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Aucd 2012 dec 2.2012

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Dr. Maheu discusses risk management for professionals wishing to consider the many opportunities currently available through telemental health and telepractice. …

Dr. Maheu discusses risk management for professionals wishing to consider the many opportunities currently available through telemental health and telepractice.

The above event is sponsored by the TeleMental Health Institute, Inc. We are the premier professional training site for professionals seeking training in telehealth. Our courses are offered in a state-of-the-art, 100% online learning environment that is fully mobile compatible. Professional training is now available from your desktop of mobile device, 24/7, at your home or office.

To receive our FREE monthly newsletter related to telemental health, telecounseling, online therapy, telepsychology or telepsychiatry and telenursing, send an email to: tmhinews@aweber.com You will also receive notices of our bonuses and discounts for professional training for CEUs and CMEs.

See other offerings at www.telehealth.org
Send questions or comments to us at www.support.telehealth.org
Contact Dr. Maheu to speak at your next workshop or conference at: www.support.telehealth.org

Published in: Health & Medicine

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  • 1. Risk Management in the Face of Unprecedented Opportunity AU CD December 2, 2012 Marlene M. Maheu, Ph. D.
  • 2. Copyright 2012 TeIeMental Health Institute, Inc, All righs reserved.
  • 3. Video Teleconferencing (VTC)
  • 4. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 5. Virtual Worlds ECOND IFE Random People Vampires Animals Robots Vehicles @ This is how you Will initially appear in Second Life You can customize your appearance later
  • 6. All Existing Legal and Ethical Rules Apply
  • 7. Skip tr: Content l Footer l Accessibility DepartmentofConsumerAffairs ‘ -GOV Board of Behavioral Sciences Search BBS Home Board Activity CONSUMER RELATED TOPICS . ... ... ... -_ D D D D V QUICK HITS >) >) >> >) >> D >) >> >) >) us What's New Board Meetings Customer Satisfaction Survey Consumer Complaint Form Department ofconsumer Affairs Frequently Asked Questions Online License Verification Pending Decisions and Opportunities for Public Participation Recommended Links Statutes and Regulations q. .r. enar. .. I let iH>n- Ilumnu 1-: nru/ Consumers App| icantJRegistrant LPCC Exams Licensees Forms/ Pubs Contact Us ’. ‘-: -rtal ~93 tr‘ Lnaii: -“ . ..C<. .>. r.e! .J. r1i. <.= .!. lefprrraetipri. !§9sers! ir1s.9ri1irrs. ?§x9h9t1rsrepr . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Notice to California Consumers Regarding Psychotherapy on the Intemet The Board of Behavioral Sciences (BBS) would like to make the following recommendations to Califomia consumers who choose to seek therapy or counseling over the lntemet. Individuals who provide psychotherapy or counseling, either in person, by telephone, or over the lntemet, are required by law to be licensed. Licensing requirements vary by state. Individuals who provide psychotherapy or counseling to persons in Califomia are required to be licensed in Califomia. Such Iicensure permits the consumer to pursue recourse against the licensee should the consumer believe that the licensee engaged in unprofessional conduct. Be a cautious consumer when seeking therapy over the Internet, or by any other means, by doing the following: -->> Verify that the practitioner has a current and valid license in the State of Califomia. -~» Be sure you understand the fee that you will be charged for the services to be rendered and that you fully understand how and to whom the fee is to be paid. -~>> Be sure you are satisfied with the methods used to ensure your communications with and by the therapist will be confidential. -->> Be sure you are aware of the risks and benefits of doing therapy, over the Internet or by any other means, so you can make an informed choice about the therapy or counseling to be provided. ~>> According to Business and Professions Code Section 2290 5, prior to the delivery of health care via telehealth, the health care provider at the originating site shall verbally inform the patient that telehealth may be used and obtain verbal consent from the patient for this use, The verbal consent shall be documented in the patient’s medical record. All laws regarding the confidentiality of health care information