see and interact with. Some game elements included in these apps include:

  • Points: Users earn points for completing tasks, such as logging workouts or reaching step goals. These points can be used to unlock new levels or rewards.

  • Rewards and Badges: Achievements are recognized with badges, providing users with a sense of accomplishment and motivation to continue their healthy habits.

  • Leaderboards and Ratings: Users can see how they rank against others, fostering a sense of competition and community.

  • Progress Bars: A measurement of success toward a goal.

  • Simulations: Used to upgrade clinicians’ and researchers’ technical skills, monitoring, and medical procedures, and showing visual health-related consequences for patients.

How gamification taps into human psychology for motivation

Gamification taps into motivation from intrinsic (inner) and extrinsic (outside) sources by providing immediate feedback and rewards. The sense of progress and achievement encourages users to stick with their health routines. 

For example, earning a badge for completing a week of workouts can boost a user’s confidence and drive to maintain their exercise regimen. This approach leverages psychological principles such as the desire for mastery and social recognition, making health goals more attainable and engaging (Gkintoni et al., 2024; Berger & Jung, 2024).

Dynamics and aesthetics in apps

Dynamics in health apps are what keep users interested. They:

  • Set and track goals

  • Give out rewards

  • Provide quick feedback

  • Let users customize their experience

  • Make the app interactive

These features help keep people engaged and motivated to use the app and work on their health goals.

Aesthetics are the emotional effects that gaming elements bring out, like curiosity, motivation, fun, connection, and winning. It’s also about the look and feel of the app. 

Use cases for health app gamification

Source: Digital Doughnut

The most popular health areas using healthcare app gamification are:

  • Medication and chronic conditions

  • Fitness

  • Physical therapy

  • Mental health

  • Pediatrics

Healthcare use cases for gamification include:

  • Having users do specific exercises to treat ailments

  • Completing competitive milestones

  • Sharing progress with other users

Benefits of Gamified Health Apps

Now that we know what health app gamification is, let’s explore why it’s so effective.

Increased engagement and retention

Gamified health apps keep users engaged by making health activities fun and interactive. Features like daily challenges and quests encourage regular app use, increasing retention rates. People are more likely to stick with an app that provides a sense of accomplishment and community.

Enhanced motivation for reaching health goals

By setting clear goals and providing rewards, gamified apps motivate users to pursue their health objectives. Whether it’s losing weight, building muscle, or improving mental health, the game-like structure helps users stay focused and committed.

Note that all rewards aren’t created equal. For instance, one study with three groups of nutrition app users had different preferences (Berger & Jung, 2024):

  • Older men who like routines prefer coupons and points.

  • Mid-30s women who are open to new things prefer progress bars and leaderboards.

  • People with high self-worth prefer progress bars and goals, but dislike social features.

These preferences relate to personality traits and demographics.

Social support and accountability through competition

Leaderboards and social sharing features create a sense of community and accountability. Users can compete with friends or join groups to tackle challenges together, fostering a supportive environment that encourages continued participation.

Improved health outcomes and behavior change

People often quit forming healthy habits over time. They may start off excited and invest a lot, but give up when the initial thrill fades.

Gamification helps with adherence to healthy habits because it:

  • Offers a path to goals with small time investments

  • Reinforces new behaviors along the way

  • Allows a gradual increase in effort once habits are formed

  • Keeps people motivated and committed

Studies have shown that gamification can lead to significant behavior changes and improved health outcomes. By making healthy habits more appealing, users are more likely to adopt and maintain them over time. For instance, nutrition apps using gamification have been effective in promoting healthier eating habits (Berger & Jung, 2024).

In short, gamification makes it easier to start and stick with healthy habits by breaking the process into fun, manageable steps. It helps overcome the common problem of people giving up when things get tough, by keeping them engaged and slowly building up their efforts over time.

To better understand how these apps work, let’s look at some of their key features.

Boy wins his computer game using health app gamification

Virtual rewards and achievements

Virtual rewards such as badges and trophies recognize user accomplishments, providing a sense of achievement and encouraging continued engagement. These rewards can be shared on social media, boosting user motivation through social recognition.

Challenges and quests

Challenges and quests offer users specific tasks to complete, such as a 30-day fitness challenge. These features provide structure and goals, making it easier for users to stay on track with their health objectives.

Progress tracking and visual representations

Visual progress tracking, such as graphs and charts, helps users see their improvements over time. This feature reinforces positive behavior by showing tangible results, motivating users to continue their efforts.

Social sharing and community building

Social features allow users to share their achievements and progress with friends and family. This creates a sense of community and support, which can be crucial for maintaining motivation and accountability.

Wearables and health apps

Person on scale with phone app

Mobile apps and wearable gadgets with game-like features also make health fun. These tools help people enjoy working out, eating better, and keeping track of their progress.  Fitness trackers and smartwatches, let users set goals, count steps, check their heart rate, and get personal tips.

