Telemedicine Hx and Data for Psychiatry Usages

Discusses the Hx of Telemedicine, data of its use, advantages and disadvantages.

1. History of Telemedicine First used in 1879 Assessment, diagnosis, treatment via telecommunication Telepsychiatry 1950s in Nebraska Psychiatric Institute Used for Psychiatric treatment or therapy Used in Underserved and Remote Areas Utilized for treatment in highly-restricted areas such as prison. 2 specific types of Telepsychiatry : Synchronous: live videoconference between provider and patient Real-time evaluations, timely care for emergencies or urgent situations Asynchronous: pre-recorded videos sent from provider to patient and vice versa Used for specialty care, areas with provider shortage, overcome language and cultural barriers.

2. Telemedicine Pre and Post Covid Background on Telehealth policy Prior to March 2020: Rural areas Services must be received at a medical facility 2-way audio-video telecommunication used Limited number of services Rate paid at 30% below in-office rate COVID-19 Public health Emergency Rural and non-rural areas No medical facility requirement for either patient or provider Any audio-video telecommunication including smartphone and audio-only phone Payout at same rate, expansion of coding for tele-visits.

3. Data

4. Telemedicine Going Forward Current barriers: expiration of the telehealth policy 5 months after the COVID-19 PHE expires. Particular issues: Rural-only limitation Location of origin to include “home”. Requirement that patient must be seen in-person within 6 months Pending bill: The Telemental Health Care Access Act- bill to repeal the new Medicare requirement that a patient must be seen by a provider IN-PERSON within 6 months of receiving mental health telehealth services.

5. Advantages to Telemedicine Limiting Covid-19 spread and exposure Decrease in no-show rates Lack of lengthy commute, factoring for traffic Increased access to care Increase availability of providers Increase availability of patients Less provider burnout

6. Disadvantages Lack of Physical Exam and M ental Status markers Increased disparities to those with lack of access to technology. Lack of reliable drug screens for those on controlled medications Or need for patient to go to other places to get drug screens

7. Acceptance of Video Call 1) Barriers to accessing the Clinic 2) Patients’ relationship with their therapist 3) Technical Interruptions 4) Patient’ expectations 5) Complexity of Issues

8. Psychiatry Residency Clinic Telemedicine Use About 20% of our Psychiatry outpatient clinic About 80% of Therapy with LCSW, Case management Fluctuates by clinic: Attending clinic sees majority in-person both psychiatrist and therapy staff. Who we see Telepsych : Patient whom have a long commute to the clinic Patient whom have good established home connections Specifically work from home occupations Patient with full-time jobs that are located outside Vincennes, IN Patient must be in the state of Indiana Otherwise we can’t bill for the visit. Granted, don’t have prescription rights outside Indiana **Some patients, actually prefer to come TO the clinic to use Zoom in a conference room

9. Big Telemedicine Questions for Thought??? How to expand telemedicine services to other areas with limited care or length wait times? For example: Psychiatry Residency Clinic has 6 week wait vs. Psychiatrist in Evansville is minimum 3 months + wait time. What legislation can be proposed to support Telemedicine services for patients? For example: allowing “home” to be an origination site for patients. What can be proposed to help overcome patient barriers to engaging in Telemedicine? For example: advocating for public areas to have access to video calling, such as libraries, homeless shelters?

10. References Gude J, Subhedar RV, Zhang MH, et al. Emerging Needs and Viability of Telepsychiatry During and Post COVID-19 Era: A Literature Review.  Cureus . 2021;13(8):e16974. Published 2021 Aug 7. doi:10.7759/cureus.16974 AMA's advocacy efforts push for permanent telehealth advancements | American Medical Association (ama-assn.org ) Moeller AM, Christensen LF, Hansen JP, Andersen PT. Patients’ acceptance of video consultations in the mental health services: A systematic review and synthesis of qualitative research. DIGITAL HEALTH. January 2022. doi:10.1177/20552076221075148 Medicare Telemedicine Snapshot (cms.gov ) Dr. Allie Thomas- Fannin , MD, Program Direction for IUSM Psychiatry Residency.