Question 1

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 2

I need a psychologist

Accepted Answer

If you are an administrator seeking services for your healthcare organization or facility, please contact us through our website,https://www.orbithealth.com/contact-us/  However, if you are a patient seeking services for yourself or your family/friend, we 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.

Question 3

How does telepsychiatry work for forensic evaluations?

Accepted Answer

Identify a small, confidential area in your forensic setting that has internet access, a desk, and a chair. We will place a video screen there and provide psychiatrists via high quality videoconferencing technology. We can use the facility’s existing computers or devices to stream a connection over a web-based telepsychiatry platform.

Alternatively, we can provide a portable device that is dedicated to telepsychiatry and is always on. The technologies we use are specifically designed for telehealth encounters and are HIPAA-compliant.

When the subject of the forensic evaluation is ready to be seen, our telepsychiatrist will appear on the screen to conduct an expert evaluation. Forensic evaluations can be recorded if given permission from the subject’s attorney or by direction of the judge presiding over the case. Otherwise, the session will not be recorded. After the session(s), the telepsychiatrist will prepare his/her forensic report.

**Contact Orbit Health to Get Connected to a Qualified Expert Witness Today:** If you have a pending legal matter that would benefit from advice, opinion or testimony from a qualified psychiatric expert, you do not need to rely on whoever happens to be located nearby.  It does not matter if there are no such experts in your area.  Orbit Health will connect you with a qualified, professional, and effective forensic psychiatric expert, transmitted to any location that has internet access.  [Reach out to Orbit Health](https://www.orbithealth.com/contact-us/) to discuss your options for telepsychiatry today.

Question 4

How can forensic telepsychiatry help your case? Which forensic issues?

Accepted Answer

In many cases, forensic evaluations and testimony can be accomplished remotely via videoconferencing. Forensic telepsychiatry makes sense, and it saves time and money. Attorneys and judges are increasingly accepting of the concept of forensic telepsychiatry as a convenient and effective way to utilize expert testimony.

Orbit Health can provide teleforensic experts to help sort through the following forensic issues:

* **Competency to Stand Trial.** In matters involving criminal defendants or other parties who lack mental capacity, a forensic psychiatrist can evaluate whether the party possesses the mental faculties necessary to stand trial on their own behalf.
* **Insanity Defense/ Criminal responsibility.** Crimes of passion often turn on the mental state of the defendant.  A forensic psychiatrist can evaluate whether a defendant possessed the mental capacity to understand the consequences and morality of their actions, or whether they should be subject to a lesser penalty or alternative treatments instead.
* **Civil Commitment/ Involuntary treatment.** Forensic psychiatrists evaluate whether individuals could pose a danger to themselves or others in order to inform a court’s decision as to the wisdom and morality of involuntary commitment to a psychiatric institution. A remote telepsychiatrist can perform an evaluation of an elderly or disabled individual and offer an opinion as to their mental capacity.  Such opinions form the basis of whether an adult or elderly person should be placed under the legal care of another.
* **Competency to Make Treatment Decisions.** End of life care is complicated at the best of times.  When an injured or ill person appears to lack the ability to make competent decisions about their own health, it is important to have a psychiatrist evaluate their mental faculties and their emotional state.  This can be accomplished remotely via telepsychiatry, wherever the patient is located.
* **Worker’s Compensation and Torts.** Injured parties, whether they suffer a physical injury, a psychological injury, or both, require expert evaluation and testimony to prove or disprove their case.  A forensic telepsychiatrist can evaluate the extent of their injuries and the emotional trauma connected thereto. Forensic psychiatrists can provide vital insight and opinion as to whether an injured worker possesses the capacity to return to work or should instead qualify for disability benefits.
* **Violence Risk Assessment.** Judges often rely on forensic psychiatrists to evaluate the propensity of a defendant for violent action when deciding upon bail.  With telepsychiatry, your defendant will have access to the most qualified and most neutral evaluation in order to ensure that the principles of justice are not violated.
* **Child custody and visitation.** Child psychiatrists can play a vital role in determining the healthiest placement for children of divorce.  With Orbit Health, the best child psychiatrists can be brought in remotely for an unobtrusive evaluation and opinion.
* **Psychic injury.** A forensic psychiatrist can remotely evaluate a plaintiff following a traumatic event to establish the extent of their emotional trauma and provide an expert, reasoned opinion as to the severity of their psychic injury, all without the expense of flying a medical professional to your location.
* **Mental disability.** Disability is available for mental and emotional disorders as well as physical ailments.  Telepsychiatrists can remotely evaluate applicants regarding whether they are capable of working or should instead receive disability benefits.
* **Malpractice cases often turn on the credibility of each side’s expert:**  Was the medical professional’s conduct appropriate, or did they violate standards and norms?  With telepsychiatry, the strength of your expert opinion will not depend solely on which licensed psychiatrists simply happen to be in your region.
* **Juvenile justice.** Experts are often employed in cases involving juveniles to establish the mindset and maturity of juvenile defendants and opine on whether they should be tried as adults
* **Other issues:** Probate/ Testamentary Capacity/ Undue Influence; Defense Base Act (workman’s comp for military contractors); Sentence Mitigation;  Personal Injury;  PTSD;  TBI (traumatic brain injury); IME (Independent Medical Examinations);  Fitness for Duty;  Sexual Assault; Sexual Harassment; Immigration (Asylum, Trafficking T-Visa, VAWA);  Intoxication/ DUI/ DFSA (Date Rape); Suicide