Augmented and virtual reality

Woman wearing a VR headset in a coworking space

Augmented Reality (AR) and Virtual Reality (VR) are two technologies that can make you feel like you’re in another world, or add digital elements to what you see. They’re also helpful to make patients feel better and teach clinicians new skills.

Top Gamified Health Apps in the Market

With all these benefits and features in mind, you might be wondering which apps to try.

Overview of leading apps using gamification

Several health apps use gamification to enhance engagement. They’ve gained popularity for their innovative use of game mechanics:

  • Fitbit: Offers activity tracking and challenges, appealing to fitness enthusiasts.

  • Gluroo: For diabetes management.

  • Headspace: Guided meditatons and other features to improve mental health and wellbeing.

  • Mango Health: Reminds and motivates patients to take their medications as prescribed.

  • MyFitnessPal: Focuses on nutrition tracking with a large food database to help those who want to improve their diet and/or lose weight.

  • Zombies, Run!: Combines storytelling with running, attracting users who enjoy immersive experiences.

User reviews and success stories

Woman wins computer game - health app gamification

Users often praise these apps for making health activities more enjoyable and motivating. Success stories highlight significant weight loss, improved fitness levels, and better overall health, demonstrating the effectiveness of gamified health apps.

Designing Effective Health App Gamification

To create a successful gamified health app, consider more than just adding fun elements—it also requires careful planning and consideration.

Balance between fun and health goals

Designing a gamified health app requires balancing entertainment with health objectives. The app should be engaging without distracting from the main goal of improving health.

Personalization and adaptability

Personalization is key to keeping users engaged. Apps should offer customizable goals and challenges to cater to individual preferences and fitness levels. Adaptability ensures that users remain motivated as they progress.

Regulatory and ethical considerations (like addiction)

The FDA oversees health-related software as medical devices, referred to as “software as a medical device.” Games that help with diseases might need approval and doctor supervision. The FDA is working on a new plan to focus on digital health products that could be risky for patients.

Beware of addictive behavior

While gamification can enhance motivation, it’s important to avoid creating addictive behaviors, like “internet gaming disorder.” So health apps need to set fair goals. 

For example, step goals should match a person’s health and abilities. Setting goals too high can cause stress and be harmful. The aim should be to motivate, not manipulate. Good health apps respect users’ choices and clearly explain how they use game-like features to help.

Because of these concerns, experts think these apps should be tested for safety before people can use them. Developers should focus on promoting healthy habits without encouraging excessive app use or dependency.

Maximizing Your Experience with Gamified Health Apps

Now that you know what to look for in a gamified health app, here are some tips to get the most out of your experience.

Setting realistic goals and expectations

It’s important to set achievable goals that align with your lifestyle and fitness level. Realistic expectations prevent frustration and help maintain motivation.

Engaging with the app’s community features

Participating in community features, such as forums or group challenges, provides additional support and accountability. Engaging with others can enhance your experience and keep you motivated.

Combining app use with real-world activities

While gamified apps are a valuable tool, combining them with real-world activities can enhance your health journey. For example, use a fitness app to track outdoor runs or join a local sports team for social interaction.

Tracking progress and celebrating milestones

Regularly tracking your progress and celebrating milestones can boost motivation and reinforce positive behavior. Acknowledge your achievements and use them as motivation to continue your health journey.

Conclusion

Health app gamification can make the journey to our wellness goals more fun. By incorporating game-like elements, these apps make health activities more rewarding, which can lead to improved health outcomes and sustained behavior change. Whether you’re looking to improve your fitness, diet, or mental health, gamified health apps provide a fun and effective way to achieve your goals.

Ready to level up your health game? Download a gamified health app today and start your fun-filled path to better wellness!

References

Berger, M., & Jung, C. Gamification preferences in nutrition apps: Toward healthier diets and food choices. Digital Health; 10. doi.org/10.1177/20552076241260482

Gamification in Healthcare: Increase Loyalty and Motivation Among Your Patients and Medical Professinoals. (n.d.). Emerline. Retrieved from https://emerline.com/blog/gamification-in-healthcare

Gkintoni, E., Vantaraki, F., Skoulidi, C., Anastassopoulos, P., & Vantarakis, A. (2024). Promoting Physical and Mental Health among Children and Adolescents via Gamification—A Conceptual Systematic Review. Behavioral Sciences; 14(2). doi.org/10.3390/bs14020102

Golovnia, S. (2024). How to (And Why You Should) Incorporate Gamification into Your Mental Health Care App. SF AppWorks. Retrieved from https://www.sfappworks.com/blogs/incorporating-gamification-into-your-mental-health-care-app

Lech, E. (2024). Gamification in healthcare: Short guide for app founders. Pragmatic Coders. Retrieved from https://www.pragmaticcoders.com/blog/gamification-in-healthcare-short-guide-for-app-founders

Legourd, J. (2022). The Gamification of Healthcare: Emergence of the Digital Practitioner? Elfie.  Retrieved from https://www.elfie.co/knowledge/the-gamification-of-healthcare-emergence-of-the-digital-practitioner

