The coronavirus crisis has forever changed healthcare, including behavioral and mental healthcare. Social workers, counselors, direct support professionals, psychologists, and others suddenly find themselves trying to provide care from a safe distance. Telehealth and telepsychiatry have helped bridge the patient-practitioner gap created by the COVID-19 pandemic.
Telemedicine refers to providing medical care using two-way electronic communication, with audio and video, between a provider and a patient. Telehealth encompasses broader services using information technology and electronic communication to support healthcare from a distance, allowing people seeking health services to stay home. Telehealth might include patient assessment, health training, health monitoring, mental health consultations, and more. Telepsychiatry helps patients receive mental health services electronically from a distant location.
Remote health visits are especially important to protecting public health during an infectious disease outbreak, of course, but they are also helpful outside of pandemics.
Telehealth has been around for decades. In the late 1950s and early 1960s, clinicians from the Nebraska Psychiatric Institute and Norfolk State Hospital used a closed-circuit television link for psychiatric consultations.
In the years since, technological advances in both software and hardware have made telehealth easier, more reliable, and more secure. A number of specialties within healthcare now use telehealth for pharmacy services, chronic care management, telestroke services, tele-ICU tools, diagnostic screening, specialty medicine consults, sleep disorders, opioid use disorders, and telepsychiatry.
The use of telehealth has grown rapidly. About 76 percent of hospitals used telehealth in 2017, according to the American Hospital Association, up from 35 percent in 2010. COVID-19 has further accelerated the adoption of telehealth in neurology, psychiatry, pulmonary critical care, and other specialties in the inpatient and outpatient space. While increasingly popular, telehealth is still uncharted territory for many doctors, clinics, hospitals, behavioral health counselors, and intellectual and developmental disabilities providers.
Barriers to telehealth have included restrictions on coverage provided by Medicare or other payers, licensure and regulations, inadequate broadband service, lack of leadership in the development of telehealth services, decentralized departments, high cost of technologies, inadequate considerations of user experience and clinician workflows, and evolving measures of success and key performance indicators.
The Centers for Medicare and Medicaid Services (CMS) is making it easier for organizations to access telehealth temporarily amid the COVID-19 public health emergency. CMS adapted its reimbursement policy to hinder community spread of the virus. Even as more people are embracing the option, uncertainty about using a telehealth or telepsychiatry program prevents many clinicians from connecting with their clients remotely.
Many struggle to determine the best way to implement a working, secure, and cost-effective means of providing telehealth services. The following best practices can help psychiatrists and other doctors integrate telehealth and telepsychiatry into their menu of patient services.
Strategies for Integrating Telehealth and Telepsychiatry
1. Assess your current systems
In many respects, psychiatrists, nurses, physicians, counselors, social workers, and other healthcare practitioners already engage in telehealth with patients through emails, phone calls, online lab results, and more. Assess your clinic’s electronic health record (EHR) system to determine its ease of use in a telehealth system. Find out if your existing system allows staff providing services to access EHR information remotely. Using technology that is already in place can save money and prevent service providers, clients, and others from having to learn completely new systems.
2. Launch a pilot program
If time allows, pilot programs can help you evaluate the effectiveness of telehealth and test how well patients and providers like it before investing time and money into a system.
For best results, teach your staff how to work the system prior to starting the pilot. Track and document the positive and negative feedback from those enrolled. Gather information, such as peak usage times, service delivery issues, and other challenges.
To ensure a smooth deployment of the new telehealth system, expand the pilot to include other departments, using the same protocols established during the trial.
In the midst of a crisis situation like COVID-19, however, you may not be able to pilot your system and obtain feedback from early adopters before deploying it.
3. Prioritize use cases
Prioritizing use cases helps patients reach the right departments to address their needs. Telehealth systems can use tools, such as drop-down menus in user portals, to ensure proper routing. Vendors can provide software solutions for prioritizing use cases.
Targeted routing helps patients feel comfortable sharing information on the telehealth portal. This is particularly important in telepsychiatry, given the sensitive nature of mental health care.
4. Create routine workflows
Prioritization requires the creation of routine workflows and predetermined responses. Flow charts, graphs, and other visual aids can help direct conversations and consultations and improve the experience for patients using the system.
5. Provide training
At the start, train employees to use the new telehealth and telepsychiatry system. You will also need accessible and easily mastered training for patients, with knowledgeable staff ready to assist. Setting up proper training and support documents, such as frequently asked questions, will improve the user experience for staff and patients. Well-trained users also improve the system’s cost-effectiveness.
While you may ultimately end up with a focused telehealth or telepsychiatry team, cross-training creates an opportunity for other employees to take on telehealth duties during peak demand in situations such as the COVID-19 pandemic.
Moving forward, telehealth can help patients and caregivers stay connected. Implementing telehealth for behavioral health services can help your practice meet immediate and future needs for remote engagement.