Starting Your TeleMental Health Program

Abdel Fahmy, MD, CPHIMSPresident, ISAM

President, Soft Landing LtdRegional Medical Director and Medical director for

Substance Abuse, Access Community Health

Health Information Technology

• Technology for comprehensive management of medical information and its secure exchange between health care consumers and providers.

• Improve health care quality; • Prevent medical errors; • Reduce health care costs; • Increase administrative efficiencies; • Decrease paperwork; and • Expand access to affordable care

HITECH Title XIII • American Recovery and Reinvestment Act of

2009 is all about HIPAA!!!• Expands BA agreements• Civil and Criminal penalties!• Penalties funds HHS civil rights enforcement• “Willful neglect” by 2/12/2011• DOJ to pursue penalties or OCR will

HIT Funds

• $19.2 Billion + $12 Billion savings

The docs get some money

• Up to $65K per physician over 5 years starting 10/10

• Penalties to hospitals by 2015• “Meaningful” use of EHR:

– Certified– Interoperability– E-Prescribing– CDSS– CPOE

EHR in Behavioral Health

EHR in the Treatment community

• Few scattered vendors that don’t have to follow standards.

• CCHIT standards due by 07/2010

• CDSS to support placement criteria

• Interoperability with medical counter-part

• Higher standards of HIPPA compliance

• Integrated eHealth technology

TeleHealth -eHealth

• Use of telecomunication to deliver healthcare

• Quality regardless of distance• Comparable efficacy to FTF• Higher rate of patient engagement• Various application including telesurgery• DoD, VA and HRSA are most advanced• Prevalence in rural States• TeleMental Health is No. 1 Application

TeleMental Health

• Some studies claim superiority

• First AV was in Nebraska Psychiatric Institute in 50’s

• 1968 Mass General Hospital started emergency psych consults

• Flourished in the 90’s

• Today we have a significant advantage with encrypted streaming and mobility

Reimbursement

• Medicare: Rural to Urban, Hub and Spoke, same as face to face plus Hub Admin fees

• PPO: Aetna, Cigna, BCBS• HMO: variable• IDPA: State by State

California, Hawaii, Texas and Louisiana have passed bills prohibiting private health insurers from discriminating between traditional medical and telemedicine service reimbursement.

Medicare

Hub sites include:• County mental health clinic or publicly funded mental

health facility • Federally Qualified Health Center (FQHC) • Hospital -- either inpatient, outpatient or a critical access

hospital (CAH) • Office of a physician or other practitioner (this includes

medical clinics) • Renal dialysis facility • Rural Health Clinic (RHC) • Skilled nursing facility • Tribal Health Center (THC)

Great Lakes States-Medicaid

• Illinois: Yes

• Indiana: Yes

• Michigan: Yes

• Ohio: SB94 – services provided by Telemedicine shall not be excluded

Developing the Program

• Mission and vision of organization

• Champion

• Needs assessment

• Feasibility studies

• Project planning and management

• Policy and procedures

• Workflow

Simple Equipment

Equipment

• Desktop computer, microphones, speakers, monitors, cameras, CODEC and other accessories – ITU standards

• Policies and procedures regarding equipment quality control and validity testing.

• Physical security • Good working condition and replace equipment

as necessary• Disaster planning and backup

Equipment – Cont.

• $100s to $40,000

• High speed connections

Privacy

• A written privacy policy to be reviewed and signed by all involved

• Provisions to prevent monitoring of patient by unauthorized parties

• The patient has to be informed at the beginning of session as to who is present at the provider’s location during the video conferencing and notified immediately if anyone else enters the room during the video conferencing session

Privacy and Confidentiality

• HIPAA compliance

• Access logs and

• Audit trails

• e-Discovery

Informed Consent

• What is TeleMental Health

• Compared to Face To Face (FTF)

• Potential risks

• Agreement is voluntarily

• Refusal will not withhold treatment

• May terminate session at any time

Training

• Mental health professionals have to be trained:– how to properly use the technology – Organization policy– HIPAA and security– Indications– When to cancel and order a FTF– Quality control and peer review

Medical Records

• Documentation same as FTF

• In addition should state:– Location of provider– Location of patient– Malfunctions interfering with quality– All personnel present during session

Food for Thought

• Social networking in web 3.0

• Texting for Health- No HIPAA products

• Avatars and Virtual counseling - Harvard

• Online group Therapy – Our specialty

MySpace

MySpace

• Started in 2003 by Internet marketing outfit eUniverse

• Has become a social media site for musicians, artists, actors and comedians

• 73 million users in the U.S. and 117 million globally (June 2008)

• No. 1 social network in the U.S. according to Nielsen

Facebook

Facebook

• More than 200 million active users • More than 100 million users log on to Facebook

at least once each day • Average user has 120 friends on the site • More than 3.5 billion minutes are spent on

Facebook each day (worldwide)• More than 850 million photos uploaded to the

site each month • More than 8 million videos uploaded each month

LinkedIn

That’s all Folks

Questions?

• Abdel Fahmy, MD, CPHIMS– Soft Landing Ltd– Oakbrook Terrace Medical Centre– 1s224 Summit Ave. Suit 310– Oakbrook Terrace, IL 60181– 630-261-9220 – Dr.Fahmy@SoftLandingRecovery.com– WWW.SoftLandingRecovery.com