Megan, S. (2022). Gamification in Healthcare Apps: Use Cases & Amazing Benefits. Digital Doughnut. Retrieved from https://www.digitaldoughnut.com/articles/2022/september-2022/gamification-in-healthcare-apps-use-cases

Milioto, M. (2024). 159 Key Fitness App Stats for 2024: Trends by Age, Market & More. Dr. Muscle. Retrieved from https://dr-muscle.com/fitness-app-stats/

Pavlov, I. (2023). 3 Main Components of Gamification to engage users in Health Apps. Nozomi. Retrieved from  https://nozomihealth.com/3-main-components-of-gamification-to-engage-users-in-health-apps/

Shukla, A. (2023). Gamification Tricks from Psychology. Cognition Today. Retrieved from https://cognitiontoday.com/gamification-tricks-from-psychology/

Struk, V. (2024). Redefining Patient Engagement: The Impact of Gamification in Healthcare. Relevant Software. Retrieved from https://relevant.software/blog/gamification-in-healthcare/#Ethical_Considerations_and_Risks_in_Gamifying_Healthcare

Suk, J. (2024). How Can Gamification Be Used in the Healthcare Industry? HurixDigital. Retrieved from https://www.hurix.com/how-can-gamification-be-used-in-the-healthcare-industry/

Terehin, A. Gamification in Healthcare: Benefits, Trends & Examples. (2024). Agente. Retrieved from https://agentestudio.com/blog/healthcare-app-gamification

Telehealth Mental Health Therapy: A Comprehensive Guide

Telehealth Mental Health Therapy: A Comprehensive Guide

by Ree AI Health Tech Med Tech

Telehealth mental health therapy has become increasingly popular, offering a convenient and accessible way for people to receive mental health support. This article will explore the world of online therapy, its benefits, challenges, and best practices for both providers and patients.

Contents

What is Telehealth Mental Health Therapy?

Telehealth mental health therapy (also known as telemental health, teletherapy, telepsychiatry, or online therapy) is the delivery of mental health services through digital platforms. It allows patients to connect with licensed mental health professionals remotely using video conferencing, phone calls, or text-based communication.

Definition and key components of telehealth mental health therapy

Woman in green sweater talking to doctor on Zoom

Telehealth therapy encompasses a wide range of mental health services provided through technology. The key components include:

  • Video conferencing sessions

  • Phone therapy sessions

  • Text-based therapy

  • Online mental health assessments

  • Digital tools and resources for mental health management

Types of mental health services offered via telehealth

Telehealth platforms offer various mental health services, including:

  • Individual therapy

  • Couples counseling

  • Group therapy

  • Psychiatry and medication management

  • Crisis intervention

85% of mental health providers offered telehealth services during the COVID-19 pandemic, with many saying they’d continue offering them services in the future (Pierce et al., 2021).

In an AAP study, 85% of pediatricians said they use telehealth for mental health visits, and over 80% of them said telehealth was very or moderately effective for mental health visits.

Platforms and technologies used for online therapy sessions

Several platforms and technologies are used to facilitate online therapy sessions:

  • HIPAA-compliant video conferencing software (Zoom for Healthcare, Doxy.me)

  • Secure messaging platforms

  • Mobile apps for mental health support

  • Virtual reality (VR) platforms for exposure therapy

For examples of how some organizations have successfully used telehealth in treatment programs for people experiencing homelessness, substance abuse disorders and mental disorders, review Chapter 4, “Examples of Telehealth Implementation in Treatment Programs from the Substance Abuse and Mental Health Services Administration (SAMHSA). 

Benefits of Online Mental Health Support

Telehealth mental health therapy offers numerous advantages over traditional in-person therapy.

Improved accessibility for rural and underserved populations

Telehealth therapy greatly improves access to mental health care for people in remote or underserved areas.

A 2024 study noted that many health providers had reduced no-show rates for behavioral health, and increased patient adherence to recommended behavioral health visits. One reason why is the potential for telehealth to mitigate anxieties that can surround in-person visits (Azar et al., 2024).

Lin et al (2018) found that health centers located in rural areas were more likely to use telehealth for mental health care, compared to those in urban areas.

A 2019 study found that telehealth significantly improved access to mental health care for rural populations, with a 45% increase in utilization of mental health services (Barnett et al., 2019).

Flexibility in scheduling and location

Online therapy allows for greater flexibility in scheduling appointments and choosing a comfortable location for sessions, which is beneficial for:

  • People with busy work schedules

  • Parents with childcare responsibilities

  • Individuals with mobility issues or disabilities

Less stigma 

Telehealth therapy can help reduce the stigma associated with seeking mental health support. Allowing patients to receive care from the privacy of their own homes removes the potential embarrassment of being seen entering a therapist’s office.

Cost-effectiveness compared to traditional therapy

Online therapy can be more cost-effective than traditional in-person therapy. A 2020 study found that telehealth mental health services were about 53% less expensive than in-person services (Lattie et al., 2020).