and a patient’s right to his or her medical information shall apply to telehealth interactions. Business and Professions Code Section 2290.5 (a) For purposes ofthis division, the following definitions shall apply: (1) ‘Asynchronous store and forward‘ means the transmission of a patient’s medical information from an originating site to the health care provider at a distant site without the presence of the patient. (2) ‘Distant site’ means a site where a health care provider who provides health care services is located while providing these services via a telecommunications system. (3) ‘Health care provider’ means a person who is licensed under this division. (4) ‘Originating site’ means a site where a patient is located at the time health care services are provided via a telecommunications system or where the asynchronous store and forward service originates. (5) ‘Synchronous interaction‘ means a real-time interaction between a patient and a health care provider located at a distant site. (6) 'l'elehealth' means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, out-io. v.. u.o Mi. ..--tor. » . --m. n. -u. -uumuuto and “ti: n. -m-umnuuto .6 R n-| OlnnO'A- in-iloiy. 1--Ira Iuhiln elm n-toimio ; .- -Id ORA . ..; -;. .-toim. .-‘.9. -um um kn-IIOH . --m. .m. ..; A.u in -in -. As. -o-mo pun
  • 8. OCPM Step 3: Legal Issues Duty to Report / Duty to Warn California State Law 6 (v) Failing to comply with the V _ child abuse reporting *1 -‘ 'i requirements of Section 11166 of the Penal Code. C ‘/ (w) Failing to comply with the elder and adult , dependent abuse reporting if 1 L requirements of Section 15630 of the Welfare and Institutions Code. CA Business 0 r r “ ‘ ' ‘ ‘ and Professions Code Sections , ‘ l ~ * _ 4989.54 (cont. )
  • 9. -l. r.i'r4 ' . . . -o K-J. -mIT:4i11.1lI)! i"’l= It= Imt= u|t: II: t=r= IiiiuIui. -iitunira . I|tq : tlII’l:4i1u. u:u= uu= i-.
  • 10. ,1 | sSkype / Reliable? r _ <: Tiles & pixelates " ‘ <: Audio gets tinny r Echoes i: Consumers might see you and hear you, without your awareness <: Can take still shots of you " No pan/ zoom capabilities “ l;2ir. op. s.caLls. .irui1;tto. ut. .
  • 11. Security Threat: Skype does not provide an audit trail, which is a pivotal HIPAA requirement 1' , H x_l ': J. ‘xi; : ; ' / ‘ ‘T it ‘, ‘-. ~;‘ [3 ( ; ./'-ll / /
  • 12. ls Skype a video platform or a social
  • 13. OCPM Step 3 Legal Issues: Which Technologies to Use? ° No Guesswork Needed — HIPAA ”comp| iant” or mp“ C°"'”"°"‘ u H _ ”com pati b| e” an: b:? fc: :s: '°"‘ between °' any Network — Practitioners need to ““'°°°'"s" be compliant, not 39 Mobile" technology — Look for documentation of compatibility with HIPAA standards
  • 14. Internet-based, VTC Companies* Claiming HIPAA Compliance - Access Psychiatry _ Interactive Care - Adobeconnect _ i-rel - IVE (cloud) - Lifesize (Logitech) - MyTherapyNet - Pass - Revation - Secure Telehealth - Secure Video Conference - Easyshare VC _ Shepell fgi - eCounseling - E Mental Health Center - Behavior Imaging Solutions - Breakthrough - Brighter Day Health - California LiveVisit - CopeToday - Consult a Doctor - Counsol. com - Smart House Calls - Soltrite - Forefront Teleca re _ W33 ' GEMS - VisHealth (Visual Telehealth) - GoToMeeting _ Vsee - iCouch “ See more at www. te| ehea| th. org[video - TMH Institute has partnered with some of these companies and will receive a referral fee if you mention TMHI. You may also get an added discount Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 15. L7’. Licensu re Requirements ° We need to be licensed in our state(s) to practice mental health ° Common: We need to be licensed in the state of residency of the patient (e. g., Florida, Texas, Utah, Vermont) ° Also Possible: Both laws may exist
  • 16. Question <* I'm ok if my malpractice carrier says they cover me online, right? Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 17. Malpractice <* Do they cover you for both regulatory and civil infractions? — If not, why not? <* Write to your malpractice carrier and ask them to clearly tell you what will happen if you get in trouble <‘ Consider that a lawsuit can involve a year or two of your life, without pay
