Question 1

Can you get reimbursements for video devices for patients who don't have a computer or smartphone?

Accepted Answer

Getting reimbursements for video devices vary depending on your work setting. Look to your workplace's patient support services, local and state government funding programs, and federally-supported services.

Federal government agencies — such as the Veterans Health Administration (Veterans Affairs, or VA) — have instituted a "Digital Divide" consult that will contact patients, discuss their needs, and send them telehealth equipment such as Apple iPads with wireless services.

Comcast offers Internet Essentials, with affordable high-speed Internet wifi, a discounted laptop or desktop computer, for those who qualify for their low-income program.

The federal government has Lifeline, a "discount on monthly telephone service, broadband Internet service, or bundled voice-broadband packages purchased from participating wireline or wireless providers." Service providers like SafeLink Wireless, Assurance Wireless, TruConnect provide wireless devices, hotspots, and accounts. States such as California implement Lifeline as Your Call Wireless, providing phone services and cell phones.

Finally, large commercial organizations such as T-mobile, Verizon, and AT&T offer Lifeline services.

Question 2

I need help.

Accepted Answer

If you are an administrator seeking services for your healthcare organization or facility, please contact us.

However, if you are a patient seeking services for yourself or your family/friend, Orbit Health cannot provide care directly to you. If this is a medical or mental health emergency, please call 911 or go to an emergency room immediately.

Immediate help

Get immediate help through MentalHealth.gov's Immediate Help page.
If you or someone you know is suicidal or in emotional distress, contact the National Suicide Prevention Lifeline. This service is available 24 hours a day, 7 days a week. Staffed by trained crisis workers.
Are you a veteran in crisis? The Veterans Crisis Line is available 24/7 — by phone, text message, and online chat.

Learn more

Find out how to get help at MentalHealth.gov
Find a psychiatrist, and learn more about psychiatric topics, at the American Psychiatric Association
Learn how to find mental health help at Mental Health America

Question 3

Does working for the federal government allow you to see patients via telepsychiatry, wherever you are?

Accepted Answer

Working for the federal government does not necessarily allow you to see patients via telepsychiatry, wherever you are. While there are no absolute contraindications to patients being assessed or treated using telemental health, you have to check with your supervisor — and any applicable administrative rules and trainings — for these rules.

Ask your supervisor about federal telework agreements, contingency plans for persons who appear in-person or who are unable to connect by video, and whether support staff are available to guide your patient in case of an outage.

Furthermore, telemedicine requires you to know which state a patient is located. You would need to follow that state's licensing laws and regulations. Usually, this means you must have a license to practice in that patient's state, have malpractice cover your practice in that state. Some states allow for a single state license to cover multiple states — the Interstate Licensure Compact, for instance — but not all states participate in this.

Resources, such as the American Medical Association Telehealth quick guide, can help you determine which laws apply.

Question 4

What's the standard of care for telepsychiatry, compared to in-person care?

Accepted Answer

Telehealth is increasingly being adopted by providers, patients, hospitals, and clinics as a great way of providing access to much needed healthcare. Policymakers and lawmakers have generally fallen behind the current practice and therefore there can be some uncertainty around what standard of care should apply.

Moreover, “Standard of care” can be subject to interpretation based on several factors, including, but not limited to:

Specialty or subspecialty, as it relates to the scope of practice of the provider Circumstances of the care Community in which care is being provided. Notably, the applicable community is debatable in telehealth, as the doctor and patient care are in different geographic areas.

The prevailing opinion in telehealth circles is that the standard of care should be based on the location where the patient is located, however, this is not a hard and fast rule. Each state has its own opinions about standards of care for telehealth and multiple jurisdictions can potentially apply.

As a provider, the best way to think about standard of care is to do what a reasonable and prudent provider do in similar circumstances. Reasonable and prudent care often depends on several components, such as:

Patient case factors- although there are no absolute contraindications for telehealth, in rare cases the patient might object to the use of the technology for reasons such as paranoia/fear about being recorded or the technology being hacked, or difficulty keeping themselves in the frame of the camera due to cognitive issues. Also, if the patient is intellectually disabled and does not understand what is going on, perhaps thinking that they are watching TV.
Setting to which care is being delivered- the environment is noisy, distracting, or not private, this can affect the quality of care provided.
Types of technologies being used- if the technology does not allow adequate audio or video, this brings down the quality of assessment and treatment.
Overall framework in which care is being provided- If telepsychiatry is conducted in the absence of other potentially important support for the patient.
Consent- consent requirements are determined by each state. Some states require specific verbal or written consent from the patient to conduct appointments via telehealth. Others do not have this requirement or have not opined on it.
Limitations around AIMS testing. There are ways to conduct AIMS testing remotely, although the provider should be cognizant of potential limitations and this should be factored in the standard of care.

