Question 1

How can Orbit Health help your forensic evaluations?

Accepted Answer

Orbit Health brings qualified expert witnesses directly to your conference room and courthouse.

Many legal matters, both civil and criminal, turn on the opinions offered by expert witnesses. Whether a case involves the damaging effects of personal injury, the reasonableness of a medical professional’s diagnosis and treatment, or the proper operation of a piece of complicated machinery, expert opinions often form the backbone of each party’s arguments to the judge and jury. Experts in the field of forensic psychiatry, in particular, are necessary for a wide variety of legal matters.

Not every jurisdiction has access to every type of expert, however.  Some parties and some matters cannot justify the expense of flying a medical professional thousands of miles to draft an opinion and testify. Moreover, with limitations imposed during the COVID-19 coronavirus pandemic and other natural disasters, it can be difficult, if not impossible, to bring an expert to the locale where a matter is taking place. Thankfully, with the use of telecommunications, you can now bring the expert to your conference meeting or courtroom immediately, efficiently, and with much less cost.

Orbit Health connects the best and brightest forensic psychiatric specialists from around the country to litigants in need of expert opinions and testimony, no matter their location, without all the extra expense and complication of travel.

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 to discuss your options for telepsychiatry today.

Question 2

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 3

How do you prescribe long-acting injectables via telepsychiatry?

Accepted Answer

Prescribing long-acting injectables (LAI) is similar to that of prescribing any medication — determine the dose, frequency, and applicable dispensing location.

Many clinics and work settings allow you to arrange for the long-acting injectable to be provided at another clinic site or nursing site. For instance, the [Veterans Affairs' telehealth system](https://telehealth.va.gov) allows a prescriber to order the medication, and request nursing support at a specific clinic, through their electronic health record.

According to the [Pharmacy Times](https://www.pharmacytimes.com/publications/specialty-pharmacy-times/2019/2019-Asembia-Recap/New-Frontiers-for-Pharmacists-Administration-of-Long-Acting-Injectable-Antipsychotics), as of 2019, pharmacists can provide vaccinations in all 50 U.S. states and the District of Columbia. Only 44 states allow pharmacists to give long-acting injectable medications. Calling your pharmacy for options can help clarify what services are available.

And, according to the [National Community Pharmacists Association](https://ncpa.org/administration-long-acting-anti-psychotic-injectable), industry programs from pharmaceutical manufacturers of long-acting injectable atypical antipsychotic medications — such as Invega Sustenna — can help determine which locations can administer such medications. Recognized "Injection Centers" are networks of pharmacies and healthcare facilities that help provide these injections.

Question 4

Should groups be based on demographics, location, culture, or perhaps topic-focused?

Accepted Answer

The more group members have in common, the easier it is for them to develop bonds.

However, in today's world, there are so many ways you can categorize people.  People of the same race may have vastly different attitudes and values, for instance.

But more than anything else, people bond over shared experiences.  Also, people with different mental conditions may have great difficulty relating to each other, even if they share the same culture or race. Thus, it is important that a group be focused on a specific mental health condition.

Question 5

Is telepsychiatry appropriate for inpatient settings?

Accepted Answer

Telepsychiatry has been utilized in a variety of inpatient units with success and is an acceptable mode of delivering care in these settings.  Both government and corporate health care organizations have embraced telepsychiatry for this purpose.  In the early days of telepsychiatry, some administrators and providers were hesitant or skeptical about using telepsychiatry for inpatient units.  Reasons given were mostly a subjective and vague concern about the ability of providers to appropriately care for severely ill patients without being on site, in person.

However, in recent years, as telepsychiatry has become more widely adopted, those concerns have diminished.  Those who have experience with inpatient telepsychiatry have come to understand that providing care in this way is not substantially different that how it would be provided in-person.  In fact, there are several advantages of telepsychiatry over onsite psychiatry in the inpatient unit:

* Telepsychiatry allows inpatient units in underserved and rural areas to be adequately staff
* Telepsychiatry allows the provider to work from the comfort of his home, rather than being forced to sit for long hours under fluorescent lights within a noisy, musty and uncomfortable inpatient unit.  
* Telepsychiatry gives providers opportunities to create any variety of schedule that works best for their lifestyle, including working during odd hours, weekdays, nights, part time, or full time.  With telepsychiatry, shifts can more easily be modified and swapped to fit the needs of the providers. 
* Telepsychiatry allows the inpatient unit to supplement staff easily and efficiently.  This is especially useful when facilities are running short on staff due to illness, surges in patient volume, or any other factors. 
* Telepsychiatry allows for 24/7 coverage of inpatient units, which is often hard to do when relying solely on in-person onsite coverage.

**The Importance of Effective Communication:** 
Effective communication is important in virtually any healthcare setting, and inpatient telepsychiatry is no different. Communication between the telepsychiatrist and members of the inpatient treatment team allows optimal coordination of patient care.  This includes:

* Reviewing the treatment plan
* Reviewing progress of the patient toward discharge goals
* Addressing urgent and emergent patient issues
* Relaying factors on the unit which may affect patient experience.  For example, excess noise from other patients, physical plant issues (like plumbing or electrical issues in the unit), overcrowding on the unit, or hostile patients that are disrupting the environment for other patients.
* Oftentimes, the way a patient presents to the psychiatrist may be different than how they behave on the unit.  It is helpful for the psychiatrist to know how the patient is doing both on and off camera.

Efforts should also be made to establish adequate communication between the telepsychiatrist and the patient.  Although communication with a severely mentally ill person can often be challenging, the telepsychiatrist should try to involve the patient in the treatment goals and plans as well as answer any patient questions and concerns.

**What about paranoid and psychotic inpatients?  Are they appropriate for telepsychiatry? **

There is no absolute contraindication for telepsychiatry and virtually any mental health condition can be treated via telepsychiatry.  However, there are certain clinical situations where a patient's mental status or condition may require that arrangements are made for onsite psychiatric care.  For more information, please see the article ["Are psychotic patients appropriate for telepsychiatry?"](https://ask.orbithealth.com/faqs/are-psychotic-patients-appropriate-for-telepsychiatry)

In summary, telepsychiatry is an appropriate and effective way to provide care to inpatient facilities, especially when there is good communication.

Question 6

What is the standard of care for telepsychiatry and/or telemedicine?

Accepted Answer

What is the Standard of Care for Telepsychiatry?

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 may have its own opinions about standards of care for telehealth and multiple jurisdictions can potentially apply.  In some, but not all states, the state medical board has language that states that standard of care for telemedicine is considered the same or similar to in person care.

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.

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 7

Is special software and training needed?

Accepted Answer

When you contract with Orbit Health, we will provide your medical practice with all of the software and training necessary to implement our telepsychiatry services.  The process is simple and requires very little setup.

Question 8

I need a psychiatrist

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.

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