Showing papers by "John Torous published in 2017"

Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust

Abstract: The promise of smartphone applications and connected technologies for mental health to advance diagnosis, augment treatment, and expand access has received much attention. Mental health disorders represent the leading cause of the loss of years of life because of disability and premature mortality and also contribute to employee absenteeism and lost productivity in economically established countries such as the United States. The potential of smartphone applications to offer new, at-your-fingertips tools and resources for mental health care is frequently cited. But this potential is not the only reason why it is hard to ignore smartphone applications. The reality of applications for clinical care is already here. More than 10 000 mental health–related applications are available to download, and that number increases daily. As smartphones become increasingly inexpensive and available to the entire population, including those with mental illness, the accessibility, immediacy, affordability, and bold marketing claims of applications will drive more patients to use them. This new reality is worrisome: studies suggest that most mental health apps in commercial marketplaces do not conform to clinical guidelines. Some may even offer dangerous recommendations, such as one application that advises people experiencing a bipolar manic episode to drink hard alcohol before bedtime to assist with sleeping.2 It is likely that most of these nonevidencebased applications may distract patients and potentially cause them to delay seeking care. Many applications do not respect the privacy of personal health information, and the price of a free application is often buried in a complex privacy policy requiring college reading comprehension—that price being the right to market and sell your data.3 Certainly there are exceptions, as a handful of safe, evidence-based, and useful applications exist. Still, these helpful applications may be to difficult to find among hundreds of more problematic applications. Finding these valuable applications, furthermore, is a challenge for both patients and clinicians. Mental health technologies like smartphone applications have not been thoroughly investigated through clinical science or overseen through regulatory control. Instead, there is a void in which the potential and preshpent reality of health applications are confusing, marred by a lack of transparency and trust. The situation exists partially because the US Food and Drug Administration (FDA) has taken a “hands-off” approach toward health applications, meaning that most mental health applications do not fall under federal regulations. The 21st Century Cures Act, Section 3060, “Clarifying Medical Software Regulations,” indicates that this hands-off approach will continue and become more lax. Astonishingly, the Apple iTunes and Android Google Play Store are the default arbiters and agents responsible for releasing (and on some occasions, withdrawing) applications, despite evidence that neither their wellknown star ratings nor number of downloads correlate well with health application quality.4 In early September 2016, Apple announced that it would no longer allow certain health applications in its marketplace. This announcement was seen as exerting more influence in protecting public interests related to health applications than the FDA.5 One of Apple’s guidelines states, for instance, that drug dosage calculators proffered on its health applications “must come from the drug manufacturer, a hospital, university, health insurance company, or other approved entity, or receive approval by the FDA or one of its international counterparts.”5 Such a move is a first step on a long journey, but it begs the question of how health application offerings will be evaluated transparently if manufacturers, hospitals, universities, health insurance companies, and the FDA do not gather evidence and define appropriate standards. Another recent first step is the greater engagement of professional societies. For example, the American Psychiatric Association recently released a smartphone application evaluation model that does not specifically recommend or endorse any one application, but rather guides clinicians in considering the safety, evidence, usability, and interoperability of an application to make a more informed decision about use.6 As mental health applications continue to mature, finding consensus and synergy between all stakeholder groups will be critical in creating transparency and trust. While the potential of mental health applications and connected technologies has powered the paradigm of mobile health for the field, it is time for clinical science to assume greater leadership, bringing greater trust and transparency. Application technology is not the limiting factor in adopting these digital tools—trust and transparency are. All of health care, and especially mental health care, revolves around expectations of confidentiality practices and respect for privacy when patients disclose their often most intimate experiences and vulnerabilities. To have therapeutic value, we suggest that VIEWPOINT

New dimensions and new tools to realize the potential of RDoC: digital phenotyping via smartphones and connected devices

Abstract: Mobile and connected devices like smartphones and wearable sensors can facilitate the collection of novel naturalistic and longitudinal data relevant to psychiatry at both the personal and population level. The National Institute of Mental Health’s Research Domain Criteria framework offers a useful roadmap to organize, guide and lead new digital phenotyping data towards research discoveries and clinical advances.

The Ethical Use of Mobile Health Technology in Clinical Psychiatry.