Challenges and Limitations of Telehealth Therapy

While telehealth therapy offers many benefits, it also comes with its own set of challenges and limitations.

Software and internet connectivity issues

One of the most common challenges in telehealth therapy is technical difficulties. These can include:

  • Poor internet connection

  • Audio or video quality issues

  • Software glitches

Younger generations tend to find virtual doctor visits easier than older generations. In any case, minimize these issues with a backup plan, like switching to a phone call if video conferencing fails.

Privacy and confidentiality concerns

Ensuring privacy and confidentiality in online therapy sessions is crucial. Therapists must use HIPAA-compliant platforms and take steps to protect patient information. patients should also be aware of their surroundings and ensure they have a private space for sessions.

Difficulty reading non-verbal cues

In video therapy sessions, it can be challenging for therapists to pick up on subtle non-verbal cues that might be more apparent in person. 68% of therapists reported difficulty in observing non-verbal communication during online sessions (Stoll et al., 2018).

Limitations for certain types of therapy or severe mental health conditions

While telehealth therapy is effective for many mental health conditions, it may not be suitable for all situations. Some limitations include:

  • Severe mental health conditions requiring in-person monitoring

  • Certain types of group therapy

  • Some forms of play therapy for children

How to Choose a Telehealth Mental Health Provider

If you’re considering telehealth therapy, here’s what to look for when selecting a provider for the best therapy experience.

Licenses and credentials

When choosing a telehealth therapist:

  • Verify the therapist’s license and credentials

  • Check if they are licensed to practice in your state

  • Look for specialized training in telehealth therapy

Platforms and security measures

Ensure that the therapist uses a secure, HIPAA-compliant platform for sessions. Ask about their privacy policies and data protection measures.

Insurance coverage and payment options

Check if your insurance covers telehealth therapy services. Many insurance providers have expanded their coverage for online mental health support in recent years. The Kaiser Family Foundation’s 2023 Employer Health Benefits Survey found that 91% of large employers included telehealth coverage in their health plans.

Assessing the fit between therapist and patient in a virtual setting

Finding the right therapist is crucial for successful therapy. Consider:

  • The therapist’s areas of expertise

  • Their approach to therapy

  • Your comfort level during initial consultations

Many telehealth platforms offer free initial consultations to help you find the right fit.

Best Practices for Effective Telehealth Therapy Sessions

To get the most out of telehealth therapy, therapists and patients should follow certain best practices.

Older woman using tablet

Set SOPs

Before starting telehealth services, the American Psychiatric Association recommends that providers assess their needs for training, space, and types of services. Organizations offering online mental health care should create standard procedures (SOPs), including quality improvement plans and ways to document provider credentials. 

Create a suitable environment for online sessions

Set up a quiet, private space for therapy sessions. This might include:

  • Using headphones for better audio quality and privacy

  • Ensuring good lighting for video sessions

  • Minimizing potential distractions

Prepare your tech and make backup plans

Before each session:

  • Test your internet connection

  • Ensure your device is fully charged

  • Have a backup plan (e.g., phone number) in case of technical issues

Establish rapport and trust

The American Psychological Association recommends developing a standard method for identifying both patients and providers at the start of each session. This could involve the provider stating their name and credentials, and asking the patient to provide their name and location. These guidelines help ensure professional and effective telehealth mental health services (Palmer et al., 2022).

Building a strong therapeutic relationship is just as important in online therapy as it is in person. Therapists should:

  • Use active listening techniques

  • Maintain eye contact by looking at the camera

  • Encourage open communication about the online therapy experience

Do therapy exercises and homework remotely

Woman touching cell phone with pink fingernails

Many therapeutic techniques can be adapted for online sessions. This might include:

  • Screen sharing for worksheets or educational materials

  • Using online tools for mood tracking or journaling

  • Assigning and reviewing homework through secure messaging platforms

A 2020 study found that 89% of patients were satisfied with their online therapy experience when therapists effectively adapted their techniques for the virtual setting (Wind et al., 2020).

Carry malpractice insurance

The American Telemedicine Association recommends telehealth providers to get malpractice insurance that covers online therapy (Palmer et al, 2022). 

When providing behavioral health care via telehealth, consult the American Psychological Association and American Psychiatric Association standards of care to ensure you’re providing ethical, quality care (Palmer et al., 2022).

The Future of Telehealth in Mental Health Care

The field of telehealth mental health therapy is rapidly evolving, with exciting developments on the horizon.

Some emerging trends in telehealth mental health care include:

  • AI-powered chatbots for initial assessments and support

  • VR therapy to treat phobias and post-traumatic stress disorder (PTSD)

  • Wearable devices for real-time mood and stress monitoring

Integration with traditional therapy models

Many mental health providers are adopting a hybrid model, combining in-person and online therapy sessions. This approach allows for greater flexibility and personalization of care.

