Question 1

How can I combat Zoom fatigue symptoms?

Accepted Answer

Videoconferencing and remote professional services are now a regular practice in many industries. However, these remote calls can lead to feelings of fatigue.

If you find yourself exhausted by all of the video calls in your life, here are a few tips:

Schedule “no meeting” blocks of time. Make sure there are parts of your day when you are away from a screen.
Avoid multitasking. When you are on a call, focus on the business of the call. Avoid pulling up a second window to read emails or conduct other work. Multitasking during calls leads to a loss of productivity and difficulty remembering what occurred in the meeting.
Limit the number of calls. Do what you can to cut down on your overall number of calls. Group calls with separate people or teams together where feasible and appropriate. If a video call is not actually necessary, resolve the issues via phone, email, or a collaborative document. Do not default to a video call for every type of meeting. If you are meeting a stranger for the first time, such as a networking connection, for example, video calls can feel personal and invasive; start with a phone call.
Take breaks. If your call lasts more than an hour, it is important to take breaks. Get up and walk around, use the restroom, get a glass of water. Everyone will have more energy and remain more productive as a result.
Turn off your self-view. Video call programs like Zoom default to displaying your own video as well as others on the call. Staring at your own face can be distracting and increase stress and anxiety. Hide yourself from your own view so you can focus on the other people on the call.
Limit on-screen stimuli. In addition to hiding your face and keeping other windows closed, do what you can to limit what you see on-screen. Encourage people to take calls in front of plain backgrounds instead of a room full of objects. Seeing five different rooms full of furniture can cause disorientation and increase mental fatigue.

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

Question 2

Do you see group therapy sessions on the horizon for telepsychiatry?

Accepted Answer

Most forms of mental health treatment can be equally effective as in person care, including group therapy. Remote group therapy has been slower to take hold than one-on-one care given by psychiatrists and mental health clinicians. However, as the world continues to embrace telehealth, group therapy is anticipated to become more prevalent.

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”).

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.

To learn more, contact Orbit Health today!

Question 4

How can Orbit Health provide COVID-19 psychiatry services?

Accepted Answer

Identify a small confidential area accessible for clinical use. All you really need is internet access, a desk, and a chair. We will place a video screen there and provide psychiatrists via high quality videoconferencing technology. We can use your existing computers or devices to stream a connection over a web-based telepsychiatry platform. Alternatively, we can provide a portable device that is dedicated to telepsychiatry and is always on. The technologies we use are specifically designed for telehealth encounters and are HIPAA compliant. Clinical encounters are not recorded.

When the patient is ready to be seen, our telepsychiatrist will appear on the screen to provide expert clinical care. After the session, the telepsychiatrist will submit the clinical documentation directly into your electronic health record.

What are the advantages of Orbit Health Telepsychiatry?

Providing telepsychiatry staff with expertise and training in COVID-19 and mental health
Providing psychiatric medication management and psychotherapy
Participating in treatment team meetings and consultation with onsite staff
Increasing patient satisfaction
Improving patient outcomes
Reducing costs of recruiting, hiring, managing and retaining onsite staff

Question 5

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."

Question 6

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 7

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

Accepted Answer

Yes, telepsychiatry has been comparable to in-person care among inmates in jail, prison, and correctional facilities. Video visits with telepsychiatric evaluations are used used to treat inmates with a variety of psychiatric illness in a range of severity, including severe mental illness. Decades of studies demonstrates telepsychiatry’s usefulness.

Vacancies and staffing issues in correctional facilities can impact access to care. Physical space requirements, security requirements, and correctional work culture pressures discourage healthcare providers from working in the correctional facility environment.

Telepsychiatry fills these vacancies, can ease burden on clinicians and providers, and takes less physical space than having more personnel on-site.

With the adoption of telepsychiatry, inmates can be seen early in their incarceration. Patient satisfaction has been shown to be high in forensic psychiatric patients with remote video visits. Acceptability has additionally shown to be high amongst jail personnel.

A meta-analysis — a study of multiple studies — looked at telepsychiatry used in acute settings, including inpatient units. They showed that the quality of clinical interaction is similar to in-person face-to-face encounters, and that telepsychiatry has been cost-effective.

Sources:

Kaftarian, Edward. "Lessons Learned in Prison and Jail-Based Telepsychiatry." Current psychiatry reports 21.3 (2019): 15.
Salmoiraghi A, Hussain S: "A Systematic Review of the Use of Telepsychiatry in Acute Settings" Journal of Psychiatric Practice. 2015; 21 (5):389-93
Brodey et al, 2000. Satisfaction of forensic psychiatry patients with remote telepsychiatric evaluation. Psych Services: Oct 51(10): 1305-7.
Leonard S: "The Successes and Challenges of Developing a Prison Telepsychiatry Service" Journal of Telemedicine and Telecare. 2004; 10 (S1): 69-71
Zaylor C, Whitten P, Kingsley C: "Telemedicine Services to a County Jail" Journal of Telemedicine and Telecare. 2000; 6 (S1): 93-95

Question 8

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 9

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 10

How can telepsychiatry help during COVID-19?

Accepted Answer

Right now, most Americans are stuck inside their homes, while the COVID-19 coronavirus pandemic continues across the U.S. and worldwide. Normal business functions have, for the most part, shut down indefinitely. Many people, however, need services beyond food and water. Staying mentally healthy during these difficult times is one of the most challenging parts of the entire ordeal, and also one of the most important. The field of telepsychiatry allows individuals who are subject to shelter-in-place orders to get the mental health services they need without having to risk physical proximity near other individuals.