Seeing is Believing: Moving Past the Challenges of Telepsychiatry

Despite major advances in technology, declines in cost, and growing effective supporting the use of videoconferencing to deliver child behavioral health services, adoption remains low, according to Douglas K. Novins, MD, of the University of Colorado at Denver. During a presentation on Friday, Oct. 29 at the AACAP 57th Annual Meeting in New York, NY, Novins discussed challenges that exist in implementing and sustaining telepsychiatry programs.

The benefits of telepsychiatry, according to Novins—who utilizes telemedicine to consult with patients in six different states, including Alaska—can be significant for children in underserved populations with little or no access to behavioral health services. Telepsychiatry programs can be adapted, refined, and modified to meet the needs of a specific practice or clinic, and guidelines and recommendations exist to guide clinicians on the components of effective use.

However, significant roadblocks to expanded use of telepsychiatry still exist, including:

• Securing the funding required to create and sustain a program, which includes purchasing equipment
• Building the technological infrastructure can be a long and complex process that could take a year or long
• Adopting standard clinical procedures for use of videoconferencing can also be a complex process
• Policy issues can be very difficult to sort through

And above all, “the idea of being physically separated with patients is not easy,” said Novins. For many clinicians, “it’s difficult to form a therapeutic alliance using this method.

There are, however, resources available that can offer a great deal of assistance to clinicians and practitioners on establishing and maintaining a telepsychiatry program.

Novins recommends the Telemental Health Guide, which features online presentations that can be viewed or downloaded, as well as other educational materials.

In another presentation, Brian Grady, MD, University of Maryland School of Medicine, Baltimore, MD, addressed some of the technical requirements and challenges of implementing a telepsychiatry program.

Telemedicine, as defined by Medicare, refers to the use of medical information exchanged from one site to another via electronic communications to improve patient health and outcomes; it is important to note that methods utilizing only audio technology do not fall under this realm, said Grady.

The American Telemedicine Association (ATA) guidelines state that practitioners who practice telepsychiatry must be able to view written or drawn material, must ensure that only the patient is present in the room (with the exception of family members or additional health care professionals, that patients are seated comfortably, and that the angle and the gaze of the camera enables psychiatrists to view the patient as accurately as possible.

Other key points presented by Grady are as follows:

• ATA guidelines also specify that equipment being used must meet security and privacy encryption
• Practitioners should exercise caution with newer technologies including Skype, Google Talk, and iChat, which may not provide sufficient security
• At this time, 33 times have legislated full licensure requirements for telemedicine across state borders; several states are pending a telemedicine license, and many have the same laws in place for telemedicine as those that exist for face-to-face consultations. It is critical that practitioners thoroughly examine state regulations before implementing telepsychiatry into the practice
• In many states, telemedicine is reimbursed by Blue Cross Blue Shield as well as some other carriers, but regulations differ by state

Finally, practitioners should be sure to do all of the legwork before starting a telemedicine program, and to ensure that the same standard of care existing in face-to-face consultations is present in telepsychiatry consults.