Potential for AI and machine learning in mental health support

AI and machine learning can revolutionize mental health care by:

  • Analyzing patterns in speech and facial expressions to detect early signs of mental health issues

  • Providing personalized treatment recommendations based on large datasets

  • Offering 24/7 support through AI-powered chatbots

Ongoing research and development in the field

Researchers continue to study the effectiveness of telehealth therapy and develop new technologies to improve mental health care. A 2022 meta-analysis of 56 studies found that telehealth therapy was as effective as in-person therapy for treating a wide range of mental health conditions (Fernandez et al., 2022).

Conclusion 

Telehealth mental health therapy can be a convenient, effective, and accessible way to access mental health support, especially in rural and underserved areas.

Whether you’re considering online therapy, or just curious about its potential, the growth of telehealth mental health services marks an exciting development in the field of mental health care. Take the first step towards better mental health today by exploring the telehealth options available to you.

References

AAP Research. (2023). AAP study shows telehealth use common in pediatric care. American Academy of Pediatrics (AAP). Retrieved from https://publications.aap.org/aapnews/news/23772/AAP-study-shows-telehealth-use-common-in-pediatric

American Psychiatric Association. (2022). Best Practices in Synchronous Videoconferencing-Based Telemental Health. Retrieved from https://www.psychiatry.org/getattachment/b87211d5-81bb-4d4f-af73-9caa738c2a1c/Resource-Document-Telemental-Health-Best-Practices.pdf/

Azar, R., Chan, R., Sarkisian, M., Burns, R. D., Marcin, J. P. , Gotthardt, C. De Guzman, K. R., Rosenthal, J. L., & Haynes, S. C. (2024). Adapting telehealth to address health equity: Perspectives of primary care providers across the United States. Journal of Telemedicine and Telecare; 1-7. doi:10.1177/1357633X241238780

Barnett, M. L., Ray, K. N., Souza, J., & Mehrotra, A. (2019). Trends in Telemedicine Use in a Large Commercially Insured Population, 2005-2017. JAMA; 320(20), 2147-2149.

Berger, E. (2021). No-Cancel Culture: How Telehealth is Making it Easier to Keep That Therapy Session. Kaiser Family Foundation (KFF) Health News. Retrieved from https://kffhealthnews.org/news/article/no-cancel-culture-how-telehealth-is-making-it-easier-to-keep-that-therapy-session/

Dr. Josh. The Impact of Telemedicine on Mental Health. SmartClinix. Retrieved from https://smartclinix.net/the-impact-of-telemedicine-on-mental-health/

Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B., & Aboujaoude, E. (2022). Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clinical Psychology & Psychotherapy; 29(4), 1307-1321.

How do I use telehealth for behavioral health care? (n.d.). Health Resources & Services Administration (HRSA). Retrieved from  https://telehealth.hhs.gov/patients/additional-resources/telehealth-and-behavioral-health

Kaiser Family Foundation. (2023). 2023 Employer Health Benefits Survey. Retrieved from https://www.kff.org/report-section/ehbs-2023-summary-of-findings/

Lattie, E. G., Adkins, E. C., Winquist, N., Stiles-Shields, C., Wafford, Q. E., & Graham, A. K. (2020). Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review. Journal of Medical Internet Research; 22(7), e15396.

Lin, C. C., Dievler, A. , Robbins, C., Sripipatana, A., Quinn, M. & Nair, S. (2018). Telehealth in Health Centers: Key Adoption Factors, Barriers, and Opportunities. Retrieved from https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05125

Macmillan, C. (2021). Why Telehealth for Mental Health Care is Working. Yale Medicine. Retrieved from https://www.yalemedicine.org/news/telehealth-for-mental-health/

Palmer, C. S., Brown Levey, S. M., Kostiuk, M., Zisner, A. R., Tolle, L. W., Richey, R. M., & Callan, S. (2022). Virtual Care for Behavioral Health Conditions. Primary Care; 49(4), 641-657. doi.org/10.1016/j.pop.2022.04.008

Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2021). The COVID-19 telepsychology revolution: A national study of pandemic-based changes in U.S. mental health care delivery. American Psychologist; 76(1), 14–25.

Stoll, J., Müller, J. A., & Trachsel, M. (2018). Ethical Issues in Online Psychotherapy: A Narrative Review. Frontiers in Psychiatry, 9, 698.

Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders. (2021). Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved from https://store.samhsa.gov/sites/default/files/pep21-06-02-001.pdf

Telehealth in Mental Health Counseling: Benefits and Barriers. (2023). Walsh University. Retrieved from https://online.walsh.edu/news/telehealth-mental-health-benefits-barriers/

What is Telemental Health? (n.d.). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/what-is-telemental-health

Wind, T. R., Rijkeboer, M., Andersson, G., & Riper, H. (2020). The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health. Internet Interventions; 20, 100317.

AI Health Chatbots for Patient Engagement

AI Health Chatbots for Patient Engagement

by Ree AI Health Tech

Have you ever wished you could get instant medical advice without waiting for a doctor’s appointment? Or maybe you’ve found yourself wondering about a symptom in the middle of the night? Well, you’re not alone, and that’s where AI health chatbots come in. 