  • 18. Existing Te| eMentaI Health Guidelines ' American Medical Association. (2000). Guidelines for Patient—Physician Electronic Mail ' American Counseling Association. (1999) (2005). ACA Code of Ethics - American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On—Line Counseling - American Psychological Association. (1997). APA Statement on Services by Telephone, Teleconferencing, and Internet, A statement by the Ethics Committee of the American Psychological Association - American Psychological Association. (2010). Ethical principles of psychologists and code of conduct - American Telemedicine Association. (2009). Evidence—Based Practice for Telemental Health - American Telemedicine Association. (2009). Practice Guidelines for Videoconferencing—Based Telemental Health - Australian Psychological Society. (2004). Guidelines for Providing Psychological Services and Products on the Internet - British Psychological Society. (2009). The Provision of Psychological Services via the Internet and Other Non—direct Means - Canadian Psychological Association. (2006). Ethical Guidelines for Psychologists Providing Psychological Services via Electronic Media - Federation of State Medical Boards of the United States, |nc. , Report of the Special Committee on Professional Conduct and Ethics. (2002) Model guidelines for the appropriate use of the Internet in medical practice - National Association of Social Workers. (1999) (2008). Code of Ethics - National Board for Certified Counselors and Center for Credentialing and Education, (2001). The Practice of Internet Counseling. (2001) ° New Zealand Psychological Psychologists Board (2011). Draft Guidelines: Psychology services delivered via the internet and other electronic media ° Ohio Psychological Association. (2010). Telepsychology Guidelines 0 Winkler, M. , Flanagin, A. , Chi-Lum, B. , White, J. , Andrews, K. , Kennett, R. , DeAnge| is, C. & Musacchio, R. (2000). Guidelines for medical and health information sites on the Internet. Journal ofthe American Medica/ Association, March 22/29, 283(12), pp. 1600-1606 A I
  • 19. a ’ t‘! , . . ’1 - V . 9‘ I I -4 ' x‘. '_, '. - ' 44 ‘ ‘ l . . - . , , . . ' . , ' - L . .. i«-'* ' ; . v ‘ ‘ «“s". ‘., -- 1’: 2'' V _ ‘ I: I “'1. »~ ' -. ' , ‘a . __ . -.__ _. , - 4 ,4’ -r I 3 K‘. '1 / . P; y '" H“ I II C -is’ ll? ‘ . l‘. :. .2‘. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved. . _y_. ::“'1. _ _ _, {_. ’ . _ _ V g - . . ~ '_ _ {fad} gr 1 Boundaries of Competence
  • 20. American Psychological Association, Ethical Principles & Standards (2002) m c «B Psychologists must be aware of multicultural and diversity issues.
  • 21. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Patient Education Step 4: Legalities Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  • 22. Nursing Homes
  • 23. Rural Hospitals
  • 24. Hospitals
  • 25. Home Health ,
  • 26. Correctiona Facilities
  • 27. Military & Veteran's Administration I / ‘ 7 Y . .4 4"’ 2. I r ' , / -, / . 1 I I . A X , I ' I .
  • 28. Australian Psychological Society (2011 revision of Internet Guidelines) ° Research—based protocols — 1.6 ”Psychologists using the internet to provide a psychological service should be aware of the extent to which therapeutic interventions via the internet are supported by research or may be contra—indicated . ... ” Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 29. Service to the Home: Migration Model ° Start with your current clients * Select those who are reliable, have good support systems and with whom you have a good working relationship ° Consider their diagnosis ° Take the time to prepare them * Plan in—person sessions at regular intervals ' Do not work through their secretaries or others
  • 30. American Telemedicine Association Videoconferencing Guidelines - Emergencies (2009) it A patient site assessment shall be undertaken, including obtaining information on local regulations & emergency resources, and identification of potential local collaborators to help with emergencies r Emergency protocols shall be created with clear explanation of roles & responsibilities in emergencies
  • 31. American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) . Determine Outside ° Be familiar with local emergency Coverage civil commitment regulations and have arrangements where possible to work with local staff to initiate/ assist with civil commitments ° Establish guidelines for determining at what point other staff and resources should be recruited to help manage emergencies
  • 32. American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) ° 39 aWaF€ 0i the impact - Be aware of safety issues Oi rcmcte care 0h with patients displaying provider's perception of strong affective or c0htF0i (OF lack thercctl behavioral states upon War the clinical conclusion of a session, interaction, and how and new patients may this might impact then interact with Pr0Vidct'5 mahagcmcht remote site inhabitants
