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TRANSCRIPT
The National TelehealthWebinar Series
October 12, 2017
Presented byThe National Consortium ofTelehealth Resource Centers
Webinar Tips & Notes
• Your phone &/or computer microphone has been muted
• Time is reserved at the end for Q&A
• Please fill out the post-webinar survey
• Webinar is being recorded
• Recordings will be posted to our YouTube Channel https://www.youtube.com/channel/UCOzpvd1OZ221AWBSF3QK-yg
Scott Baker, MBABusiness Innovations Manager, InSight Telepsychiatry
Barb Johnston, MSN, MLNCEO and Co-Founder of HealthLinkNow
Three Perspectives on Telepsychiatry: Adult, Pediatric, and Direct-to-Consumer
TelepsychiatryDirect to Consumer
Barb Johnston, MSN, MLM
Telepsychiatry: Direct to Consumer
Appropriate Benefits Challenges Questions
Appropriate
Condition-NOT suicidal or homicidal Most mental health issues OK Patient has required TM equipment Private/safe environment Communication via email/cell for back up Informed Consent Signed and Documented Observe State and/or International
laws/regulations
Case Example: 35 yr
Severe depression NOT suicidal or homicidal
Nurse at local community hospital Wanted psychiatrist out of community Works till 3pm-school age children “I didn’t want people at work to know” “It felt more personal somehow” “Prefer video approach”
Benefits for Patients
Meets Standard of In Person Care Many Patients expect/request it More flexible appointment times Convenience-no travel (time/cost) Less stress-familiar surroundings Avoid taking time off work/school Vacation or business travelers Maintain privacy
Benefits for Providers
Many Patients expect/request it More flexible schedule/appointment times Convenience-no travel (time/cost) Enjoy home or office-familiar surroundings Opportunity to expand/improve practice Learning new way to work No extra overhead costs High patient satisfaction
Challenges
Securing private location Patients changing technology Previous VC dropped sessions-resolved Getting buy in from PCPs Payment: Insurance payers, private pay Rules/regulations-States and payers Professional standards-same as in person Appropriate attire and background Sit up and remain center of screen
How to be a Telesuccess: Implementing and Utilizing a Successful
Telepsychiatry Program
Scott Baker, MBA
Agenda
• Telepsychiatry Overview
• Models of Telepsychiatry
• Special Populations
• Program Planning
• Implementation
TelepsychiatryA medium for delivering psychiatric care through
videoconferencing technology
Settings for Telepsychiatry• Outpatient clinics
• In-home
• Primary Care Offices
• Emergency Departments
• Hospital Medical Floors
• Inpatient Units
• Urgent Care Centers
• Mobile Health Clinics
• CMHCs
• FQHCs
• ACT Programs
• Residential Programs
• Schools
• Corrections
• Skilled Nursing
Telepsychiatry is Different
Telepsychiatry
Focus on conversation and collateral collection
Long-term physician-patient relationship
Typically 8-12 appointments
Multiple types of appointments
Other Branches of Telehealth
Focus on physical observation
Short-term encounters
Single consultation
Urgent care
Scheduled Services ModelRemote providers can be used to complete most tasks
that an onsite provider would
Initial Assessments and Testing
Treatment Team
Meetings
Medication Management
Therapy and Counseling
Group Sessions
On-Demand ModelRapid, on-demand access to a psychiatric professional
Psychiatric Assessments
Admission and
Commitment Decisions
Consults and Orders
Rounding Referrals
Asynchronous Model
• Some organizations do this with “store and forward” or telepsychiatry
– Session is recorded (with permission) with a facilitator trained to ask certain questions
– The session is then reviewed by a psychiatrist at a later time
Direct-to-Consumer Model
• Convenient value-add for consumers
• Flexible hours for providers in private practice
• Great for night and weekend appointments
• Expand care almost anywhere (home, dorm room, hub site, etc.)
