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