Seven things to know before utilizing telepsychiatry in your practice

Jay H. Shore

NEW ORLEANS — A presenter here at Psych Congress addressed seven “perils” of telepsychiatry and provided “pearls” for how to resolve them.

“Research has been going on for the last couple decades in telepsychiatry, and at this point there is a robust evidence base,” Jay H. Shore, MD, MPH, of the University of Colorado Anschutz Medical Campus, said during the session. “Now, there is a good cohort of randomized controlled studies, approximately 20 to 25, of good quality, that demonstrate interventions over video conferencing are equally as effective as interventions in-person or face-to-face.”

Studies have also shown cost-savings, “which is really a no brainer,” Shore said.

“I think where we are with cost now is: What are the real implications for the health care system, [and] can we reduce overall cost with telepsychiatry?” he said. “There’s some innovative studies coming out right now looking at that, particularly in integrated care.”

Now that a strong evidence base has been established for telepsychiatry, the focus should shift to how to perfect telepsychiatry practices in real life. Shore explained seven common challenges of telepsychiatry and provided solutions for each of them.

Building an effective team

Perils: not using a team-based approach, inefficient team composition due to temperament and roles, lack of role definition, and site-based silos.

Pearls: establish a clear definition of roles and be aware of telepsychiatry team needs regarding administrative and clinical areas.

Regulatory compliance

Perils: not having a comprehensive understanding of common regulatory requirements, including licensure, standard of care, Ryan Haight Act, credentialing, security and privacy.

Pearls: hold some in-person visits; utilize exemption; partner with local prescribers; use encrypted, HIPPA-compliant systems; and stay up-to-date with regulatory requirements.

Managing psychiatric emergencies

Perils: being unprepared for emergencies, and lacking in local/patient site knowledge.

Pearls: have clinical protocols and conduct them before ever seeing a patient; cover key areas such as enrollment, rooming, clinic policies, emergencies, labs, documentation and prescribing; consider having a patient support person for in-home patients; and educate patients and staff.

Culture and technology

Perils: lack of understanding of the impact culture and setting have on administrative and cultural processes, lack of local knowledge, and not being cognizant of different settings between patient and clinician.

Pearls: make frequent site visits or at least an initial site visit to become familiar with patient settings; stay updated on local culture; conduct an ongoing assessment of patient reaction and comfort with technology; monitor the impact of technology on the clinical process; and have a clinical “contract” around technology use.

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Hybrid relationships (ie, communicating with patients in multiple ways)

Perils: miscommunication, digital transference, and lack of clear direction regarding the methods and modes of communication.

Pearls: practice before using video conferencing with a patient; actively manage hybrid relationships; establish clear boundaries, roles and methods of communication; and consider using a formal one-page digital relationship policy.

Sustainability

Perils: long-term funding and reimbursement plan, workflow adaptation, and workforce development.

Pearls: utilize tele-teaming vs. a single “doc in the box,” and financial planning.

Managing program growth

Perils: failure to plan, not realizing what works for one clinic may not work for others, and moving beyond the clinical champion.

Pearls: have a strategic framework, utilize resource centers, do not be afraid of using a new approach if needed, iterative growth, and “inculcate, inculcate, inculcate,” Shore said. – by Amanda Oldt

Reference:

Shore JH. Overcoming the 7 common perils of telepsychiatry. Presented at: U.S. Psychiatric and Mental Health Congress; Sept. 16-19, 2017; New Orleans.

For more information:

American Telemedicine Association: http://thesource.americantelemed.org/home

American Psychiatric Association: https://www.psychiatry.org/psychiatrists/practice/telepsychiatry

Disclosure: Shore reports employment and stock options from Colorado Access.