Telepsychiatry, more so than other specialties of telehealth, offers almost the same level of services as onsite psychiatry. Therefore, the standards of care should be considered very similar. In fact, some state medical boards (such as the Medical Board of California) make it clear that the standard of care is the same.

In reality, what a psychiatrist can do remotely may vary somewhat from what can be done in person. For example, a psychiatrist examining a patient remotely through video cannot physically touch the patient to assess for physical conditions such as cogwheel rigidity. In these cases, psychiatrists rely on onsite staff or other ways of obtaining a reasonable amount of information to make a diagnosis and adequate treatment plan.

Ultimately, standards of care can be interpreted in a variety of ways, and telehealth makes it even more vague and sometimes confusing. Therefore, the provider should use their best judgment, considering clinical factors, their means to resources, and the overall nature of the care being provided.

Disclaimer- this article is our best effort to provide useful information and does not constitute legal advice. Please make sure to consult with entities such as state medical boards, their malpractice carrier, and potentially legal counsel prior to practicing healthcare.

Question 5

How do you optimize internet speeds, audio and video?

Accepted Answer

Internet Speed: Anyone can test the bandwidth by going to websites like speedtest.net. Upload speeds of over 3mps are generally effective if there are not a whole lot of other programs running on the computer. However, it’s probably best to shoot for higher speeds and your internet service provider can give you options. If you can afford it, its best to have the highest speeds the company can offer. Also, ask for “dedicated bandwidth” which some companies offer that prevents your neighbors internet usage to bring down your own bandwidth. Also, keep in mind that other devices running in the same household can hog up bandwidth and reduce the quality of the telehealth connection.

Computer: Most computers these days have enough power for videoconferencing. However, computers that have a minimum of 8 gigs of RAM and I7 processors provide a more reliable videoconferencing experience (you might be able to get away with using an I3 or I5 processor, but this sometimes results in a slow computer response).

Video: Most (but not all) computers these days have cameras that are adequate for videoconferencing. If your computer does not have a good camera, webcams can be purchased cheaply ($50-100). While 720p video mode (“HD ready”) may be adequate, it is helpful to have a 1080p resolution (High Definition).
While video is important, appointments are more often impacted by poor audio. Oftentimes, people run audio through their computers which is hit or miss. For a better quality of audio, you can purchase a microphone/speaker combination device which can be plugged into the USB port of your computer. This will make audio clearer and filter out background noise.

It is a good idea to do a test run with the patient, clinic, or hospital, prior to the appointment to determine what equipment is being used and to experience the quality of the videoconferencing appointment. Look to make sure there is no pixilation, freezing, graininess, or blurry video. Make sure the video and audio are in sync--- in other words, the audio is not lagging behind the video. Make sure that the audio is clear and that you can easily understand what the other person is saying. Both parties (patient and doctor) should be able to talk at the same time and still hear each other if the audio is working correctly.

Paying attention to and optimizing the quality of video and audio will improve the telehealth experience for everyone.

Question 6

Why are mental health problems pervasive in correctional facilities?

Accepted Answer

There is a growing scientific consensus that proper mental health care is one of the most important parts of rehabilitation for incarcerated individuals. Mental health treatment is one of the most effective components in reducing the likelihood of repeat offenses. Although mental health disorders are neither a necessary nor a sufficient factor in either criminal activity or violence, mental health issues undoubtedly contribute to the likelihood of running afoul of the law.

In the United States, there are more mentally ill people in correctional facilities than there are in mental health hospitals. Many criminal offenders struggle with mental illness and wind up in a correctional facility, and many incarcerated individuals develop psychological conditions as a result of their confinement. The rate of mental illness in prisons may be as high as two to four times greater than in the general public.

Providing proper mental health services to people in jails, prisons, halfway houses and other facilities helps everyone. Inmates get the psychiatric care that they need to become more productive members of society. In addition, the risk of suicide and other dangers can be mitigated, and healthy inmates are less likely to be involved in altercations with guards or other inmates while incarcerated.

By giving your correctional facility access to telepsychiatry, you can provide the mental health care that your inmates both need and deserve, without incurring the risk, inconvenience, and cost of either transporting inmates to treatment centers or transporting mental health professionals to your institution.

Question 7

Do you see group therapy sessions on the horizon for telepsychiatry?

