Telepsychiatry improves time to care plus frequency of care for behavioral health patients: study

A study published in the Journal of Rural Mental Health of the American Psychological Association (abstract) studied the usage of hybrid psychiatric care–a combination of telepsychiatry and in-person care–among rural dwelling patients. Their findings were quite positive:

  • Hybrid care reduced time to in-person care by 30 percent in the intervention group versus the control group of in-person care only
  • Two-thirds of those receiving hybrid care had an outpatient telepsychiatry encounter per month, as opposed to 50.3 percent among the control group
  • The intervention group used telepsychiatry for over a quarter of their visits

Emergency department visits, antipsychotic medication adherence and readmission rates were similar among both groups.

The retrospective analysis of 242 patients (outpatient visit + 11 months) studied adult Medicaid patients in Missouri who had received a telepsychiatry visit following a hospitalization or emergency department visit resulting from substance use disorder or a behavioral health episode. 

Rural America is considered to be highly underserved in mental health, with many barriers to follow-up care after an inpatient admission or an ER/ED visit. As the authors of the study stated, ‘the current study suggests that offering telepsychiatry can help close the gap in access to mental health care between rural and urban populations, particularly during the time after an inpatient admission or an emergency department visit. As telepsychiatry service options continue to grow, making this delivery mode available to rural populations may have a positive impact on mental health outcomes in the United States.’ The Mobihealthnews article attributed the telepsychiatry system to Genoa Healthcare.

A random walk through ATA 2014

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/05/ATA_Button_color_filled.jpg” thumb_width=”150″ /] Editor Donna attended ATA 2014 on Monday only. This article is a set of impressions (mainly) of the exhibit floor and visits to a number of select booths.

Donna, it’s Baltimore. You’re not in NYC or Las Vegas.

Arriving after a long trip to a city you used to visit regularly, but haven’t been to in over 30 years, is disorienting, especially when you are heading on a fair spring day to a section that didn’t exist then. The Inner Harbor and Camden Yards resemble Atlanta, not necessarily a bad thing since the parts of ‘Charm City’ they replaced were largely past ‘gentrification’. The Baltimore Convention Center was unexpectedly huge, the distance to registration made longer by a taxi driver who dropped me off at another entrance two blocks away. Any resolve I had to drop in on the many educational sessions was dissuaded by the sheer length of the halls. The thick Exhibit Guide confirmed that the show floor filled two city blocks–a challenge to cover and spend time with my appointments before the close of the day.

Was it a hardware show, a software show or somewhere in between?

You could make a case for both views. One observer I walked with at the start compared it to a radiology trade show–all hardware. Yet a closer look indicated that the hardware–the PCs, tablets and smartphones–was there to show software that integrated: systems to track patients, distribute information, workflows, store and forward images and reports. It was about enabling secure consults, platforms, interoperability, two-way data flows, mitigating readmissions and putting telehealth, telemedicine and education into provider and patient hands. It was also about making the business case. It was most definitely NOT about gadgets and single purpose peripherals, though the latter were still quite visible. The old picture of telehealth closed systems, of proprietary monitoring devices feeding data onto a proprietary PC platform where it’s seen by a care manager, is so 2011.

Noteworthy: the growth in specialized services like telepsychiatry, teleneurology, teleradiology and teledermatology. Contrast: despite VGo‘s ubiquitous telepresence robots accosting you on the floor, a tablet-faced robot following a nurse down the hospital hall and ‘consulting’ with patients will likely still be a rarity.

Patient engagement on top

Traditional telehealth device makers are connecting their devices and opening up their reporting platforms to be accessible to patients. But there are bumps along the way in this transition. A&D Medical has gone ‘Wellness Connected’ with a mobile app (more…)

Australia’s telehealth incentive programme nears end

A multi-million dollar financial incentive programme to encourage Australian clinicians to start telehealth [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/02/GovAustelehealth.jpg” thumb_width=”150″ /]schemes is due to end in June. Launched as a four-year programme in July 2011, the Telehealth On-Board Incentive Programme was funded from a wider AU$620 million telehealth initiative, but the end of the programme was brought forward to June 2014.

The Medicare rebates and financial incentives for specialist video consultations were introduced to address some of the barriers to accessing medical services, particularly specialist services, for Australians in remote, regional and outer metropolitan areas. The Telehealth On-Board incentive was one of five financial incentives in the wider initiative and encouraged and supported the initial and ongoing provision of telehealth services to eligible patients by practitioners. (more…)

Startup develops online telepsychiatry platform

A Chattanooga based startup has launched an online videoconferencing facility for providing remote counselling services.  WeCounsel (wecounsel.com) claim their browser based application is “HIPPA compliant”, a key selling point for their product, although it  is not obvious from their website what specific aspcts of HIPPA they have addressed with their platform. WeCounsel claim to have around 75 clients using the platform to provide direct counselling services to patients.