Question 5

How can Orbit Health provide COVID-19 psychiatry services?

Accepted Answer

Identify a small confidential area accessible for clinical use. All you really need is internet access, a desk, and a chair. We will place a video screen there and provide psychiatrists via high quality videoconferencing technology. We can use your existing computers or devices to stream a connection over a web-based telepsychiatry platform. Alternatively, we can provide a portable device that is dedicated to telepsychiatry and is always on. The technologies we use are specifically designed for telehealth encounters and are HIPAA compliant. Clinical encounters are not recorded.

When the patient is ready to be seen, our telepsychiatrist will appear on the screen to provide expert clinical care. After the session, the telepsychiatrist will submit the clinical documentation directly into your electronic health record.

What are the advantages of Orbit Health Telepsychiatry?

* Providing telepsychiatry staff with expertise and training in COVID-19 and mental health
* Providing psychiatric medication management and psychotherapy
* Participating in treatment team meetings and consultation with onsite staff
* Increasing patient satisfaction
* Improving patient outcomes
* Reducing costs of recruiting, hiring, managing and retaining onsite staff

Question 6

Has research been done to prove forensic telepsychiatry works? What’s the evidence base?

Accepted Answer

Yes, telepsychiatry has been comparable to in-person care among inmates in jail, prison, and correctional facilities. Video visits with telepsychiatric evaluations are used used to treat inmates with a variety of psychiatric illness in a range of severity, including severe mental illness. Decades of studies demonstrates telepsychiatry’s usefulness.

Vacancies and staffing issues in correctional facilities can impact access to care. Physical space requirements, security requirements, and correctional work culture pressures discourage healthcare providers from working in the correctional facility environment.

Telepsychiatry fills these vacancies, can ease burden on clinicians and providers, and takes less physical space than having more personnel on-site.

With the adoption of telepsychiatry, inmates can be seen early in their incarceration. Patient satisfaction has been shown to be high in forensic psychiatric patients with remote video visits. Acceptability has additionally shown to be high amongst jail personnel.

A meta-analysis — a study of multiple studies — looked at telepsychiatry used in acute settings, including inpatient units. They showed that the quality of clinical interaction is similar to in-person face-to-face encounters, and that telepsychiatry has been cost-effective.

Sources:

* Kaftarian, Edward. "Lessons Learned in Prison and Jail-Based Telepsychiatry." Current psychiatry reports 21.3 (2019): 15.
* Salmoiraghi A, Hussain S: "A Systematic Review of the Use of Telepsychiatry in Acute Settings" Journal of Psychiatric Practice. 2015; 21 (5):389-93
* Brodey et al, 2000. Satisfaction of forensic psychiatry patients with remote telepsychiatric evaluation. Psych Services: Oct 51(10): 1305-7.
* Leonard S: "The Successes and Challenges of Developing a Prison Telepsychiatry Service" Journal of Telemedicine and Telecare. 2004; 10 (S1): 69-71
* Zaylor C, Whitten P, Kingsley C: "Telemedicine Services to a County Jail" Journal of Telemedicine and Telecare. 2000; 6 (S1): 93-95

Question 7

Can medication be prescribed via telepsychiatry?

Accepted Answer

Yes.  Our licensed psychiatrists are able to prescribe medications for patients they diagnose and treat remotely.  Our providers will write and sign the prescriptions, which can then be transmitted to the clinic for local fulfilment.

Question 8

What services does Orbit Health offer?

