The ABCs of Telepsychiatry

Telepsychiatry is a form of videoconferencing that can provide psychiatric services to patients living in remote locations or otherwise underserved areas.¹ Services include diagnosis and assessment, medication management, individual and group therapy, and consultations between psychiatrists and other health care providers.¹ Indeed, “telemental health” is “one of the most active applications of telehealth rendered in the United States.”²

POLL: Would You Recommend Telepsychiatry?

A growing evidence base supports the use of telepsychiatry,³ which has demonstrated effectiveness in an array of settings, populations, and age ranges⁴ and a variety of treatments and conditions (eg, anger management,⁵ autism, posttraumatic stress disorder,³ and schizophrenia⁶.) Additionally, telepsychiatry is cost-effective. For example, one study found it to be at least 10% less expensive per patient than service provided face to face.⁷

How is Telepsychiatry Delivered?

Telepsychiatric services can be delivered through many media, including asynchronous or social relationship environments, electronic mail, remote monitoring devices (eg, home telehealth store and forward technology), chat rooms, and other Internet-based formats.² Videoconferencing is one of the most established and studied modes of delivery and is the subject of a recent article titled “Telepsychiatry: Videoconferencing in the Delivery of Psychiatric Care.”³

Administrative Issues in Telepsychiatry

According to the author, telepsychiatry raises a unique set of administrative issues.

• Jurisdiction: A psychiatrist must hold a medical license in the state where the patient is located during the telepsychiatric visit and be familiar with state regulations concerning the presence of medical staff with the patient, written consent for the use of telemedicine, or requirement for face-to-face visits. It is also important to ascertain rules of payers (eg, state Medicaid plans) and other licensing bodies (eg, the Drug Enforcement Agency).
• Malpractice: Psychiatrists should inform their malpractice carriers of their intent to practice telepsychiatry, and be familiar with its telemedicine guidelines.
• Credentialing: Psychiatrists working within health care systems should follow the guidance of the appropriate oversight body.
• Electronic records: Providing telepsychiatric services across health care systems necessitates familiarity with the ownership and sharing of medical records between providers.
• Technical requirements: A transmission speed of 384 kilobytes per second is considered to be the minimum acceptable bandwidth for videoconferencing.
• HIPAA compliance: The videoconferencing system must be compliant with federal and state privacy requirements, which require encryption of all electronic protected health information.
• Room configuration: Size of the room, lighting, angle, distance of videoconferencing equipment, types of camera controls, and backdrops play an important role in appropriate videoconferencing. Recommendations can be found in the “Telemental Health Guide.”⁸
• Written protocols should address issues such as how patients obtain laboratory tests, schedule appointments, receive prescriptions, and how care is coordinated with other providers.