The Chattanooga Times recently reported that WeCounsel has been signed up by a larger telepsychiatry facility provider InSight to resell the WeCounsel online platform as a lower cost alternative to the traditional videoconferencing facilities which requires relatively expensive equipment.

Telepsychiatry: a new practitioner’s experience

Daniel W. Knoedler, MD in Psychiatric News chronicles his first week as a full-time telepsychiatrist, working for the Green Bay VA Hospital in Green Bay, Wisconsin. He is definitely a bit stressed as he adjusts to working alone in a cold basement, his image in the video system and the Loneliness of the Long-Distance Psychiatrist who doesn’t have face-to-face contact with patients–and his own socialization. Yet he thinks telemedicine is useful in addressing the lack of access to care for patients and that the technology is not much of a barrier. He does worry about the consequences of not shaving, leading to some musings on Howard Hughes.  Telepsychiatry: First Week in the Trenches

Telepsychiatry pilot success in the Bronx

More on telepsychiatry: a pilot at Lincoln Hospital in The Bronx (borough of NYC) for adolescent telepsychiatry consultations reported success with only one in 10 patients being hospitalized after the telehealth consultation, according to Louis Capponi, M.D., chief medical informatics officer for New York Health & Hospitals Corporation, the parent of Lincoln Hospital. “The impact was very profound in terms of the number of patients that were able to (be) discharged safely.” HHC is considering expanding the pilot to patients who come in through the prison system. What is puzzling is that in the exclusive interview with Dr. Capponi in FierceHealthIT, there is no information on the duration of the pilot, the number of patients in the program, or details that would give our readers some framework beyond ‘engaging patients through technology’.

Telehealth counselling program expands in Texas

Following on from our article on the school telehealth scheme in Michigan  (Smaller scale telehealth and telecare sucesses, [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/videoconf-Texas.jpg” thumb_width=”150″ /]TTA Jan 4), we report now how a remote counselling clinic started by Texas A&M to provide psychological counselling to rural population has expanded. The Telehealth Counselling Clinic in Centerville, Leon County, was started from a grant in 2007 to the Center of Community Health Development (Texas A&M) and Leon County, and provides counselling using Texas A&M faculty and graduate students in the counselling psychology program, supervised by licensed psychologists.

The service has now been expanded to Madison and Washington counties based on the success seen in Leon County. Two more sites are planned for opening  in 2014. (more…)

A highlight from ATA 2013 Fall Meeting: Psychiatric appointments as a ‘data-file’

In a conversation at a recent Health 2.0 NYC event, this Editor asked Doug Naegele what was the most surprising topic at the recent American Telemedicine Association conference in Toronto. Doug has graciously contributed this short article. He is the founder of Infield Health, a firm dedicated to increasing health outcomes and reducing total cost of care by putting discharge instructions on mobile phones. 

At the ATA Fall Meeting in Toronto last month, Dr. Peter Yellowlees gave a presentation on his work at University of California-Davis around telepsychiatry. I was struck by a few of his discussion points:

1. It may be helpful to see psychiatric consults as ‘data files’ and not events that require mandatory real-time evaluation.
2. If we accept that these consults can be described as data files, then they can be forwarded to remote psychiatrists for viewing, evaluation, and treatment recommendations much in the same way radiological scans are remotely evaluated. (more…)

Addicted to mobile health? Telepsychiatry to the rescue!

Dr. Joseph Kvedar of Boston’s Center for Connected Health counted himself in this Editor’s camp as annoyed by the mHealth hype (inflicted by those we’ve dubbed the D3HDigital Health Hypester Horde), and far more of a believer in SMS for health programs. His blog post is a ‘kind of edge’ towards thinking that mHealth can be habit-forming. In the CCH’s own clinical trials, more participants have smartphones (tracking the general population’s adoption) even with the lag among those with chronic disease (maybe a question of affordability?) and want apps. And then he sees the pattern of people checking their smartphone obsessively, like budgies with bells and mirrors….along with a study that indicates that patients with a passive sensor to upload blood glucose measurement, rather than pushing a button, were “significantly more adherent to their plan and had better health outcomes.” Not having to do something in the Diabetic’s Perpetual Battle of Stalingrad is addictive? Well, this is edging towards a nomination for ‘What in the Blue Blazes?” Could mobile health become addictive? (CHealth Blog) Hat tip to reader Bob Pyke via Twitter

Well, we can send Dr. K to a connected psychiatrist for a session of e-therapy.  (more…)