Abstract: The rapid rise of mobile health technologies, such as smartphone apps and wearable sensors, presents psychiatry with new tools of potential value in caring for patients. Novel diagnostic and therapeutic applications of these technologies have been developed in private industry and utilized in mental health, although these methods do not yet constitute standard of care. In this article, we provide an ethical perspective on the practical use of this novel modality by psychiatrists. We propose that in the present context of limited scientific research and regulatory oversight, mobile technologies should serve to enhance the psychiatrist-patient relationship, rather than replace it, to minimize potential clinical and ethical harm to vulnerable patients. We analyze areas of possible ethical tension between clinical practice and the consumer-driven mobile industry, and develop a decision-tree model for implementing ethical safeguards in practice, focused on managing risk to the therapeutic relationship, informed consent, confidentiality, and mutual alignment of treatment goals and expectations.

Data Security and Privacy in Apps for Dementia: An Analysis of Existing Privacy Policies

Abstract: Introduction Despite tremendous growth in the number of health applications (apps), little is known about how well these apps protect their users' health-related data This gap in knowledge is of particular concern for apps targeting people with dementia, whose cognitive impairment puts them at increased risk of privacy breaches In this article, we determine how many dementia apps have privacy policies and how well they protect user data Methods Our analysis included all iPhone apps that matched the search terms "medical + dementia" or "health & fitness + dementia" and collected user-generated content We evaluated all available privacy policies for these apps based on criteria that systematically measure how individual user data is handled Results Seventy-two apps met the above search teams and collected user data Of these, only 33 (46%) had an available privacy policy Nineteen of the 33 with policies (58%) were specific to the app in question, and 25 (76%) specified how individual-user as opposed to aggregate data would be handled Among these, there was a preponderance of missing information, the majority acknowledged collecting individual data for internal purposes, and most admitted to instances in which they would share user data with outside parties Conclusions At present, the majority of health apps focused on dementia lack a privacy policy, and those that do exist lack clarity Bolstering safeguards and improving communication about privacy protections will help facilitate consumer trust in apps, thereby enabling more widespread and meaningful use by people with dementia and those involved in their care

Navigating Ethics in the Digital Age: Introducing Connected and Open Research Ethics (CORE), a Tool for Researchers and Institutional Review Boards.

Abstract: Research studies that leverage emerging technologies, such as passive sensing devices and mobile apps, have demonstrated encouraging potential with respect to favorably influencing the human condition. As a result, the nascent fields of mHealth and digital medicine have gained traction over the past decade as demonstrated in the United States by increased federal funding for research that cuts across a broad spectrum of health conditions. The existence of mHealth and digital medicine also introduced new ethical and regulatory challenges that both institutional review boards (IRBs) and researchers are struggling to navigate. In response, the Connected and Open Research Ethics (CORE) initiative was launched. The CORE initiative has employed a participatory research approach, whereby researchers and IRB affiliates are involved in identifying the priorities and functionality of a shared resource. The overarching goal of CORE is to develop dynamic and relevant ethical practices to guide mHealth and digital medicine research. In this Viewpoint paper, we describe the CORE initiative and call for readers to join the CORE Network and contribute to the bigger conversation on ethics in the digital age.

Digitally Driven Integrated Primary Care and Behavioral Health: How Technology Can Expand Access to Effective Treatment.

Abstract: Widespread implementation of integrated primary care and behavioral health is possible, but workforce shortages, competencies to deliver evidence-based approaches, and sufficient reimbursement are lacking There are numerous telehealth solutions that could be utilized to assist with integration efforts that have the potential to be successfully used alone or in combination This will require that the developers of such technologies understand the current evidence base for effective integration efforts and apply this knowledge to new solutions Evidence-based models of integrated care such as the collaborative care model have a robust evidence base including studies that demonstrate effective delivery from remote locations Technology solutions that can serve as practice extenders by performing some of the tasks, and can expand the competency of primary care providers to treat mild to moderate mental illness, have an emerging literature in the behavioral health arena that shows promise for integrating care More widespread implementation of effective integrated primary care and behavioral health can be accomplished with the help of technology solutions that can address the problems of workforce shortages and competencies Use of these technologies alone or in combination is a growing area of research and development and an untapped frontier that warrants further investigation

The digital mental health revolution: Opportunities and risks.