  • 33. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 34. Smart Phone Explosion It Nearly half (46%) of American adults are smartphone owners as of February 2012, an increase of 11 percentage points over the 35% of Americans who owned a smartphone last May. .. ' Smartphone owners are now more prevalent within the overall population than owners of more basic mobile phones. (PEW,2012)
  • 35. INTERN ET USAGE STATISTICS The Internet Big Picture VVorld Internet Users and Population Stats WORLD INTERNET USAGE AND PoPULA11ON STA11S11CS December 31,2011 Internet Users Penetration Growth Users % Latest Data (% Population) 2000-2011 of Table 139,875,242 13.5 °/ o 2.9884 % 6.2 % 1,016,799,076 26.2 % 789.6 % 44.8 % 500,723,686 613 °/ o 376.4 % 22.1 °/ o 77,020,995 35.6 % 2.2448 % 3.4 % 273,067,546 78.6 % 152.6 % 12.0 % 235,819,740 395 % 1.2051 % 10.4 °/ o Oceania I Australia 35,426,995 7.620.480 23,927,457 67.5 % 214.0 % 1.1 % WORLD TOTAL 6,930,055,154 360,985,492 2,267,233,742 32.7 % 528.1 % 100.0 % NOTES: (1) Internet Usage and World Population Statistics are for December 31. 2011. (2) CLICK on each world region name for detailed regional usage information. (3) Demographic (Population) numbers are based on data from the US Census Bureau and local census agencies. (4) Internet usage information comes from data published by Nielsen Online, by the International Telecommunications Union. by %, local Regulators and other reliable sources. (5) For definitions, disclaimers, and navigation help, please refer to the Site Surfing Guide. (6) Information in this site may be cited, giving the due credit to www. internetwor| dstats. com. Copyright © 2001 - 2012. Miniwatts Marketing Group. All rights reserved worldwide. Internet Users Dec. 31, 2000 4.514.400 114304.000 105096.093 3.284.800 108096.800 18.068919 Population ( 2011 Est. ) 1.037.524.0513 3,879.740.877 816,426,346 216258.843 347394.870 597.283.165 World Regions Africa Europe Middle East North America Latin America I Carib.
  • 36. 4 . Store Mac iPod iPhone iPad iTunes Support Q Features Built—in Apps rt . ' " ». —-. i0S iCloud Tech Specs Over 500,000 apps. For work, play, and everything in between. The apps that tome with your rPh<_me are ‘JUST the l_)€*gIIii1llh_). Browse the App Store to flnrjl lnindrecls of tliousauds more. "I he whore apps you <: l0wnl<: »a(l. the more you realize theres almost no hunt to what your IPh«3ne can (lo. Learn more about the App Store ~ P34», V ,4“. PrD'. EtCll"‘. um htt : www.
  • 37. Happtique Log In Sign Up View our ma pti ue p Nk)! Jik*l'lr= Snuru‘ About Us pg Cerulication Entenses v mHealth Zone Contact Us Reister Our app catalog has 10,000+ apps categorized into 300+ professions and clinical topics Less searching. More finding. VIEW APP CATALOG Happtique is a mobile health application store and app — management solution that helps healthcare providers, physicians, and patients easily integrate mHea| th into
  • 38. Apps: Selection Criteria Usability Privacy & confidentiality — Passwords and alerts — Does it transmit info? Ratings Evidence-Base — For underlying theory — For app itself
  • 39. i Eta-ivii‘. oiIi'— A-uni: 31L'liI'l! Viewour _ _ . -_ . _ A appcatalog v . Mob *Hv. :li‘th Source ll -. l_LA_I. l.1-3'50!‘ I -Au T l r 'fl9 r l l . !¢Ju. t1t9ll!1~: tiaisll-11-=1: App Certification Happtique. a mobile health application store and total app management solution. is developing an App Certification Program for medical. health. and fitness apps The purpose of the program is to help users identify apps that meet high operability, privacy. and security standards and are based on reliable content. Under the direction of a Blue Ribbon Panel. Happtique has developed a set of draft standards that it will use to certify medical. health and fitness apps The draft standards address operability. privacy. security. and content issues: each area consists of multiple standards and associated performance requirements Download draft App certification standards. The public comment period for the draft App Certification Standards is closed. After carefully considering all comments. Happtique will release updated standards in the fall. Like 1 : "Tweet 11
  • 40. Questions? Thohlzl UOU Marlene M. Maheu, Ph. D. TeleMenta| Health Institute, Inc. Phone: 619-255-2788 Email: mmaheu@te| ehealth. ORG Copyright 2012Te| eMenta| Health Institute, Inc. All rights reserved.

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