Accepted Answer

Most forms of mental health treatment can be equally effective as in person care, including group therapy. Remote group therapy has been slower to take hold than one-on-one care given by psychiatrists and mental health clinicians. However, as the world continues to embrace telehealth, group therapy is anticipated to become more prevalent.

Question 8

How can I improve the telehealth experience for those with hearing difficulties or who are deaf?

Accepted Answer

You and your team may treat persons who have hearing difficulties, whether they are hard of hearing or death. Consider the following in your workflow, such as involving staff to troubleshoot audio quality, involving a sign language interpreter, and sharing your screen:

Check to make sure if the patient is understanding you. Have them repeat back what you said from time to time.
If you have a telepresenter (a staff member on the patient side), they can tell you if its poor audio quality or if its good quality but the patient just can’t hear you because of their impairment. You can have the telepresenter repeat your words to the patient during your appointment.
If the patient knows American Sign Language, you can easily include an ASL interpreter into the videoconferencing session as part of a group chat.
Type out what you want the patient to know and screen share it with them. Make sure to use a big text so they can easily see the words. You can put your words in a Word document or the like, then click screen share. Problem solved!
If all else fails, arrange for the patient to be seen in person. Usually this is not necessary as there are so many ways to ensure good quality of audio. These days, audio via technology should not differ much from the audio in person.

Check out our full post on "Telepsychiatry for the Hearing Impaired – Top 10 Tips."

Question 9

How can a provider start a telepsychiatry practice?

Accepted Answer

To start a telepsychiatry practice, you must be licensed by the state to practice, and meet the requirements of your practice. Ideally, you would have board certification in psychiatry.

You'll additionally need broadband, a desktop computer such as a Mac or Windows PC, along with a webcam. Ideally, you can use a dedicated microphone and speaker headset, to maximize your audio.

You need to ensure you have the right software. You need to ensure you have an electronic health record, a prescription system, and ways to receive and send messages. Your videoconferencing setup -- whether it's Zoom, Google Meet, or Microsoft Teams -- needs to be HIPAA-compliant, and you would need a signed business associates agreement (BAA). While you could create a telemedicine service from scratch, there can be costs for telehealth implementation. Costs include human resources (HR) time, but also marketing, malpractice and legal, along with additional training time.

Finally, you can join an existing group, like Orbit Health. Orbit Health offers full-time and part-time positions in adult psychiatry (outpatient, inpatient, partial hospitalization, and more), child & adolescent psychiatry, community psychiatry, emergency & crisis psychiatry, and forensic psychiatry/health. Partnering with Orbit Health is a faster way to implement telepsychiatry services than building your own services from scratch. Orbit Health provides telepsychiatry for facilities across the United States, with board-certified physicians and nurse practitioners licensed in all 50 states.

Whether you enjoy working from home or on-site, Orbit Health has multiple positions for psychiatrists, nurse practitioners, and more! Here’s why people like working for Orbit Health — where you can tell us about your job interests and apply to work with us.

Question 10

How can I combat Zoom fatigue symptoms?

Accepted Answer

Videoconferencing and remote professional services are now a regular practice in many industries. However, these remote calls can lead to feelings of fatigue.

If you find yourself exhausted by all of the video calls in your life, here are a few tips:

Schedule “no meeting” blocks of time. Make sure there are parts of your day when you are away from a screen.
Avoid multitasking. When you are on a call, focus on the business of the call. Avoid pulling up a second window to read emails or conduct other work. Multitasking during calls leads to a loss of productivity and difficulty remembering what occurred in the meeting.
Limit the number of calls. Do what you can to cut down on your overall number of calls. Group calls with separate people or teams together where feasible and appropriate. If a video call is not actually necessary, resolve the issues via phone, email, or a collaborative document. Do not default to a video call for every type of meeting. If you are meeting a stranger for the first time, such as a networking connection, for example, video calls can feel personal and invasive; start with a phone call.
Take breaks. If your call lasts more than an hour, it is important to take breaks. Get up and walk around, use the restroom, get a glass of water. Everyone will have more energy and remain more productive as a result.
Turn off your self-view. Video call programs like Zoom default to displaying your own video as well as others on the call. Staring at your own face can be distracting and increase stress and anxiety. Hide yourself from your own view so you can focus on the other people on the call.
Limit on-screen stimuli. In addition to hiding your face and keeping other windows closed, do what you can to limit what you see on-screen. Encourage people to take calls in front of plain backgrounds instead of a room full of objects. Seeing five different rooms full of furniture can cause disorientation and increase mental fatigue.

Learn more in our complete article, "Videoconferencing Fatigue and What to Do About It."

The Ultimate Guide to Telepsychiatry

Most popular