Abstract: This editorial introduces the special issue on digital mental health. The promise of digital, mobile, and connected technologies to advance mental health, and especially psychiatric rehabilitation, continues to rapidly evolve. New sensors and data, such as those derived from increasingly ubiquitous smartphones, offer a new window into the functional, social, and emotional experiences of illness and recovery at a personalized and quantified level previously unimaginable (Ben-Zeev & Badiyani, 2016; Free et al., 2013; Torous, Kiang, Lorme, & Onnela, 2016). These new technologies may also help assess and monitor mental health on a population level and provide early interventions and resources to those in need, regardless of their location (East & Havard, 2015). The papers comprising this special issue make important and exciting contributions to the mental health field in general and to digital mental health for psychiatric rehabilitation in particular. These papers illustrate that we are at the beginning of an era that may provide new knowledge and evidence-based tools to better promote mental health diagnosis, treatment, rehabilitation, and recovery. (PsycINFO Database Record

A comparison of passive and active estimates of sleep in a cohort with schizophrenia

Abstract: Sleep abnormalities are considered an important feature of schizophrenia, yet convenient and reliable sleep monitoring remains a challenge. Smartphones offer a novel solution to capture both self-reported and objective measures of sleep in schizophrenia. In this three-month observational study, 17 subjects with a diagnosis of schizophrenia currently in treatment downloaded Beiwe, a platform for digital phenotyping, on their personal Apple or Android smartphones. Subjects were given tri-weekly ecological momentary assessments (EMAs) on their own smartphones, and passive data including accelerometer, GPS, screen use, and anonymized call and text message logs was continuously collected. We compare the in-clinic assessment of sleep quality, assessed with the Pittsburgh Sleep Questionnaire Inventory (PSQI), to EMAs, as well as sleep estimates based on passively collected accelerometer data. EMAs and passive data classified 85% (11/13) of subjects as exhibiting high or low sleep quality compared to the in-clinic assessments among subjects who completed at least one in-person PSQI. Phone-based accelerometer data used to infer sleep duration was moderately correlated with subject self-assessment of sleep duration (r = 0.69, 95% CI 0.23–0.90). Active and passive phone data predicts concurrent PSQI scores for all subjects with mean average error of 0.75 and future PSQI scores with a mean average error of 1.9, with scores ranging from 0–14. These results suggest sleep monitoring via personal smartphones is feasible for subjects with schizophrenia in a scalable and affordable manner. Smartphones may one-day offer accessible, clinically-useful insights into schizophrenia patients’ sleep quality. Despite the clinical relevance of sleep to disease severity, monitoring technologies still evade convenience and reliability. In search of a preferential method, a group of Harvard University researchers led by Patrick Staples investigated the validity of data collected via patients’ own mobile phones. The team, with a cohort of 17 schizophrenia patients, compared the quality of data produced by smartphone sensors and smartphone-delivered questionnaires to that of an in-clinic evaluation. The results significantly showed that smartphone monitoring could generate information that approached the accuracy of in-clinic assessments. The team noted some areas for improvement; however, this study provides convincing justifications for further research into this non-invasive, low-cost, scalable method to monitor the sleep quality of schizophrenic patients.

Methodology and Reporting of Mobile Heath and Smartphone Application Studies for Schizophrenia.

Abstract: The increasing prevalence of mobile devices among patients of all demographic groups has the potential to transform the ways we diagnose, monitor, treat, and study mental illness. As new tools and technologies emerge, clinicians and researchers are confronted with an increasing array of options both for clinical assessment, through digital capture of the essential behavioral elements of a condition, and for intervention, through formalized treatments, coaching, and other technology-assisted means of patient communication. And yet, as with any new set of tools for the assessment or treatment of a medical condition, establishing and adhering to reporting guidelines-that is, what works and under what conditions-is an essential component of the translational research process. Here, using the recently published World Health Organization mHealth Evaluation, Reporting and Assessment guidelines for evaluating mobile health applications, we review the methodological strengths and weaknesses of existing studies on smartphones and wearables for schizophrenia. While growing evidence supports the feasibility of using mobile tools in severe mental illness, most studies to date failed to adequately report accessibility, interoperability, costs, scalability, replicability, data security, usability testing, or compliance with national guidelines or regulatory statutes. Future research efforts addressing these specific gaps in the literature will help to advance our understanding and to realize the clinical potential of these new tools of psychiatry.