BenefitsC
on
sum
er • Reduces time in
hospital
• Provides access to specialists
• Flexible hours for scheduling appointments
• Facilitates continuity of care
• Reduces wait times
• High consumer and family satisfaction
Tele
me
nta
l He
alth
Pro
vid
er • Increases time and
efficiency
• Decreases transportation costs
• Increases number of visits
• Improves communication and collaboration
• Ability to see a diverse consumer population
• Flexibility to work from home
Co
mm
un
ity • Increases access to
specialists
• Reduces inappropriate admissions
• Connects siloed health care organizations
• Improves population health
• Reduces risks and liabilities
Challenges
Programs
Complying with multiple state and
federal regulations
Getting buy in from a new program
Designing efficient workflows
Providers
Licensure in multiple states
Must make time to interact with onsite staff
Potential to feel isolated
Special Populations
Refers to any group of consumers that present unique barriers to communicating or understanding that require adaptability in the approach to treatment
Only provide services to consumers with whom you have the training to effectively work and communicate
Children
• Success depends on their ability to sustain attention
• A flexible approach is an asset
• Set firm boundaries
• Parents may need to be involved in sessions
Aging Adults
• Sound is very important• Have someone else in the
room to act as your hearing “translator” if needed
• Though there is a higher chance of having dementia, this population can still get a lot out of telepsychiatry– Still able to talk, engage
and demonstrate cognitive deficits
Other Populations
• Autism Spectrum Disorder
• English as a second language
• Indigent populations
Patient AppropriatenessEducate the individual on telebehavioral health
to determine if it’s right for them
AppropriateIndividuals…
Are busy and struggle to find time in their schedule to get away
Have limited mobility or access to transportation
Work full time or have multiple jobs
Are in school full or part time
Would not otherwise bother to schedule a mental health appointment
Need timely care and treatment
Inappropriate Individuals Are…
In crisis or emergency situations such as being suicidal, psychotic or violent
With no access to reliable internet or a smart device with a camera or microphone
Who have been educated on telehealth, but are still very uncomfortable with the technology or refuse to use it
Who are medication-seeking
Implementing a Telepsychiatry Program
Consider Regulatory and Legal Environment
Cultivate Stakeholder Buy-In
Select Technology
Design Workflows
Provider Credentialing
Training
Program Planning
Know State-Specific Regulation and Rules
• Licensure
• State Medical Board
• Reimbursement
• Medicaid
• Private Payers
• Physician-Patient Relationship & prescribing
• Telemedicine specific legislation or regulation
• Permitted services, professionals, sites, etc.
Cultivate Stakeholder Buy-ins
Providers Executives IT
Medical Affairs
Community Payers
Select Your Providers
Medical Affairs• Plan ahead! Provider credentialing is the largest
roadblock to launching new programs– Are your bylaws conducive to telepsychiatry?
– Will you accept credentialing by proxy?
• Licensing
• Credentialing
• Paneling
• Payer Enrollment
• Maintenance of Certification, Reappointments, CMEs
Design Workflows
• Proactively design a system that works for you
– Goal should be integration
• When will you use telepsychiatry? How?
• Who will take the records? How will they be sent?
• Who will be the facilitator?
– What will they do?
– How will they communicate with the remote provider?
• How will scheduling work?
1 2 3
Practice Guidelines
The American Telemedicine Association and the American Psychiatric Association both
have guidelines for the practice of telepsychiatry and are excellent resources.
Questions and Discussion
The National Telehealth Webinar Series
3rd Thursday of every month
Next Webinar:
Topic: Increasing Connectivity for Rural Health Care Facilities
Presenter: Karen Lee, VP of the Rural Health Care Program, USAC
Host: The Upper Midwest Telehealth Resource Center
Date: 11/16/17
Times: 8:000AM HST, 10:00AM AKDT, 11:00AM PDT, 12:00PM MDT, 1:00PM CDT, 2:00PM EDT
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TRC activity is supported by grants from the Office for the Advancement of Telehealth, Federal Office of Rural Health Policy, Health Resources and Services Administration, DHHS