The market segment for chatbots is expected to grow from $196 million in 2022 to approximately $1.2 billion by 2032 (Clark & Bailey, 2024). These digital health assistants are changing the game in healthcare, offering support and information around the clock. But what exactly are they, and how do they work? 

Contents

What Are AI Health Chatbots?

AI health chatbots are smart computer programs that help patients with health-related information and support. These virtual health assistants use advanced technologies like natural language processing (NLP) and machine learning (ML). NLP and ML allows them to understand context and emotions in conversations, and respond to user queries in a human-like manner (Karlović, 2024).

Think of the virtual health assistant as your personal health companion to (Laranjo et al., 2018):

  • Answer basic health questions
  • Provide information about symptoms and conditions
  • Offer medication reminders
  • Guide you through simple diagnostic processes

Some popular AI health chatbots include:

Now that we understand the concept of AI health chatbots, let’s explore the various advantages they bring to healthcare.

Benefits of AI Health Chatbots

AI health chatbots have several advantages for both patients and healthcare providers. 

24/7 availability

One of the most significant advantages of AI health chatbots is their round-the-clock availability. Have a health concern at 2 AM? Your chatbot is there to help, providing instant support when you need it. 

Cost reduction

Chatbots are mostly free for patients. Some apps are covered by insurance when prescribed by a health provider (Clark & Bailey, 2024).

By handling routine inquiries and preliminary assessments, chatbots can significantly reduce healthcare costs, especially when the patient does not have to see a health provider in person. They free up health providers for more complex tasks, leading to more efficient resource allocation.

For example, GlaxoSmithKline launched 16 virtual assistants within 10 months, resulting in improved customer satisfaction and employee productivity (Winchurch, 2020).

Improved patient engagement and satisfaction

Chatbots make it easier for patients to engage with their health–even for older adults (Clark & Bailey, 2024). They provide a low-barrier way to ask questions and learn about health topics, improving overall health literacy (Bickmore et al., 2016). They’re also easier to use than a traditional patient portal or telehealth system, which saves time.

Faster triage 

In an emergency, every second counts. AI chatbots can quickly assess symptoms and help determine the urgency of a situation, potentially saving lives by ensuring rapid response to critical cases (Razzaki et al., 2018).

The benefits we’ve discussed here come from a range of key features that AI health chatbots offer. Let’s take a closer look at these capabilities.

Key Features of AI Chatbots in Healthcare

AI health chatbots come packed with features designed to support various aspects of healthcare. Some of the uses of health chatbots include (Clark & Bailey, 2024):

  • Physical wellbeing
  • Chronic conditions
  • Mental health
  • Substance use disorders
  • Pregnancy 
  • Sexual health
  • Public health

Let’s discuss some of the use cases and applications for AI health chatbots.

Appointment scheduling

AI chatbots can manage appointments, allowing patients to easily book, reschedule, or cancel appointments without human intervention. It’s usually easier than doing so in a patient portal.

Symptom checking and preliminary diagnosis

Many chatbots offer an online symptom checker. You input your symptoms, and the chatbot asks follow-up questions to provide a preliminary assessment. While this doesn’t replace a doctor’s diagnosis, it can help you decide if you need to seek immediate medical attention (Semigran et al., 2015).

Medication reminders and management

Pink pill box

Forget to take your pills? AI chatbots can send timely reminders, helping you stay on top of your medication schedule. Some even track your medication history and can alert you to potential drug interactions (Brar Prayaga et al., 2019).

Post-op care and chronic disease management

After an operation or minor surgery, a chatbot can guide the patient through the recovery process at any time, day or night. It can also answer questions about symptoms and concerns related to a chronic illness (ScienceSoft, n.d.). 

Mental health support 

AI chatbots are increasingly being used to provide mental health support. They can offer coping strategies, mood tracking, and even cognitive behavioral therapy exercises. While they don’t replace professional help, they can be a valuable first line of support (Fitzpatrick et al., 2017).

Health tracking and personalized recommendations 

Woman checking iphone with Apple watch

AI chatbots can track your health data over time by integrating with wearable devices and apps. They can then provide personalized health recommendations based on your activity levels, sleep patterns, and other health metrics (Stein & Brooks, 2017).

Healthcare systems can successfully implement AI chatbots by following a careful approach, as we’ll discuss next.

