What does The Big White Wall offer and how does it support the improvement of healthcare through IT?

By using digital technology Big White Wall (BWW) creates the capacity to effectively tackle mental and behavioral health issues at scale thereby transforming the way health care is delivered.

BWW’s digital community supports its members to self-manage their care with the collaboration and guidance of 24/7 health care professionals called Wall Guides, plus clinicians and peers. It offers personalized pathways to support and recovery, with optimization of mental health, through a choice of safe emotional well-being services available 24/7 via mobile, app, tablet and PC. It is an anonymous service that breaks down the barriers of stigma that may prevent patients from seeking help, as well as making healthcare more accessible from anywhere with internet access. BWW builds a community and connectedness amongst its members, and delivers the following services:

• Facilitated and monitored online discussion and creative expressions—bricks, Talkabouts
• Self-management resources—Useful Stuff
• Facilitated and monitored evidence-based courses on management of mental health conditions—Guided Support
• Access to live web-based therapy sessions via audio, webcam and instant messaging—BWW Connect

Big White Wall puts patients in the drivers’ seat, allowing them to navigate their health journey. Members can access care and support whenever and wherever. It is the only end-to-end digital solution that ensures 24/7 peer and professional support, including clinical management, and access to a range of interventions. Patients can personalize their experience, finding the content and peer support that is most likely to be relevant and helpful to them, via an algorithm. BWW is anonymous, so patients do not have to worry about the stigma around receiving a mental health service. It is completely safe ("wall guides" monitor codes of behavior, protect confidentiality and ensure that individuals can share issues and feelings without receiving improper responses). Additionally, it is always accessible from the privacy of one's own computer, tablet or smartphone. It is also more accessible as it operates 24/7, with activity peaking on the service outside of office hours. BWW was designed using prevailing evidence to address the gaps in current mental health care and to provide a platform that would encourage more individuals to seek help.

What are your members’ primary concerns when using the Big White Wall platform through a mobile device and how do you go about solving them?  

That it is convenient and easy to use. BWW is available 24/7 from a desktop, laptop, tablet or smartphone, all that is needed to access the service is the Internet. BWW is optimized for mobile via an app for iOS and Andriod. Providing a 24 hour service which is easily accessible is crucial: BWW’s highest levels of use are outside clinician office hours when services are unlikely to be available.

What, in your opinion, have been the most important achievements of mHealth in the last year?

• Broaden the ability to collect data
• Wearables
• Ability to help with prevention: lifestyle changes
• Sheer number and variety of mhealth products
• Ability to personalize care

And what have been the biggest challenges (for mHealth)?

• Evaluating solutions/products
• Building the products for the right demographics
• Consumers are not as health literate as some of the products require
• Products don’t always lead to long-term behaviour change
• Regulatory challenges

What will you be presenting at the upcoming mHealth Summit Europe (May 11-12, Riga, Latvia) and why do you think HIMSS events represent an important platform for eHealth?

I will be talking about moving mHealth from pilots to true implementation (scalability).

HIMSS events attract all the stakeholders who need to be at the table in order for eHealth success to be fully realized. They allow individuals and organizations the opportunity to come together to discuss, strategize and collaborate on eHealth initiatives.

Gernot Marx, Director of the Department of Surgical Intensive Care and Intermediate Care at the University Hospital of RWTH Aachen, is also head of Germany's first intensive telemedicine centre.

As a member of the Programme Advisory Committee for the mHealth Summit Europe, taking place on 11-12 May in Riga, Latvia, Marx is placing special attention on dialogue with his colleagues from across Europe. "The theme of the Summit is not only important because it's looking ahead to what the future of healthcare beholds", Marx comments, explaining his commitment, "I think holding such a pan-European event in Riga at this time is sending an important political message".

Cooperation at the European level is not new territory for Marx, and not just because his home base in Aachen is just across the border from Belgium and the Netherlands. His area of interest in intensive telemedicine is based on peer-to-peer cooperation because he virtually provides a second opinion that so many patients want and need.

Professor Marx, you founded Germany's first intensive telemedicine centre and have been working on this service with several hospitals across the nation since 2012. Are you satisfied with the results to date?

Intensive telemedicine is extremely effective. This is not my hypothesis – it is a proven fact. International studies and successful projects in the United States have shown patient mortality can be reduced, in some cases, by up to 50 per cent! In addition, the patients' long-term quality of life has improved with intensive telemedicine. Shorter in-patient stays are also worth noting, especially from a cost perspective. Meanwhile, rehabilitation measures and long-term care are being used less frequently. There have been no pharmacological or technical innovations which have delivered results anywhere near as impressive as these over the last 20 years.

So intensive telemedicine helps reduce costs?

We are concerned primarily about sharing and obtaining knowledge and improving the quality of care, not financial gain. But yes, studies from the U.S show that telemedical cooperation can reduce costs. On average, intensive care costs up to six times more than the cost of care in a normal ward. Up to a quarter of total hospital costs come from intensive care. Let's look at sepsis, for example. Treating sepsis costs €4.5 bn a year in Germany alone. Yet it's still a common occurrence to see patients being treated for sepsis for weeks, even months, with some even needing dialysis. But if the blood poisoning can be immediately recognised and properly treated, its complications can be prevented. This is exactly the kind of situation where telemedicine a savings potential of several million a year.

How do physicians and patients respond to bringing in an external consultant?

You might think that the recent debates about privacy and spying would scare people away when we ask their permission to bring in a telemedical consult. But the opposite is actually the case: the level of acceptance is extremely high. Both the patient and the family are in favour of using telemedicine. They see it as a valuable addition to their sense of certainty in the quality of care, a safety net, if you like. When asked whether the project should continue at a regional level, over 80 per cent of those surveyed were fully in favour of it and the remainder also supported the idea. This is overwhelmingly positive feedback.

Are there reservations about the "omnipotence" of the university consultant?

A classic misunderstanding: it's not about the all-knowing academic pushing his colleagues aside, as sometimes happens in intensive medicine. Our colleagues working in basic and standard care know this perfectly well. We're working on strengthening the exchange of ideas and knowledge at a peer-to-peer level and working together to build a stronger safety net. It's only through close teamwork that different perspectives will begin to merge. This adds to the quality of our work and ultimately to the patients' benefit.

You've given us extremely positive insights into intensive telemedicine. Does it have any negative aspects?

Telemedicine does not replace the doctor on site; he or she is irreplaceable. And telemedicine is not a last-minute miracle cure.

Your personal conclusion: is intensive telemedicine a care model of the future?

Yes, intensive telemedicine is a care model of the future! We want to ensure a better quality of care even as the workload of healthcare workers continues to increase while reducing the cost of intensive care treatment. I am convinced that we can overcome these challenges with telemedicine.

Advantages of intensive telemedicine at a glance

• comprehensive access to critical care expertise
• reduction in mortality rates
• lower costs
• care closer to home, improved patient care according to established guidelines in underdeveloped regions
• creation of innovative jobs not dependent on location