Professional Documents
Culture Documents
DOI 10.1007/s11920-015-0630-9
Telepsychiatry Today
Steven Chan 1 & Michelle Parish 1,2 & Peter Yellowlees 1
Introduction
Telemedicines definitions vary in scope. Some broadly define
it as the transfer of medical information from one site to another by electronic communications, encompassing not just
two-way video, but also e-mail, smartphones, and other telecommunications technology, with the ultimate goal of diagnosing and treating illnesses [1, 2]. This broad definition implies the potential to shift medical care towards new models of
Bencounterless^ digital communication [3]. In a more focused
definition, the Centers for Medicare and Medicaid Services
define telemedicine as two-way, real-time interactive communication. This occurs between a patient and a practitioner at
distant sites [4]. This often is referred to as synchronous
telemedicine.
Telepsychiatryinterchangeably known as telemental
healthis the application of telemedicine to mental health.
Though telepsychiatry can encapsulate the aforementioned
broader definition of not just video but also smartphone apps,
mobile devices, and sensors [511], this paper will specifically
cover synchronous telepsychiatry as video-based health services involving the transmission of video over distance, and
briefly discuss non-real-timeor asynchronousmethods of
video consults. Research from 2012 through 2015 will primarily be discussed and reviewed.
Advantages of Telepsychiatry
A significant amount of research has demonstrated the advantages of telepsychiatry beyond increasing access to care. Use
of telepsychiatry leads to high patient and provider satisfaction ratings and achieves health outcomes equivalent to inperson care [12]. Younger generationschildren and adolescentsparticularly prefer telepsychiatry over in-person
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concordance of child psychiatrist diagnoses and treatment recommendations between videoconferencing and face-to-face
modes [62].
A recent randomized controlled trial used a hybrid approach to care for children with ADHD living in underserved
communities. The trial combined synchronous, asynchronous,
and in-person modes of interaction, as well as web-based educational approaches and the involvement of teachers, parents, and primary care physicians, all supported by an electronically enabled treatment team from the University of
Washington. The results in 224 children were significant with
improvement in both inattention and hyperactivity symptoms
[6366]. This novel telepsychiatry service model of hybrid
collaborative mental health services using multiple technologies has already been described as not only being a new way
to practice but also demonstrating a new standard of practice
that is potentially significantly better than the traditional inperson gold standard level of care [62].
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Business Environment
The business environment, though improving, has not been
historically conducive towards telemedicine. Reimbursement
remains an issue with payers, such as the Centers for Medicare
and Medicaid Services, placing constraints on how telemedicine services can be used. Inconsistent laws across states also
play a role, though as of May 2015, 27 states and the District of
Columbia had legislated Bparity^ in the reimbursement of telemedicine services. Other states still do not reimburse telemedicine visits at the level of an in-person visit [76]. Licensure
requirements, prescription rules, and documentation requirements also vary by state [14, 77]. The VA has legislation
supporting national licensing to their own facilities for all their
providers, and it is likely that this will be extended to the US
Department of Defense and possibly all federal programs soon,
but a national licensing process for all physicians practicing
telemedicine is still likely some years away. Summary analysis
reports of these constantly changing policies and legislative
activities are freely available online [78, 79]. Finally, there are
logistical and financial challenges for anyone setting up
telepsychiatry programs, such as telemedicine infrastructure
costs and high turnover rates for rural healthcare workers [80].
Personal Biases and Lack of Training
Attitudinal change is still a problem at both health system
leadership and provider levels. Most health system leaders in
the USA are still from a generation that has not fully adopted
technology and are wary of the sorts of changes that technology can bring. Their gold standard is still the in-person consultation, despite the massive changes in some medical disciplinesnamely pathology, radiology, cardiology, and dermatologyenabled by information technologies. Many are unable to envision the sorts of changes that might occur in mental health if technologies were adopted more aggressively.
Conclusion
The field of telepsychiatry is an exciting area within which to
work. Compared with the past, there is now a rapidly changing and much more hospitable legislative and business climate, a solid evidence base, and enthusiasm for the approach
from both psychiatrists and patients. Telemedicine, with
telepsychiatry at the forefront, will continue to be actively
promoted by patients and increasingly by younger generations
of providers and health leaders. At a policy level,
telepsychiatry is increasingly being promoted by health insurers, given increasing efforts for telemedicine reimbursement parity, a new telemedicine accreditation program for
telemedicine medical service companies from the American
Telemedicine Association [81], and telemedicines move beyond national borders [14].
Eventually, there will be hybrid models of care that combine both in-person and technology-driven care, the latter of
which can include e-mail, instant messaging, asynchronous
telemedicine, and more. We envision seeing telepsychiatry
taught routinely in medical schools, residency training, and
continuing medical education programs [66].
References
Papers of particular interest, published recently, have been
highlighted as:
Of importance
Of major importance
1.
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