Accepted Answer

Orbit Health offers all of the key psychiatric services to all 50 states.

Weekday, weekend, on-call, overnight, flexible, subspecialty care, consultation, remote medical director.

* **Community outpatient & inpatient services:** Orbit Health provides telepsychiatrists to your ED via high quality videoconferencing technology. To the patient, this is no different than having an onsite psychiatrist. The doctor reviews the medical record, meets with the patient, and submits the clinical documentation directly into your electronic medical record. [Read More](https://www.orbithealth.com/telepsychiatry-services/outpatient-and-community-clinics/)
* **Addiction Treatment Centers:** Telepsychiatrists are made available to clinics and residential treatment programs. Face-to-face appointments with patients happen virtually, and will look and feel almost identical to in-person appointments. The telepsychiatrists are also available to consult with other members of the treatment team via videoconference. [Read More](https://www.orbithealth.com/telepsychiatry-services/addiction-treatment-centers/)
* **Emergency Departments & Crisis Centers:** Orbit Health provides telepsychiatrists to your ED via high quality videoconferencing technology. To the patient, this is no different than having an onsite psychiatrist. The doctor reviews the medical record, meets with the patient, and submits the clinical documentation directly into your electronic medical record. [Read More](https://www.orbithealth.com/telepsychiatry-services/emergency-departments-and-crisis-centers/)
* **Skilled Nursing Facilities & Assisted Living:** Orbit Health provides telepsychiatrists at the patient’s bedside via high quality videoconferencing technology. From the patient’s perspective, there is little difference between an appointment with an onsite psychiatrist and that of a telepsychiatrist. The doctor reviews the medical record, meets with the patient, and submits the clinical documentation directly into the electronic medical record. [Read More](https://www.orbithealth.com/telepsychiatry-services/skilled-nursing-facilities-and-assisted-living/)
* **Forensic Telepsychiatry Services:** In many cases, forensic evaluations and testimony can be accomplished remotely, via videoconferencing. Forensic telepsychiatry makes sense, and it saves time and money. Attorneys and judges are increasingly accepting the concept of forensic telepsychiatry as a convenient and effective way to utilize expert testimony. [Read More](https://www.orbithealth.com/telepsychiatry-services/forensic-telepsychiatry-services/)

Question 9

Why choose Orbit Health for your correctional facility?

Accepted Answer

Orbit Health is different from other telepsychiatry companies because Orbit Health's primary mission is to [end the cycle of mass incarceration of the mentally ill.](https://www.orbithealth.com/telepsychiatry-services/correctional-care/cycle-of-mass-incarceration-of-the-mentally-ill/)   Led by the world’s leading experts and pioneers in correctional telepsychiatry, Orbit Health has specialized knowledge, skill, and experience to provide the finest quality of services to jails, prisons, juvenile detention centers, and forensic hospitals.

Many correctional settings struggle to meet State and Federal mental health care mandates, often due to limited psychiatric resources.  Patients behind bars struggle to achieve psychiatric stability, making it difficult to function in these settings and leading to worsening outcomes, such as rules violations and enhanced sentences.  Time and again, Orbit Health has improved access to care while reduced patient backlogs, thereby helping facilities function safely and efficiently.

Orbit Health's goal is to ensure patients attain stability before, during, and after incarceration in order to achieve success in any setting.  Mental and emotional stability reduces the rate of recidivism, and nobody in the world does this better than Orbit Health.

If you are looking for correctional telepsychiatry services for your facility, or you are a provider looking for a job opportunity in corrections, [contact Orbit Health today](https://www.orbithealth.com/contact-us/)!

Question 10

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](https://mobile.va.gov/sites/default/files/vamobile-discussion-series-202009-slides.pdf) that will contact patients, discuss their needs, and send them telehealth equipment such as Apple iPads with wireless services.

Comcast offers [Internet Essentials](https://internetessentials.com), 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](https://www.fcc.gov/lifeline-consumers), 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](https://www.safelinkwireless.com), [Assurance Wireless](https://www.assurancewireless.com), [TruConnect](https://www.truconnect.com) provide wireless devices, hotspots, and accounts.  States such as California implement Lifeline as [Your Call Wireless](https://yourcallwireless.com/lifeline/), providing phone services and cell phones.

Finally, large commercial organizations such as [T-mobile](https://www.t-mobile.com/offers/lifeline-program), [Verizon](https://www.verizon.com/solutions-and-services/lifeline/), and [AT&T](https://www.att.com/home-phone/lifeline/) offer Lifeline services.

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