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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]];<ref>{{cite web | url = http://www.medscape.com/viewarticle/727435 | title = Psychiatric Care Shortage: What the Future Holds | date = 2 September 2010 | accessdate = 7 August 2013 | first = Jeffrey A. | last = Lieberman | publisher = [[Medscape]]}}</ref> 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 (United States)|Medicare]] (CMS) services does cover telemedicine services, including telepsychiatry in many areas.
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]];<ref>{{cite web | url = http://www.medscape.com/viewarticle/727435 | title = Psychiatric Care Shortage: What the Future Holds | date = 2 September 2010 | accessdate = 7 August 2013 | first = Jeffrey A. | last = Lieberman | publisher = [[Medscape]]}}</ref> 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 (United States)|Medicare]] (CMS) services does cover telemedicine services, including telepsychiatry in many areas.

Overall, telepsychiatry provides increased access to services and has helped enhance the provision of services to families with children and other patients who are homebound. Patients participating in telepsychiatry say they are satisfied with the care they are receiving and that they feel telepsychiatry is a reliable form of practice.<ref>{{cite web | url = http://www.psychiatry.org/practice/professional-interests/underserved-communities/telepsychiatry | title = Telepsychiatry | publisher = [[American Psychiatric Association]]</ref>


==Sub-specialties==
==Sub-specialties==

Revision as of 12:34, 18 August 2014

Telepsychiatry, also known as e-psychiatry[1], 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.[2] 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[3] 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;[4] 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.

Overall, telepsychiatry provides increased access to services and has helped enhance the provision of services to families with children and other patients who are homebound. Patients participating in telepsychiatry say they are satisfied with the care they are receiving and that they feel telepsychiatry is a reliable form of practice.[5]

Sub-specialties

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

In-home Telepsychiatry

Psychiatric treatment of patients who are at home or in another private setting is called home-based telepsychiatry,[6] and it can require only a webcam and high-speed internet service. There are no special licenses needed in order to practice telepsychiatry.[7] 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 in-home telepsychiatry are best served doing so from within a secure, HIPPA compliant online platform.

Led by psychiatrist Dr. 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.[8]

Individual psychiatrists are adopting this method more and more with willing, interested patients,[3] and it is an especially useful tool for consumers with limited mobility included the elderly and the disabled. Unfortunately, in-home 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.

Emergency telepsychiatry

Many private practice, clinics and hospitals lack the necessary training to provide their patients mental health treatment. ER’s and doctors’ offices are often times left with the task of treating mental health. Patients often times seek treatment for mental illness from these places because access to mental health providers are limited. Most doctors lack the time or training to treat mental illness. Telepsychiatry can free up valuable time for doctors. Emergency telepsychiatry provides much needed care in rural areas by improving access to psychiatric care.[9]

Forensic telepsychiatry

Forensic 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.[10]

Crisis 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.[11] 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 emergency room disposition. Rather than employ expensive, short-term locum tenens doctors or have emergency room 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.[12]

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.[13] With the increased throughput offered by telepsychiatry, psychiatric consumers enjoy reduced wait times and faster access to care.

Routine 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. [14]

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)

Correctional Facilities

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.[15]

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[16] and the Schizophrenia Research Foundation in Chennai.[17] Private players like Mindcares[18] and Online Psychiatrist[19] are also increasing telepsychiatry's availability.

See also

References

  1. ^ Telepsychiatry
  2. ^ "Telepsychiatry". American Psychiatric Association. Retrieved 7 August 2013.
  3. ^ a b Hoffman, Jan (23 September 2011). "When Your Therapist Is Only a Click Away". New York Times. Retrieved 7 August 2013.
  4. ^ Lieberman, Jeffrey A. (2 September 2010). "Psychiatric Care Shortage: What the Future Holds". Medscape. Retrieved 7 August 2013.
  5. ^ {{cite web | url = http://www.psychiatry.org/practice/professional-interests/underserved-communities/telepsychiatry | title = Telepsychiatry | publisher = American Psychiatric Association
  6. ^ Ikelheimer, Douglas M. "Treatment of Opioid Dependence via Home-Based Telepsychiatry". Psychiatric Services. doi:10.1176/appi.ps.59.10.1218-a. Retrieved 7 August 2013.
  7. ^ http://www.e-psychiatry.com/telepsychiatry-solutions-for-practice.php | title = Telepsychiatry Solutions for your Practice | publisher = e-Psychiatry | date = March 10, 2013
  8. ^ "Dr. Jill Afrin". Changing the Face of Medicine. National Library of Medicine. Retrieved 2/8/14. {{cite web}}: Check date values in: |accessdate= (help)
  9. ^ http://www.e-psychiatry.com/emergency_consultation_telepsychiatry.php | title = Emergency and Consultation-Liasion Telepsychiatry | publisher = e-Psychiatry | date = January 9, 2014
  10. ^ Miller, T. W.; Burton, D. C.; Hill, K.; Luftman, G; Veltkempf, L. J.; Swope, M. (2005). "Telepsychiatry: critical dimensions for forensic services". Journal of the American Academy of Psychiatry and the Law. 33 (4): 539-546. PMID 16394233.
  11. ^ Shore JH; Hilty, D.M.; Yellowlees, P. (2007). "Emergency Management Guidelines For Telepsychiatry". General Hospital Psychiatry. 29 (3): 199–206. doi:10.1016/j.genhosppsych.2007.01.013. PMC 1986661. PMID 17484936.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Williams, Mike; Pfeffer, Michael; Boyle, Juliana; Hilty, Donald M. (December 2009). "Telepsychiatry in the Emergency Department: Overview and Case Studies" (PDF). California HealthCare Foundation. Retrieved 7 August 2013.
  13. ^ title=Alleviate Psychiatric Boarding in Washington with Telepsychiatry | author=James Varrell, MD| source=Insight Bulletin http://insightbulletin.com/alleviate-psychiatric-boarding-in-washington-with-telepsychiatry/
  14. ^ http://insighttelepsychiatry.com/resources-2/consumer-resource-center/
  15. ^ Comparison of Telemental Health Technologies
  16. ^ "Telemedicine Centre". PGIMER, Chandigarh. Retrieved 10 November 2013.
  17. ^ "Tele Medicine". Scarf India. Retrieved 10 November 2013.
  18. ^ "Our Vision". Mindcares. Retrieved 10 November 2013.
  19. ^ "Services". Online Psychistrist India. Retrieved 10 November 2013.

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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • 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. PMID 14763673.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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