Telepsychiatry

Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. The term typically describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing. Telepsychiatry services can be offered through intermediary companies that partner with facilities to increase care capacities, or by individual providers or provider groups. Most commonly, telepsychiatry encounters take place at medical facilities under the supervision of onsite staff, though at-home models are becoming accepted as long as they are in compliance with HIPAA standards.

One of the drivers behind telepsychiatry's growth in the United States has been a national shortage of psychiatrists, particularly in specialty areas such as child and adolescent psychiatry; telepsychiatry can allow fewer doctors to serve more patients by improving utilization of the psychiatrist's time. Telepsychiatry can also make it easier for psychiatrists to treat patients in rural or under-served areas by eliminating the need for either party to travel. The most common means of insurance coverage for telehealth services among the United States is to incorporate coverage into the Medicare program. Reimbursement for Medicare-covered services must satisfy federal requirements of efficiency, economy and quality of care. Since 1999, Medicare and Medicaid reimbursement for all kinds of telehealth services have expanded, requirements of providers have been reduced, and grants have been given to support telehealth program adoption. For 2014, the Center for Medicare (CMS) services does cover telemedicine services, including telepsychiatry in many areas.

Sub-specialties

Telepsychiatry includes a variety of sub-specialties based on different contexts of service delivery.

Home-based telepsychiatry

Psychiatric treatment of patients who are at home or in another private setting is called home-based telepsychiatry or direct-to-consumer telepsychiatry, and it can require only a webcam and high-speed internet service. However, in order to avoid the risk of violating the patient-provider relationship, issues of security and possible HIPAA violations, providers who wish to practice home-based telepsychiatry are best served doing so from within a secure, HIPPA compliant online platform.

Led by psychiatrist Jill Afrin, South Carolina Department of Health Deaf Services Program has used home-based telepsychiatry as a part of its services since the mid-1990s.

Individual psychiatrists are adopting this method more and more with willing, interested patients, and it is an especially useful tool for consumers with limited mobility included the elderly and the disabled. Unfortunately, home-based telepsychiatry is not typically reimbursed by private payors or Medicaid, though many states are adopting measures into their legislation in the form of parity laws that would allow for it to be reimbursed in the future.

Correctional telepsychiatry

Correctional telepsychiatry is the use of a remote psychiatrist or nurse practitioner for psychiatry in a prison or correctional facility, including psychiatric assessment, medication consultation, suicide watch, pre-parole evaluations and more. Telepsychiatry can deliver significant cost savings to correctional facilities by eliminating the need for prisoners to be escorted to off-site appointments and psychiatric interventions. One of the early pioneers of correctional psychiatry was Edward Kaftarian, MD. As the Chief of Telepsychiatry in the California prison system, Dr. Kaftarian assembled a staff of 70 telepsychiatrists to serve 25 prison facilities, making it the largest correctional telepsychiatry program in the world. As a spinoff of this mission, Dr. Kaftarian founded Orbit Health Telepsychiatry, a company that serves prison and jails across the nation. Increasingly, jail and prison psychiatry is becoming one of the largest use cases of telemedicine.

On-demand telepsychiatry

As of 2008, guidelines are being developed for the provision of telepsychiatric consultation for emergency psychiatric patients, such as the evaluation of suicidal, homicidal, violent, psychotic, depressed, manic, and acutely anxious patients. However, emergency telepsychiatry services are already being provided to hospital emergency departments, jails, community mental health centers, substance abuse treatment facilities, and schools. Emergency telepsychiatry can ease staff shortages in overworked hospital emergency departments and increase patient throughput and ED disposition. Rather than employ expensive, short-term locum tenens doctors or have emergency department physicians evaluate the psychiatric stability of their patients, hospitals can use telepsychiatry to decrease costs and increase patient access to behavioral health evaluations by psychiatric specialists.

Crisis telepsychiatry is also an efficient means of reducing the need for psychiatric boarding. Psychiatric boarding is when a mentally ill resident is detained, often in a hospital emergency department, while waiting for proper psychiatric treatment. With the increased throughput offered by telepsychiatry, psychiatric consumers enjoy reduced wait times and faster access to care.

