Question 1

What are the benefits of telepsychiatry?

Accepted Answer

In addition to the obvious benefit of being able to see a mental health professional while under quarantine, telepsychiatry offers many additional advantages to traditional mental health care. Telepsychiatry can be much more economically feasible for many individuals who are unable to afford mental health care. Seeing a doctor from the comfort of your home eliminates the need to deal with travel, lost work hours, childcare, and other expenses that may arise from the need to travel to a specific location. It can also lead to lower co-pays by reducing overhead costs for mental healthcare providers.

Telepsychiatry also brings mental health care to regions that are currently under-served, such as rural areas. Not every locale has licensed, available mental healthcare professionals, and telepsychiatry allows qualified professionals to treat patients anywhere they can find an internet connection.

Moreover, telepsychiatry can help to escape some of the stigma associated with mental health care. Patients do not need to drive to a hospital or medical office and sit in a waiting room with strangers while at their most vulnerable. Instead, patients can simply log on and connect directly with their mental healthcare professionals.

If you are an administrator of a health system or a healthcare provider in need of a way to deliver mental health services, reach out to Orbit Health to discuss how telepsychiatry can expand your options for healthcare delivery and meet the needs of patients in today’s challenging environment.

Question 2

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 3

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 4

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
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
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
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
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

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:

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?"

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

Question 6

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 7

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.

Question 8

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

Notably, the applicable community is debatable in telehealth, as the doctor and patient care are in different geographic areas.

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.