Question 1

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 2

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).

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 3

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

Accepted Answer

Yes, children, adolescents, and families can benefit from telepsychiatry. In a variety of mental health conditions such as ADHD, autism, and OCD, studies have indicated that video visits are useful in accessing psychiatric specialists and improving symptoms.

In attention deficit hyperactivity disorder (ADHD) studies with telepsychiatry, for instance, improvement in hyperactivity and combined ADHD has been shown in hundreds of children in randomized clinical trials, combining video visits with child psychiatrists along with caregiver behavior, versus treatment with their primary care providers augmented with telepsychiatry consults. In autism, clinicians can use telepsychiatry videoconferencing for diagnosis & assessment. And, in obsessive-compulsive disorder (OCD), video visits reduced symptoms versus a waitlist control in a randomized clinical trial.

We additionally see video visits used to give behavioral parent training, with live therapists, showing treatment response and improvements in children ’s symptoms as well as easing of parental burden. Video visits can also help with parental coaching for children with autism, to help conduct home assessments, and for communication coaching.

The American Academy of Child and Adolescent Psychiatry provides expert guidance on how to deliver psychiatric services to this population, including optimizing clinical visits. This guidance is assembled by experts on the Committee on Telepsychiatry and the Committee on Quality Issues.

Sources:

Myers K, vander Stoep A, Zhou C, et al. Effectiveness of a telehealth service delivery model for treating attention-deficit hyperactivity disorder: results of a community-based randomized controlled trial. J Amer Asso Child Adolesc Psychiatry 2015;54(4):263-74.
American Academy of Child and Adolescent Psychiatry Committee on Telepsychiatry and the Committee on Quality Issues. Clinical Update for Telepsychiatry with Children and Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 2017;56(10):875–893.
Comer JS, Furr JM, Miguel E, Cooper-Vince CE, Carpenter AL, …Myers KM & Chase R. Remotely delivering real-time parent training to the home: An initial randomized trial of Internet-delivered Parent-Child Interaction Therapy (I-PCIT). Journal of Consulting and Clinical Psychology. 2017; 85 (9): 909–917.
Lee JF, Schieltz KM, Suess AN, Wacker DP, Romani PW, Lindgren SD, Kopelman TG, Padilla Dalmau YC. Guidelines for developing telehealth services and troubleshooting problems with telehealth technology when coaching parents to conduct functional analyses and functional communication training in their homes. Behavior Analysis Practice DOI 10.1007/s40617-014-0031-2; Published online 27 November 2014.
Myers K and Roth DE. Telepsychiatry with children and adolescents. In: Martin A, Volkmar FR, and Bloch MH (Eds), Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, 5th Edition. Wolters Kluwer, Philadelphia, 2018; Chapter 6.3.5.
Reese RM, Jamison R, Wendland M, Fleming K, Braun MJ, Schuttler JO et al. Evaluating interactive videoconferencing for assessing symptoms of autism. Telemedicine and J E Health. 2013;19(9):671-677.
Storch EA, Caporino NE, Morgan JR, Lewin AB, Rojas A, Brauer L et al. Preliminary investigation of web-camera delivered cognitive-behavioral therapy for youth with obsessive-compulsive disorder. Psychiatry Research. 2011;189(3):407-412.
Vander Stoep A, McCarty C, Zhou C, Rockhill CM, Schoenfelder E, Myers K. The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: caregivers’ outcomes. Journal of Abnormal Child Psychology. 2016; 45(1):27-43.

Question 4

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. 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!

Question 5

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 6

What is #endthecycle? Why provide mental health care throughout the legal system?

Accepted Answer

The sad reality is that jails and prisons have become the new asylums. According to the Treatment Advocacy Center, 383,000 individuals with severe psychiatric disease were behind bars in the United States in 2014- roughly equivalent to the size of the city of Cleveland, Ohio. It is tragic and unacceptable that many people who deserve mental health treatment are instead thrown behind bars where they are exposed to trauma and further deterioration.

At Orbit Health, we are determined to disrupt the cycle of mass incarceration of the mentally ill by inserting telepsychiatry at every stage of the criminal justice system. This ensures that people who are vulnerable to incarceration have access to the right care at the right time.

Why is it important to provide mental health care throughout the legal system? People who are in the active phase of a mental illness (psychotic, depressed, manic, etc), are not able to function appropriately within the legal system and can disrupt the courts and correctional facilities. By contrast, when people are adequately treated for the mental illness, they are better able to navigate within the legal system, care for themselves, and stay out of trouble.

Perhaps most importantly, we have an ethical obligation to take care of our fellow man to reduce suffering and protect our communities. Orbit Health is there to help people get the care they need, whether it is at the time of arrest, in court, behind bars, or on parole.

At Orbit Health, we believe that a healthier person means a healthier society. Its time to #endthecycle of mass incarceration of the mentally ill.

Question 7

How can telepsychiatry help your correctional facility?

Accepted Answer

Orbit Health brings the most qualified mental health professionals right to your facility, without the need for in-person contact. Telepsychiatry allows your facility access to qualified, capable psychiatrists, including specialists in the field of incarceration, located anywhere around the country. Telepsychiatry offers benefits such as:

You are not limited to the services of the nearest mental health treatment center.
Doctors are not put at risk by being placed in direct contact with inmates.
Increased access, including compliance with state and federal health regulations, at a reduced cost.
Reduced gaps in care: Get help from experts in post-traumatic stress disorder, incarceration, violence, gender transition, and any other specific issues faced by your inmates.

Question 8

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 9

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

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 10

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."