At its most fundamental level, measurement-based care is not complex. The two simple ingredients are even reflected in the name: (i) objective measurements and (ii) resulting care decisions based on that data (1). Yet the real-world challenges to measurement-based care abound, as even collecting objective measures in a reliable and valid manner is not trivial. Thus, the role of digital technologies like smartphones to augment objective measurement presents a clear and compelling case. That case is exemplified by the recent publication of FaurholtJepsen et al. (2) which underscores the potential of smartphone measurement-based care yet al.so highlights many of the new concomitant challenges. Faurholt-Jepsen et al. present an interesting analysis of MONARCA II trial data on the association of self-reported survey data, gathered from loaner smartphones in-patients with bipolar disorder, with clinical measurement of those same symptoms. Over this nine-month study, they report a strong association between mixed symptoms and irritability evaluated daily by patients via smartphones and traditional discrete study visits. These results are important and highlight not only the feasibility of this method of measurement collection, but also its clinical potential to impact care. Equally important are results that some smartphone-based measurements did not yield associations such as those on mixed mood with either quality of life or functioning. Like any new tool, smartphone-based measurements will be reliable and valid for certain outcomes but not others. Assuming technology is a panacea that does not require the type of careful clinical research by Faurholt-Jepsen et al is a dangerous but seductive route. A quick glimpse at the Apple iTunes and Android Google Play store reveals the extent to which such unproven and untested apps have proliferated. Understanding the reliability and validity of these new measurements, or creating new scales (3), is the more arduous but valuable path forward. More subtle challenges toward technology augmented measurement-based care are also highlighted in Faurholt-Jepsen et al. The authors note a chief advantage of smartphone reporting is to minimize recall bias, yet also astutely note that their results may have been impacted by any number of confounding factors. One that deserves special note is that ‘patients using the smartphonebased monitoring tool reported improved quality of life and reduced perceived stress during the trial’. It is possible to speculate that daily symptom reporting may increase introspection and self-reflection, which for some people may have positive therapeutic benefit. It is of course also possible to speculate any number of mechanistic hypothesis which could also explain how the simple act of recording symptoms become much more. Thus, objective measurement via smartphones, for some, may be also serve to alter those very outcomes— blurring the lines between ecological momentary assessment and interventions. Given the goal of measurement-based care is to use data to drive outcomes, the immediate linking of data and outcomes offers a fascinating avenue for further exploration. Of course, delivering on the promise of measurement-based care also means utilizing data to drive clinical decision making and improve patient outcomes (4). Beyond the interesting links of measurement and intervention discussed above, how can these findings improve care? Faurholt-Jepsen et al. use of smartphone-based measurement to identify important findings about mixed symptoms and irritability raises a formidable challenge to the clinical community in how to act upon and implement these results. In recent years, recognition of the numerous implementation challenges for digital tools into clinical care has become apparent ranging from workflow, technical, billing, and ideological among numerous others (5). Researchers developing new measurement-based tools and scales will increasingly have to be aware of these real-world challenges as digital tools face the additional nuances of constant technology updates and privacy regulations (6). Technologies like smartphones to augment measurement-based care in mental health will continue to proliferate. But as Faurholt-Jepsen et al. and

中文翻译：

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使用智能手机工具衡量基于测量的护理进展

在最基本的层面上，基于测量的护理并不复杂。这两个简单的成分甚至反映在名称中：(i) 客观测量和 (ii) 基于该数据的护理决策 (1)。然而，基于测量的护理面临的现实挑战比比皆是，因为即使以可靠和有效的方式收集客观的测量也不是微不足道的。因此，智能手机等数字技术在增强客观测量方面的作用提供了一个清晰而令人信服的案例。FaurholtJepsen 等人最近发表的文章就是一个例子。(2) 这强调了基于智能手机测量的护理的潜力，同时也强调了许多新的伴随挑战。Faurholt-Jepsen 等人。对关于自我报告调查数据关联的 MOARCA II 试验数据进行了有趣的分析，从患有双相情感障碍的住院患者借用智能手机收集，对这些相同症状进行临床测量。在这项为期九个月的研究中，他们报告说，患者每天通过智能手机和传统的离散研究访问评估的混合症状和烦躁之间存在很强的关联。这些结果很重要，不仅突出了这种测量收集方法的可行性，而且突出了其影响护理的临床潜力。同样重要的是，一些基于智能手机的测量结果并没有产生诸如混合情绪与生活质量或功能之间的关联。与任何新工具一样，基于智能手机的测量对于某些结果是可靠和有效的，但对于其他结果则不然。假设技术是一种不需要 Faurholt-Jepsen 等人进行的仔细临床研究的灵丹妙药，这是一条危险但诱人的途径。快速浏览一下 Apple iTunes 和 Android Google Play 商店，就会发现此类未经证实和未经测试的应用程序激增的程度。了解这些新测量的可靠性和有效性，或创建新的量表 (3)，是更艰巨但更有价值的前进道路。Faurholt-Jepsen 等人还强调了对技术增强的基于测量的护理的更微妙的挑战。作者指出智能手机报告的一个主要优势是最大限度地减少回忆偏差，但也敏锐地注意到他们的结果可能受到了许多混杂因素的影响。值得特别注意的是，“使用基于智能手机的监测工具的患者在试验期间报告了生活质量的提高和压力的减轻”。可以推测，每日症状报告可能会增加内省和自我反省，这对某些人可能具有积极的治疗益处。当然，也可以推测任意数量的机械假设，这些假设也可以解释记录症状的简单行为如何变得更多。因此，对某些人来说，通过智能手机进行客观测量也可能有助于改变这些结果——模糊生态瞬时评估和干预之间的界限。鉴于基于测量的护理的目标是使用数据来推动结果，数据和结果的直接联系为进一步探索提供了一条引人入胜的途径。当然，兑现基于测量的护理的承诺也意味着利用数据来推动临床决策和改善患者结果 (4)。除了上面讨论的测量和干预的有趣联系之外，这些发现如何改善护理？Faurholt-Jepsen 等人。使用基于智能手机的测量来确定有关混合症状和烦躁的重要发现，这对临床社区如何采取行动和实施这些结果提出了严峻的挑战。近年来，从工作流程、技术、计费和意识形态等众多方面，数字工具在临床护理中面临的众多实施挑战已变得显而易见 (5)。开发新的基于测量的工具和量表的研究人员将越来越需要意识到这些现实世界的挑战，因为数字工具面临着不断更新的技术和隐私法规的额外细微差别 (6)。诸如智能手机之类的用于增强基于测量的心理健康护理的技术将继续激增。但正如 Faurholt-Jepsen 等人一样。和