Table 4 Summary of design considerations for MBC systems

Improved patient-clinician communication

Design with patient-provider interaction in mind. Features could include open-ended questions that allow patients to provide additional information and context to clinicians. Design results dashboard so patients and clinicians can easily co-review and discuss MBC results and reasons for clinical changes (or barriers to change) during sessions

Empowering to patient

Ensure that displays of MBC results clearly illustrate changes in outcomes and goals over time

When introducing MBC to patients, encourage them to “own” it as their own recovery-related tool, as opposed to something mandated by clinicians or clinics

Support patients in accessing their own MBC data outside of clinical sessions

Improved communication between clinicians

Make MBC results accessible and understandable and relevant to clinicians from multiple disciplines who offer various types of treatments (e.g., pharmacotherapy, psychotherapy, case management, psychiatric care). Also make results understandable to clinicians who may have infrequent contact with patients and who provide non-SUD-related services. Avoid using SUD-specific jargo

Patient self-reports are subjective

Emphasize to clinicians that MBC is just one additional data source, not meant to replace clinical judgment or objective measures

Recognize that incentives for dishonest reporting may vary between patients and over time

Emphasize that some non-substance use outcome may be less subject to bias even if there are concerns about under-reporting of substance use (e.g., coping skills, self-efficacy, depression)

Consider incentivizing MBC engagement (e.g., rewards or privileges for completing assessments) and avoid punitive consequences based on responses to MBC assessments (e.g., self-reporting substance use on MBC assessments should not trigger punishment or loss of privileges)

Lack of personalization

Measure patients’ goals as part of MBC to contextualize the meaning of MBC results

Measure domains that are potentially valuable across a range of patients – e.g., engagement in valued activities

Burden of time

Send MBC questionnaires automatically to patients’ mobile devices to reduce the need for clinicians to administer, score, enter, and save data from measures

Make MBC results available using devices that are already available to clinicians (e.g., desktop computers) and patients (e.g., mobile devices and/or patient-facing computers in clinics, when available)

Utilize existing software that does not require patients and clinicians to install and learn new software—e.g., questionnaire links that can be sent to patients via text message and completed via web browser; questionnaire results that can be viewed via web browser or electronic health record software

Clinician anxiety or difficulty with using new technology

Utilize existing devices and software to support MBC, when possible

Ensure MBC data collection and storage has adequate security protections in place

Communicate data security protections and limitations to patients and clinicians

Minimize clinician burden

Utilize devices and software that are already used by clinicians (e.g., desktop computers, electronic health record systems, internet browsers) and patients (e.g., mobile phones, text messaging software, internet browsers)

Quantify results over time

Provide easy to read graphical summaries to summarize multiple data points

Highlight or flag patients that appear to be “at risk” and in need of intervention based on historical trends in score

Easy for patients

Utilize short MBC questionnaires and collect passive data to understand how long clients spend completing measures

Emphasize personalization

Measure patient goals in addition to progress

Allow SUD-specific MBC to potentially be augmented with measures for other clinical targets (e.g., depression, anxiety, insomnia) as needed