Question 1

What is Zoom Fatigue, and why does it occur?

Accepted Answer

As the COVID-19 coronavirus pandemic continues into its second year, people have become accustomed to handling most or all of their personal and professional interactions remotely. Videoconferencing has become a normal part of daily life. Videoconferencing fatigue, now commonly called “Zoom fatigue” in reference to one of the most popular videoconferencing platforms, refers to the exhaustion caused by constant video calls.

While Zoom fatigue is not yet an official diagnosis, many psychologists state that the condition is both real and prevalent in the new pandemic era.

Constant video calls on any platform, including Google, Skype, Microsoft Teams, FaceTime, and other professional platforms can lead to fatigue. People can start to feel extra irritable, less energized, constantly “on the clock” for work, confused or awkward during meetings, and isolated even while communicating with others.

There are scientific reasons for these feelings. Video calls can make people feel like they are always “on.” People are hyper-aware of their appearance, their mannerisms, the sound of their voice, and they can begin to feel like they are “performing” in a way that is not true of in-person interactions. The silence on the other end of the line when people mute their microphones, delays in response time, as well as the added effort necessary to identify nonverbal cues via video chat, contribute to stress and fatigue as well.

Video calls from home also allow us to become easily distracted. When technology fails us--the WiFi goes out, someone’s camera or microphone fails to work, etc.--we can feel even more overwhelmed.

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

Question 2

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 3

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 4

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 5

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

Accepted Answer

Yes, telepsychiatry is comparable to in-person visits. In fact, studies have shown that telepsychiatry is effective for diagnosing mental disorders across ages — children, adults, and the elderly — and across ethnicities. Across studies, telepsychiatry has shown to provide clinical outcomes equivalent to face-to-face visits. Plus, across studies, diagnoses, and demographics, patients generally achieve improved symptoms and improved quality of life.

In fact, telepsychiatry has advantages over in-person care. Video visits increase access to a psychiatric practitioner, and can assist with collaborative care. Even those in rural communities and remote areas of the world — in other words, geographies with sparse populations — can access specialty care with the help of telepsychiatry.

Telepsychiatry is cost-effective. A study limited to the cost of providing clinical service has shown 10% reduction in cost per patient, when telepsychiatry was used versus in-person care. In the majority of studies, telepsychiatry is more cost-effective.

And both patients and providers are satisfied with telepsychiatry video visits. Patients feel they get along with their provider

Sources:

Hubley, S., Lynch, S. B., Schneck, C., Thomas, M., & Shore, J. (2016). Review of key telemental health outcomes. World journal of psychiatry, 6(2), 269.
Hilty DM, Ferrer DC, Parish MB, et al. The Effectiveness of telemental health: A 2013 review. Telemed J E Health 2013;(19):444-454.
Janca, 2000. Telepsychiatry: an update on technology & implications. Curr Op Psych 13: 591-7.
O'Reilly R, Bishop J, Maddox K, Hutchinson L, Fisman M, Takhar J. Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial. Psychiatr Serv. 2007;58(6):836-43.
Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and e-Health, 22(2), 87-113.

Question 6

What conditions are treatable through telepsychiatry?

Accepted Answer

Telemedicine allows for treatment of any condition that does not require physical presence to treat. Psychiatry is uniquely suitable for telemedicine practice. Therapy, counseling, diagnosis, and treatment for nearly every psychological disorder — whether related to mood, anxiety, cognitive functioning, substance dependency, etc. — can be conducted via telepsychiatric sessions.

Telepsychiatry has the added benefit of allowing for specialists to conference in from anywhere in the country, or even the world, meaning that you can treat more specific, more esoteric, or more exotic conditions as needed.

Question 7

Do I need specialized equipment for telepsychiatry?

Accepted Answer

In order to implement telepsychiatry, you need only a solid internet connection (DSL, cable, T1 or higher) and a device capable of videoconferencing. While a laptop or PC with a good web camera and microphone are preferable, a tablet or even a smartphone can work in a pinch for teleconferencing.

No specialized media equipment is necessary, although you can certainly set up a conference room for ideal communications with a larger group of people.

Question 8

Is telepsychiatry as effective as in-person sessions?

Accepted Answer

The psychiatric professionals at Orbit Health are among the best in the industry. They can provide clinical diagnoses, treatments, and effective outcomes, as well as increase community health in wellness, especially in underserved areas.

The lack of physical proximity does not inhibit our experts’ ability to diagnose and treat patients suffering from any number of psychiatric conditions. The level of privacy and confidentiality is the same as in-person care.

Research shows that telepsychiatry is just as effective as in-person, face-to-face care. Many patients, in fact, find that psychiatric treatment via videoconferencing is less intimidating or embarrassing. Patients, psychiatrists, and other professionals have all reported high levels of satisfaction with telepsychiatry since its inception.

Question 9

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 10

Where do patients receive treatment?

Accepted Answer

Patients can visit their local clinic, medical office, or hospital. Wherever you can set up a private space for video conferencing, patients can comfortably sit and engage with our mental health professionals.