Scheduled Telepsychiatry

Many facilities that offer behavioral health care are turning to telepsychiatry providers to allow for an increased care capacity. With routine telepsychiatry, a consistent provider or small group of providers serve a regular caseload of consumers in previously scheduled blocks of time. Remote providers can be consulted for medication management, treatment team meetings, supervision, or to offer traditional psychiatric assessment and consultations.

Having access to remote providers allows facilities, especially those in rural areas that struggle to recruit and maintain providers, access to a greater variety of speciality care to offer their consumers.

Facilities that use routine telepsychiatry include:

Community Mental Health Centers (CMHCs) Outpatient clinics Federally Qualified Health Centers (FQHCs) Universities and Schools Residential Programs Nursing Homes Accountable Care Organizations (ACOs) Substance Use Treatment Centers Military Bases

HIPAA compliance in the United States

HIPAA (the Health Insurance Portability and Accountability Act) is a United States federal law that establishes security and privacy standards for electronic medical information exchange, including telemental health services. In order to comply with HIPAA guidelines, many providers develop their own specialized videoconferencing services, since common third-party consumer solutions do not include sufficient security and privacy safeguards. There are also a growing number of HIPAA-compliant technologies available for telepsychiatry.

In India

India's large population and relatively small number of psychiatrists makes telepsychiatric service a good option for expanding access to mental health care. Telepsychiatry in India is still a young industry, but it is gradually growing, led by institutes such as the Post Graduate Institute of Medical Education and Research in Chandigarh and the Schizophrenia Research Foundation in Chennai.

In the UK

The NHS has been slow at recognising the merits of telepsychiatry, perhaps because the regional set up of the NHS makes the provision non-location based virtual service difficult for the bureaucracy of a state owned model to implement, though there are now some NHS Mental Health Trusts such as Oxford NHS Foundation Trust who are starting to see the cost benefits and to set up services. There is a UK based group of consultant psychiatrists, Psychiatry-UK LLP, working in a chamber model, providing a national telepsychiatry service. However, though they are registered with the Care Quality Commission as a qualified provider of medical services and can be found on the NHS Choices website, they are, as yet, only seeing patients who self fund or who have suitable health insurance.

See also

• Psychiatry
• Telemental Health
• Telepsychology
• Telehealth
• Telemedicine
• Telebehavioral Health
• Use of technology in treatment of mental disorders

Further reading

• Frueh BC, Monnier J, Elhai JD, Grubaugh AL, Knapp RG (2004). "Telepsychiatry Treatment Outcome Research Methodology: Efficacy Versus Effectiveness". Telemedicine Journal and e-Health. 10 (4): 455–8. doi:10.1089/tmj.2004.10.455. PMID 15689650.
• Hilty DM, Marks SL, Urness D, Yellowlees PM, Nesbitt TS (January 2004). "Clinical And Educational Telepsychiatry Applications: A Review". Canadian Journal of Psychiatry. 49 (1): 12–23. doi:10.1177/070674370404900103. PMID 14763673.
• Frueh BC, Monnier J, Elhai JD, Grubaugh AL, Knapp RG (2004). "Telepsychiatry Treatment Outcome Research Methodology: Efficacy Versus Effectiveness". Telemedicine Journal and e-Health. 10 (4): 455–8. doi:10.1089/tmj.2004.10.455. PMID 15689650.
• Monnier J, Knapp RG, Frueh BC (December 2003). "Recent Advances In Telepsychiatry: An Updated Review". Psychiatric Services. 54 (12): 1604–9. doi:10.1176/appi.ps.54.12.1604. PMID 14645799.

External links

• Donald M. Hilty, MD, Weiling Liu, BS, Shayna Marks, BS, Edward J. Callahan (October 2003). "The Effectiveness of Telepsychiatry: A Review". Canadian Psychiatric Association Bulletin.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• American Association for Emergency Psychiatry
• "Look onscreen, the doctor will see you now" Focus, Illinois Public Media, April 11, 2014