Characterizing Smartphone Engagement for Schizophrenia: Results of a Naturalist Mobile Health Study

Abstract: Introduction: Despite growing interest in smartphone apps for schizophrenia, little is known about how these apps are utilized in the real world. Understanding how app users are engaging with these tools outside of the confines of traditional clinical studies offers an important information on who is most likely to use apps and what type of data they are willing to share. Methods: The Schizophrenia and Related Disorders Alliance of America, in partnership with Self Care Catalyst, has created a smartphone app for schizophrenia that is free and publically available on both Apple iTunes and Google Android Play stores. We analyzed user engagement data from this app across its medication tracking, mood tracking, and symptom tracking features from August 16th 2015 to January 1st 2017 using the R programming language. We included all registered app users in our analysis with reported ages less than 100. Results: We analyzed a total of 43,451 mood, medication and symptom entries from 622 registered users...

Patient access to electronic psychiatric records: A pilot study

Abstract: Background OpenNotes, a national movement offering patients access to their doctor׳s notes, lies at the intersection of health policy and health technology. Despite interest in OpenNotes, little is known about how such may be implemented in psychiatry departments using electronic medical records. This study reports on the first pilot project to examine the experience of patients and clinicians when open access to psychiatric records was provided within an ongoing treatment relationship. Methods Fifteen clinicians in an outpatient psychiatry clinic in a Boston medical center agreed to participate in the study and 52 of their patients to participate. Those patients had the opportunity to read their progress notes through a patient site linked to an electronic medical record. Patients and clinicians were surveyed 20 months later. Results Results from this select group suggest that open access to notes was perceived as helpful to patients and did not negatively impact the patients or the treatment relationship. In addition, our experience was that mental health clinicians could be engaged in the process of OpenNotes. Conclusion This is the first study to implement and assess the impact of patients’ access to psychiatric records in an outpatient setting. Although many questions remain to be studied and a more diverse sample is needed for future research, the potential impact to enhance mental health treatment and the patient-clinician relationship is suggested for selected psychiatric patients. Policy around providing psychiatry patients access to their notes can be informed by reactions of both clinicians and patients.

Patient-Driven Innovation for Mobile Mental Health Technology: Case Report of Symptom Tracking in Schizophrenia

Abstract: This patient perspective piece presents an important case at the intersection of mobile health technology, mental health, and innovation. The potential of digital technologies to advance mental health is well known, although the challenges are being increasingly recognized. Making mobile health work for mental health will require broad collaborations. We already know that those who experience mental illness are excited by the potential technology, with many actively engaged in research, fundraising, advocacy, and entrepreneurial ventures. But we don't always hear their voice as often as others. There is a clear advantage for their voice to be heard: so we can all learn from their experiences at the direct intersection of mental health and technology innovation. The case is cowritten with an individual with schizophrenia, who openly shares his name and personal experience with mental health technology in order to educate and inspire others. This paper is the first in JMIR Mental Health's patient perspective series, and we welcome future contributions from those with lived experience.

The New Digital Divide For Digital BioMarkers.

Abstract: As smartphone and sensors continue to become more ubiquitous across the world, digital biomarkers have emerged as a scalable and practical tool to explore disease states and advance health. However, as the digital divide of access and ownership begins to fade, a new digital divide is emerging. Who are the types of people who own smartphones or smart watches, who are the types of people who download health apps or partake in digital biomarker studies, and who are the types of people who are actually active with digital biomarker apps and sensors – the people providing the high-quality and longitudinal data that this field is being founded upon? Understanding the people behind digital biomarkers, the very people this emerging field aims to help, may actually be the real challenge as well as opportunity for digital biomarkers.

High potential but limited evidence: Using voice data from smartphones to monitor and diagnose mood disorders.

