Question 1

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](https://www.ama-assn.org/practice-management/digital/ama-telehealth-quick-guide), can help you determine which laws apply.

Question 2

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 3

How can Orbit Health serve residential youth homes?

Accepted Answer

Orbit Health believes in protecting the health and wellbeing of our precious youth, especially those who have mental/emotional problems and developmental disabilities. Working in partnership with residential youth homes, Orbit Health has vast experience serving vulnerable youth remotely, through state-of-the-art videoconferencing technology (“[Telepsychiatry](https://www.orbithealth.com/what-is-telepsychiatry/)”).

At pivotal moments in a child’s journey, we are there to ensure high quality and trauma informed care. Our mission is to keep these children on the right path of life and out of the [cycle of mass incarceration](https://www.orbithealth.com/telepsychiatry-services/correctional-care/cycle-of-mass-incarceration-of-the-mentally-ill/).

To learn more, [contact Orbit Health today](https://www.orbithealth.com/contact-us/)!

Question 4

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.

Question 5

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 6

I need help

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 7

What is telepsychiatry?

Accepted Answer

Telepsychiatry is the delivery of psychiatric care remotely using technology, usually through videoconferencing platforms.  It can involve mental health evaluations, therapy, medication management, and patient education.    Telepsychiatry is the fastest growing sector of the telemedicine and is the future of mental health care.

Telepsychiatry is a form of telemedicine that generally refers to the delivery of psychiatric assessment and care via telecommunication, typically using videoconferencing software. The practice of telepsychiatry has been in development since well before the pandemic quarantines, as an effort to account for the millions of Americans who suffer from mental illnesses but are unable to get proper psychiatric care.

Telepsychiatry brings mental health care to individuals who are unable to see a medical professional in person for any of a variety of reasons, including the cost and availability of travel, incarceration, or contagion. Now, with shelter orders and quarantines keeping medical offices closed and people restricted to their homes, telepsychiatry provides a promising alternative to in-person psychiatric care.

Question 8

What hardware and apps should I use for telehealth visits for those with hearing impairments?

Accepted Answer

If you see enough patients, you are bound to run into patients who may be hard of hearing or deaf. Persons with disabilities deserve great care. Effective communication is essential to ensure a high quality of care.

Consider using the following computer equipment, hardware setup, and apps, for your telehealth and telepsychiatry visits:

* Make sure that there is as little background noise as possible on both sides of the camera. This can be challenging in certain facilities that are inherently noisy, such as jails or inpatient units.  Its helpful to have a dedicated office for telepsychiatry that can be insulated against background noise.
* Use a high-quality microphone speaker on both sides of the telehealth session. These are easy to use and inexpensive devices.  You just plug and play, with a USB port.
* If the quality is still not good, you can connect the audio through the telephone while keeping video with the telemedicine platform.
* Provide the patient with headphones (noise cancelling preferred). This allows the patient to increase the volume and minimize the diffraction of noise.
* There are several closed-captioning apps on the market. Also, some videoconferencing platforms include closed captioning as an option.  Just be sure that these technologies are all HIPAA compliant.

Check out our full post on ["Telepsychiatry for the Hearing Impaired – Top 10 Tips."](https://www.orbithealth.com/telepsychiatry-for-the-hearing-impaired-top-10-tips/)

Question 9

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."](https://www.orbithealth.com/telepsychiatry-for-the-hearing-impaired-top-10-tips/)

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."](https://www.orbithealth.com/videoconferencing-fatigue-what-to-do/)

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