One in five Americans suffers from a behavioral health condition. It’s among the top five reasons for hospital admissions and re-admissions and the most expensive one, costing the US healthcare system some $45.3 billion annually.

Tel Aviv University biomedical engineer Uri Nevo decided to create a smartphone-based solution for patients and their psychiatrists to continuously and unobtrusively monitor changes in behavior and address them before they get out of control.

“There are medications to stabilize patients but no objective tools for assessing a patient’s mental state,” explains Keren Sela, a researcher from Nevo’s lab who helped develop the Lifegraph app and data visualization dashboard three years ago.

“We worked on the technology for the first year and then started clinical trials in three large mental health centers here in Israel,” Sela tells ISRAEL21c. “That helped us improve the technology and learn about detecting different behavioral situations in patients with severe mood disorders. We are now looking to expand to the United States.”

Lifegraph uses machine learning to monitor sleep patterns, mobility, communication activity and vocal characteristics of psychiatric patients passively from their built-in smartphone sensors. With the patient’s permission, the patient, caregiver and doctor are alerted to changes so that quick action can be taken to avoid hospitalization.

“When a person on medication gets worse because the meds aren’t working anymore, everything collapses and you’re hospitalized again. Our aim is to stop these relapses of mental illness,” says Dr. Dror Dolfin, the Israeli psychiatrist consulted by Nevo, his former army buddy, before developing the app.

“This is the greatest need we have today in psychiatry,” Dolfin says.

24-hour access to physician

Lifegraph provides the unprecedented ability to detect and address small behavioral changes between appointments, and to prioritize which patients need immediate attention, says Dolfin, who practices at Geha Mental Health Center in Petah Tikva.

“If you can pick up on these minute changes you can better monitor the patient’s status and ask him to come in and talk to you right away,” he tells ISRAEL21c.

“When a person on medication gets worse because the meds aren’t working anymore, everything collapses and you’re hospitalized again. Our aim is to stop these relapses of mental illness.”

During the Lifegraph trial phase over the past year and a half, Dolfin detected early signs of manic behavior in the same patient twice, successfully managing to avoid hospitalization. “I saw him more often, talked to his friends and changed his meds. If it would have gone on for another week he would have been hospitalized.”

Dolfin emphasizes that using Lifegraph is voluntary.

“It has to be agreed upon by patient and doctor as part of a relationship where the doctor says, ‘Let’s try to make sure you don’t get worse and maybe this will help.’ If the patient feels it’s like ‘big brother’ watching, he won’t use it. But if he feels it gives him 24-hour access to a physician who cares about him, he will use it.”

Privacy protected

Sela says that Lifegraph’s objective behavioral sensing platform is unique.

“There are many companies in this field but our solution is the only one that is totally passive and clinically validated. It can be integrated easily and unobtrusively,” she says.

“We collect what we can from smartphone sensors. We don’t record calls or know specific locations or identities. The app runs in the background and collects data and doesn’t drain the battery.

“Yet we still thought that this would be a challenge in terms of privacy and patients’ fears. However, we had very good acceptance from patients. Of a few hundred patients approached, 94 percent were willing to install the app and keep it on for a year. Only a few uninstalled it after a few days,” Sela reports.

These initial study patients, still being monitored today, provided strong proof of concept. The app showed 90% sensitivity and specificity in identifying outpatient mental state.

“It detected significant changes in behavior about a month before the doctor knew about a mental deterioration,” says Sela.

Lifegraph runs unobtrusively in the background and doesn’t record the user’s identity. Photo: courtesy
Lifegraph runs unobtrusively in the background and doesn’t record the user’s identity. Photo: courtesy

The Lifegraph founders are now seeking external funding as well as partners in pharma, health insurance, telemedicine or other healthcare sectors to penetrate the US market. Sela says potential customers include pharma companies looking to provide wider and more innovative services beyond medication.

She and the third cofounder, Asaf Liberman, earned their postgraduate degrees in Nevo’s biomedical engineering lab and now work full time for Lifegraph. Still based at Tel Aviv University, the company has been funded by Ramot (the university’s tech-transfer company) and by the Office of the Chief Scientist of the Israeli Ministry of Economy and Industry.

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