How to Integrate AI Chatbots in Healthcare Systems

Hand holding phone with AI health chatbot conversation

Integrating AI health chatbots into existing healthcare systems requires careful planning and execution. Here’s a roadmap for successful implementation (Palanica et al., 2019 & Nadarzynski et al., 2019):

  1. Assess Needs and Set Goals: Before implementing a chatbot, healthcare providers should clearly define what they hope to achieve. Is the goal to reduce wait times, improve patient engagement, or streamline triage processes?
  1. Choose the Right Solution: Not all chatbots are created equal. Select a solution that aligns with your goals and integrates well with your existing systems.
  1. Ensure Data Security: Implement robust security measures to protect patient data. This includes encryption, secure authentication processes, and regular security audits.
  1. Train Healthcare Providers: It’s crucial to train your staff on how to work alongside these AI systems. They should understand the chatbot’s capabilities and limitations.
  1. Educate Patients: Clear communication with patients about the role and capabilities of the chatbot is essential. Set realistic expectations and provide guidance on how to use the system effectively.
  1. Start Small and Scale: Begin with a pilot program, gather feedback, and make improvements before rolling out the chatbot more broadly.
  1. Continuous Monitoring and Improvement: Regularly assess the chatbot’s performance. Are patients finding it helpful? Are there common issues or misunderstandings? Use this data to continually refine and improve the system.
  1. Measure Impact: Track key performance indicators (KPIs) to measure the impact of the chatbot. This might include metrics like patient satisfaction scores, reduction in wait times, or cost savings.

While AI health chatbots offer impressive features and benefits, it’s important to acknowledge and address the challenges that come with using them in healthcare.

Addressing Concerns and Limitations of AI Health Chatbots

While AI health chatbots offer numerous benefits, they also come with their fair share of challenges and limitations. It’s important to be aware of these as we continue to integrate these technologies into our healthcare systems.

Accuracy concerns 

One of the primary concerns with AI health chatbots is the potential for misdiagnosis. While these systems are becoming increasingly sophisticated, they’re not infallible. A chatbot might misinterpret symptoms or fail to consider important contextual information that a human doctor would catch (Fraser et al., 2018).

Another reason chatbots could share inaccurate information is that AI health chatbots use fixed datasets, which may not include the latest medical info. Unlike doctors who can access current data, chatbots might give outdated advice on health topics (Clark & Bailey, 2024).

Data privacy and security 

Hacker in a red hoodie

Healthcare data is highly sensitive, and the use of AI chatbots raises important questions about data privacy. How is patient data stored and protected? Who has access to the information shared with these chatbots? These are critical issues that need to be addressed to ensure patient trust and comply with regulations like HIPAA (Luxton, 2019).

Federated learning is a new way to train AI models that keeps data private. It lets different groups work together on an AI model without sharing their actual data. Instead, each group trains the model on their own computers using their own data. They only share updates to the model, not the data itself. Hospitals and researchers can team up to create better AI models while keeping patient information safe and private (Sun & Zhou, 2023). 

Ethical considerations 

The use of AI in healthcare raises several ethical questions. For instance, how do we ensure that these systems don’t perpetuate biases in healthcare? There’s also the question of accountability – who’s responsible if a chatbot provides incorrect advice that leads to harm (Vayena et al., 2018)?

Bias in AI Algorithms

Illustration of a smiling chatbot

AI chatbots in healthcare raise concerns about bias and fairness. If the data used to train these chatbots isn’t diverse or has built-in biases, the chatbots might make unfair decisions. This could lead to some groups getting worse healthcare.

Bias can come from many sources, like choosing the wrong data features or having unbalanced data. Sometimes, chatbots might learn the training data too well and can’t handle new situations.

To fix these problems, we need to be aware of possible biases, work to prevent them, and keep checking chatbots after they’re in use. This helps ensure AI chatbots benefit everyone equally in healthcare (Sun & Zhou, 2023). 

Integration challenges 

Implementing AI chatbots into existing healthcare systems isn’t always straightforward. There can be technical challenges in integrating chatbots with electronic health records (EHRs) and other healthcare IT systems. Ensuring seamless data flow while maintaining security is a complex task (Miner et al., 2020).

Patient trust 

Building and maintaining patient trust is crucial for the success of AI health chatbots. Some patients may be hesitant to share personal health information with a machine, preferring the human touch of traditional healthcare interactions.

Trustworthy AI (TAI) helps explain how AI chatbots work, balancing complex math with user-friendly results. It’s important for building trust in AI systems. While progress has been made, more work is needed to make AI chatbots more transparent and trustworthy (Sun & Zhou, 2023).

Doctors and nurses do more than diagnose–they offer comfort and build trust with patients. AI chatbots can’t replace this human touch or handle complex medical issues that need deep expertise.

It’s not all doom and gloom! Exciting trends are shaping the future of AI health chatbot technology.

AI chatbots are useful medical tools, especially where healthcare access is limited. The combo of AI efficiency and human empathy can improve healthcare. The future likely involves doctors handling complex cases and emotional care, with chatbots supporting them, depending on tech advances, acceptance, and regulations (Altamimi et al., 2023). Here are some exciting trends to watch.

Advanced NLP 

Future chatbots will likely have an even better understanding of context and nuance in language. They might be able to detect subtle cues in a patient’s language that could indicate underlying health issues.

Integration with IoT and wearables 

man checking fitness watch with cell phone

As the Internet of Things (IoT) expands in healthcare, chatbots will likely become more integrated with wearable devices and smart home technology. Imagine a chatbot that can access real-time data from your smartwatch to provide more accurate health advice.

Personalized medicine 

AI chatbots could play a crucial role in the move towards personalized medicine. By analyzing vast amounts of patient data, they could help tailor treatment plans to individual genetic profiles and lifestyle factors.