Abstract: OBJECTIVE This article evaluates the potential of smartphone audio data to monitor individuals recovering from mood disorders. METHOD A comprehensive literature review was conducted based on searches in 9 bibliographic databases. RESULTS Seven articles were identified that used smartphone audio data to monitor participants with bipolar disorder from 4 to 14 weeks. The studies captured audio data in various contexts (e.g., in-person daily conversations, phone calls) and used common audio features (e.g., pitch and volume) to ascertain clinically relevant outcomes, including mood and social rhythm. Findings suggest that the utility of audio data in clinical and research contexts remains relatively unexplored and presents some challenges. For example, information on adherence and engagement among individuals recovering from bipolar disorder were often insufficient to gauge the generalizability of findings. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Despite growing interest, additional research is required to confirm clinical utility of smartphone audio data for mood disorders. (PsycINFO Database Record

Use of Electronic Resources for Psychiatry Clerkship Learning: A Medical Student Survey

Abstract: The primary aim of this study is to examine medical students’ use patterns, preferences, and perceptions of electronic educational resources available for psychiatry clerkship learning. Eligible participants included medical students who had completed the psychiatry clerkship during a 24-month period. An internet-based questionnaire was used to collect information regarding the outcomes described above. A total of 68 medical students responded to the survey. Most respondents reported high utilization of electronic resources on an array of devices for psychiatry clerkship learning and indicated a preference for electronic over print resources. The most commonly endorsed barriers to the use of electronic resources were that the source contained irrelevant and non-specific content, access was associated with a financial cost, and faculty guidance on recommended resources was insufficient. Respondents indicated a wish for more psychiatry-specific electronic learning resources. The authors’ results suggest that a demand exists for high-quality electronic and portable learning tools that are relevant to medical student education in psychiatry. Psychiatry educators are usefully positioned to be involved in the development of such resources.

Preparing Residents and Fellows to Address Ethical Issues in the Use of Mobile Technologies in Clinical Psychiatry.

Abstract: Mobile technology holds promise for identifying, tracking, and addressing mental health issues across large numbers of people. Given the burden of mental disorders felt throughout the world, such innovation is welcome—and yet the rapid advancement of mobile health technology has outpaced both clinical evidence and regulatory oversight, introducing a number of serious ethical concerns [1]. Early experience suggests that individuals using mobile health technologies, such as smartphone apps, encounter issues related to confidentiality, deception, and commercial exploitation [2, 3]. People who live with mental illnesses may have greater likelihood and more serious negative consequences of these issues—due to stigma, threats to informed decision-making, and lessened access to care—than others in the general population [4]. These concerns may have the greatest impact in the professional lives of residents and fellows, especially those who may more rapidly embrace technological innovation in their clinical work than their more senior colleagues. Academic psychiatrists may or may not wish to incorporate mobile health technologies in their clinical care practices, but they certainly should engage with their trainees to learn more about such advances so that there is an opportunity to learn and reflect on the rapidly changing nature of clinical psychiatry. Moreover, academic psychiatrists and their trainees should approach such innovation with keen attention to ethical implications. Recognizing the ethical aspects of engaging mobile mental health technologies is an important first step in navigating the complexities of digital psychiatry and ensuring that patient care practices involving technology are both safe and appropriate. Confidentiality issues are common but perhaps underappreciated in mobile health, because mobile apps can and do collect a tremendous amount of personal information, and some companies may base their business model around the selling of personal profile data, for example, to pharmaceutical companies or health systems [5]. Deception has already emerged in the early deployment of mobile mental health technologies. Luminosity, which sells cognitive training programs and apps directly to consumers, recently settled charges by the US Federal Trade Commission because of the company’s claims that its programs could delay cognitive symptoms associated with dementia [3]. These examples underscore the potential for commercial exploitation of individuals who live with or at risk for mental disorders—people who may feel embarrassed and marginalized because of their symptoms. Such individuals could be reassured by the appearance of privacy associated with “direct to consumer” use of a phone or other mobile device for their mental health needs. Unfortunately, these digital health consumers pay for supposed services that do not yet have a sufficient evidence base to demonstrate their potential value to improving personal health. And because so little is known and even less is disclosed to consumers, full and authentic informed consent is not yet, or perhaps ever, possible [6]. In the absence of appropriate safeguards, consumers of mobile mental health technology encounter a number of threats to ethical standards normally expected in clinical care and research. Such topics should be introduced to residents and fellows in didactic * Laura Weiss Roberts LWRoberts.Author@gmail.com

Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study.

Abstract: Background: Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear. Objective: In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use. Methods: An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use. Results: All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68). Conclusions: We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice. [JMIR Mhealth Uhealth 2017;5(11):e160]

2nd Symposia on Computing and Mental Health

Abstract: The World Health Organization predicts that by the year 2030, depression and other mental illnesses will be the leading disease burden globally. The rapid penetration and advancement of mobile phones and technology have given rise to unprecedented opportunities for close collaboration between computation researchers and mental health practitioners. The intersection between wearable computing, design of naturalistic observation experiments and statistical causal inference offers promising avenues for developing technologies to help those in mental distress; yet human factors inquiry and design are often the missing ingredients in this powerful mix. This second inter-disciplinary workshop will provide an opportunity for researchers in mental health, computation and causal inference to come together under the much needed auspices of human-centric design, towards the development and deployment of new technologies mental health technologies and interventions.

Mobile Technologies in Child and Adolescent Psychiatry: Pushing for Further Awareness and Research.

Abstract: Over the past four decades, mobile devices have evolved from the once bulky and expensive cellular phones of the past to the sleek, inexpensive, and omnipresent smartphones of today, which are used by adults and children alike. In the United States nearly 75% of teens either own or have access to a smartphone. Family income and place of residence do not appear to change teens’ access to smartphones drastically; 61% of teens in households with income less than $30k have access to smartphones, as do 68% of those living in rural areas. This increasing accessibility to smartphones raises important questions about their potential use as a vehicle to deliver improved mental health interventions, particularly in view of the continuing shortage of child and adolescent psychiatrists. A better understanding among clinicians of how smartphones can affect treatment is also important because children and adolescents are already using various forms of self-help applications (apps). The purpose of this column is to identify advantages and disadvantages of using mobile technology in the psychiatric treatment of children and adolescents, and also to identify the questions that remain to be answered in this ever growing aspect of child mental health. While the present article is not a comprehensive review of the literature available to date, we draw extensively on that literature to address the above issues concerningmental health treatment usingmobile technologies. A basic function of cell phone technology—texting—has already infiltrated into Child and Adolescent Psychiatry practice. DeJong and Gorrindo reviewed the use of texting in patient care and some of the advantages that it offers, which include speed and directness of interaction, accessibility, and portability. Preliminary evidence shows that adolescents are

M48. Digital Phenotyping in Schizophrenia Using Smartphones.

Abstract: Background: The purpose of our study is to determine if self-reported symptom surveys and passive data (GPS, accelerometer, voice samples, call logs, text logs, and phone use data) collected from patients with schizophrenia in real time on their personal smartphone may be useful in predicting reoccurrence of psychotic symptoms. Methods: Research subjects are adults (age 18–45, both sexes) who have been diagnosed with schizophrenia or schizoaffective disorder and are currently in treatment. Inclusion criteria include owning a smartphone capable of running the study application. Subjects use the smartphone app for a 3-month period. During this period the app will always be constantly collecting data, up to 1 million data points per day per subject as outlined in the background section. In addition, subjects will have psychiatric batteries including the PANSS, CGI, BPRS, and GAF completed as part of monthly check-up meetings with study staff. Outcome measures include (1) Adherence to and Acceptability of the Smartphone Application. (2) Comparison of Smartphone Application Data to Clinician Collected Metrics 3) Sensitivity of the Smartphone Application in Predicting Symptom Change Through Individual Data Streams (Surveys, GPS, Accelerometer, Voice, Call Logs, Text Logs, Screen Data) and in combination. Results: To date 14 of 20 subjects have been recruited into the study. Three have completed the study, 2 have dropped out, and 9 are currently active. The subjects who dropped out of the study did so related to factors other than smartphone and app use. No subjects have complained about the app use or its tracking. We plan to recruit 6 more subjects in the next month. From data pooled from all subjects to date, the total duration of minutes not using the phone shows a negative correlation with the warning signs scale (P = .0001) as well as the length of outgoing phone calls (P = .0024). Taking medications is correlated with the number of outgoing text messages sent (P = .0004). Conclusion: Preliminary sensor data indicates that there are small but statistically significant correlations with psychiatric symptoms for patients with schizophrenia. Results to date also suggest that tracking patients with schizophrenia via their personal smartphone is acceptable in a research context and there is no evidence of harm to date. Using patients’ own phones to assess symptoms offers a potentially cost effective and scalable means to gather new streams of objective data regards patient’s state and real time functioning.