Enhanced diagnostic capabilities 

While current chatbots are limited to preliminary assessments, future versions might have more advanced diagnostic capabilities. They could potentially analyze images or audio recordings to aid in diagnosis.

Support for clinical trials 

AI chatbots could streamline the process of clinical trials by helping to recruit suitable participants, monitor adherence to trial protocols, and collect data.

Conclusion

AI health chatbots are making healthcare easier to access, more personal, and more efficient. They offer 24/7 support, lower costs, and get patients more involved in their health. But there are still issues to solve, like making sure they’re accurate, keeping data private, and fitting them into current healthcare systems.

As tech improves, these chatbots will get smarter and play a bigger role in healthcare. It’s important for everyone – doctors and patients – to keep up with these changes.

Whether you work in healthcare or you’re just curious, now’s the time to try out these chatbots. By staying informed, we can use technology to make healthcare better, without losing the human connection.

Have you used AI health chatbots before? What are your thoughts on them? 

References

AI-Powered Chatbots for Healthcare. (n.d.) ScienceSoft. Retrieved from https://www.scnsoft.com/healthcare/chatbots

Altamimi, I., Altamimi, A., Alhumimidi, A. S., Altamimi, A., & Temsah, H. (2023). Artificial Intelligence (AI) Chatbots in Medicine: A Supplement, Not a Substitute. Cureus, 15(6). doi.org/10.7759/cureus.40922

Bickmore, T. W., Utami, D., Matsuyama, R., & Paasche-Orlow, M. K. (2016). Improving access to online health information with conversational agents: a randomized controlled experiment. Journal of Medical Internet Research, 18(1), e1.

Brar Prayaga, R., Jeong, E. W., Feger, E., Noble, H. K., Kmiec, M., & Prayaga, R. S. (2019). Improving refill adherence in Medicare patients with tailored and interactive mobile text messaging: pilot study. JMIR mHealth and uHealth, 7(1), e11429.

Clark, M. & Bailey, S. (2024). Chatbots in Health Care: Connecting Patients to Information. CADTH Horizon Scans. Canadian Agency for Drugs and Technologies in Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK602381/

Fitzpatrick, K. K., Darcy, A., & Vierhile, M. (2017). Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR Mental Health, 4(2), e19.

Fraser, H., Coiera, E., & Wong, D. (2018). Safety of patient-facing digital symptom checkers. The Lancet, 392(10161), 2263-2264.

Karlović, M. (2024). 14 ways chatbots can elevate the healthcare experience. Infobip. Retrieved from https://www.infobip.com/blog/healthcare-ai-chatbot-examples

Laranjo, L., Dunn, A. G., Tong, H. L., Kocaballi, A. B., Chen, J., Bashir, R., … & Coiera, E. (2018). Conversational agents in healthcare: a systematic review. Journal of the American Medical Informatics Association, 25(9), 1248-1258.

Luxton, D. D. (2019). Ethical implications of conversational agents in global public health. Bulletin of the World Health Organization, 97(4), 254.

Miner, A. S., Laranjo, L., & Kocaballi, A. B. (2020). Chatbots in the fight against the COVID-19 pandemic. NPJ Digital Medicine, 3(1), 1-4.

Nadarzynski, T., Miles, O., Cowie, A., & Ridge, D. (2019). Acceptability of artificial intelligence (AI)-led chatbot services in healthcare: A mixed-methods study. Digital Health, 5, 2055207619871808.

Palanica, A., Flaschner, P., Thommandram, A., Li, M., & Fossat, Y. (2019). Physicians’ Perceptions of Chatbots in Health Care: Cross-Sectional Web-Based Survey. Journal of Medical Internet Research, 21(4), e12887.

Razzaki, S., Baker, A., Perov, Y., Middleton, K., Baxter, J., Mullarkey, D., … & Majeed, A. (2018). A comparative study of artificial intelligence and human doctors for the purpose of triage and diagnosis. arXiv preprint arXiv:1806.10698.

Semigran, H. L., Linder, J. A., Gidengil, C., & Mehrotra, A. (2015). Evaluation of symptom checkers for self diagnosis and triage: audit study. BMJ, 351, h3480.

Stein, N., & Brooks, K. (2017). A fully automated conversational artificial intelligence for weight loss: longitudinal observational study among overweight and obese adults. JMIR Diabetes, 2(2), e28.

Sun, G., & Zhou, H. (2023). AI in healthcare: Navigating opportunities and challenges in digital communication. Frontiers in Digital Health, 5. doi.org/10.3389/fdgth.2023.1291132

Vayena, E., Blasimme, A., & Cohen, I. G. (2018). Machine learning in medicine: Addressing ethical challenges. PLoS Medicine, 15(11), e1002689.

Winchurch, E. (2020). How GlaxoSmithKline launched 16 virtual assistants in 10 months with watsonx Assistant. IBM. Retrieved from https://www.ibm.com/products/watsonx-assistant/healthcare