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CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
CPA Conference, April 2013 - Telepractice Informed Consent
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CPA Conference, April 2013 - Telepractice Informed Consent

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Marlene Maheu gives a telehealth presentation to the California Psychological Association (CPA) conference in April 2013 in Newport Beach, California. She presented on the topic, " Telepsychology and …

Marlene Maheu gives a telehealth presentation to the California Psychological Association (CPA) conference in April 2013 in Newport Beach, California. She presented on the topic, " Telepsychology and the Informed Consent Process.”

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 our 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

For more than 65 hours of CEU or CME training that is 100% online, see telehealth.org. Earn your required training hours from the comfort of your home or office. Again, www.telehealth.org

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  • 1. I , |55=j, I_3r| y;t_: ~:m3.x: : , . ( I A _ KQIQII‘ Ill: -m I Te/ epsycho/ ogy & the Informed Consent Process: Practical Strategies for Managing Your Online Therapy Risk CALIFORNIA PSYCHOLOGICAL ASSOCIATION April 13,2013 Marlene M. Maheu, Ph. D. Te| eMenta| Health Institute, Inc. arr»: I‘; -=; ._: -‘r 1;. _‘r.
  • 2. I , :5-= .i, I__= rw : ~:m_r. ::: ,. (( " ‘I ‘A . umu~. .». iIlu. .-m Disclaimer « WHO I AM: I am a licensed psychologist, not an attorney, physician, marketing or information technology (IT) professional. * MY GOAL: My goal is educational only. I will outline the issues and alert you to what's happening in a way to help think through the issues, help you move forward, and protect yourself as well as your clients or patients. I hope to inspire you to use technology in ways that help you, your clients and our profession. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in my presentation for your specific circumstance. I assume no responsibility in connection therewith your choices. - YOUR PART: You are encouraged to seek specific advice from your specific legal, regulatory, ethical and malpractice bodies before offering any online services or programs to consumers. Get all such opinions in writing, and have your informed, trusted, local, legal counsel review them for their full significance. arr»: .': ~;. _:-‘c 1;. _‘r.
  • 3. I , |55:, ‘,I3r| y;I_ : ~1:V»I: l3l (. ( I A . (JI: hI: —>. IIlI. .-Iv I Learning Objectives 6 Name at least 5 issues addressed by the APA Te/ epsycho/ ogy Guidelines that can be handled by a thorough informed consent process. ° Describe at least 3 ways in which evidence- based traditional telepsychology models differ from practicing online using SKYPE. 0 Name at least 3 issues that need to be covered by the informed consent process for using telepsychology in your practice. arr»: I‘; -'r. _:~: 'I; ._‘r.
  • 4. P V I I I Copyright 2012 TeIeMentaI Health Institute, Inc. All righs reserved. r x I 7
  • 5. II The Future I ‘: :'-f''‘‘-**' *‘**‘~'= -‘* . :-— ~v, ".». . '(Irg. .-»". - “'I". "/‘.3-‘F. ‘rir’ ‘~" 7 */ —,~'. <"-'¢‘»'~. #‘ I+; s~cI: <~*’»; g¢’m‘*z, r«. _ __ _ __ __ _I. ~r? *>: ®:s"€'srt~*’x«§9. ' Wt" at "W" V I ‘ "4' ‘(I ‘F: IX)’ " 9”" ‘-31,; ~f— Y‘-’ ,
  • 6. All Existing Legal and Ethical Rules Apply
  • 7. Do No Harm
  • 8. |; g=, ‘,_5I: I II_ : ~17;V/ I-I3: 4. Hunt: ->-IIli. ,-Iv Newest Guidance from Leading Professional Associations (442-2013) American Psychological Association Te/ epsycho/ ogy Guidelines (soon to be released) American Telemedicine Association ATA Practice Guidelines for Video—based Online Mental Health Services (in comment period) American Counseling Association Standards Revision, Section IIH" (in comment period) Association of State and Provincial Psychology Boards Te/ epsycho/ ogy Guidelines 9 E—Passport (Licensure) (in comment period) Federation of State Medical Boards (FSMB) and the American College of Physicians (ACP) Position paper: Online Medical Professionalism: Patient and Public Relationships: Policy Statement (in comment period) arr»: I‘; -'r. _:-v «.3,
  • 9. Hunt: ->-IIli. ,-Iv 5 issues commonly addressed by all new Standards & Guidelines 1. Follow state law re: licensure 2. Follow state & federal law re: HIPAA & technology 3. Learn & be competent in the technology you choose (calls for both clinical and technical training) 4. Have an emergency plan 5. Document, document, document (starts with informed consent) 32' I’ _: -*: ‘I‘Jj.
  • 10. I , |gn: §,I_: m;I : ~1;I. ~.x: I (. (( " " ' I (JI: hi: r.IIlI. .-Iv I 5 I I, , ASPPB’s Telepsychology E—Passport (open for comment now — ASPPB. org) Attest to being competent with the telecommunications technologies that will be used to provide telepsychological services to clients/ patients based on the E. Passport applicant's education, training and experience. Attest to be knowledgeable of and will practice within the specified legal requirements of his/ her home jurisdiction and all other (distant) jurisdictions where the practice or delivery of services is occurring, including but not limited to any requirement to have liability insurance in the jurisdiction into which the services are being provided. 9 Consider these issues in your informed consent process -) Develop specific wording with your attorney 5:33’: I’; -'r; ._i-‘I’ ufr,
  • 11. DEPARTMENT OF CONSUMER AFFAIRS Si ; ': ContentlFoofer Accessibiliy i seaich Q ‘Q This Site L i Califomia -GOV “T. ” BOARD 0lF PSYCHOLOGY Home Abou Us Applicant contactus consumer Forms/ Pubs Laws/ Regulations Licensee/ Registrant Information on Telepsychology The following information regarding telepsychology has been excerpted with the permission of the primary author from "Regulation of Telepsychology: A Survey of State Attorneys General" by Gerry Koocher & Elisabeth Morray, Professional Psychology: Research and Practice, October. 2000. vol, 31, issue #5, pages 50&508, QUICK HITS Board Meetings Continuing Education 1 Before engaging in the remote delivery of rriental health services via electronic irieans, practitioners should carefully assess their competence to offer Decision pending and the particular services and consider the limitations of efficacy and effectiveness that may be a function of remote delivery, Opportunities for Public ll 2. Practitioners should consult with their professional liability insurance carrier to ascertain whether the planned services will be covered. Ideally. a written Panicipation confirmation from a representative of the carrier should be obtained. Examinations ll 3, Practitioners are advised to seek consultation from colleagues and to provide all clients with clear written guidelines regarding planned emergency Expen Witness Recniiiineni practices (e, g,, suicide risk situations), FAQS ll 4. Because no uniform standards of practice exist at this time, thoughtful wntten plans that reflect careful consultation with colleagues may suffice to . . . . document thoughtful professionalism in the event of an adverse incident. Filing a complaint with the V V V V V V V V Bop ll 5 A careful statement on limitations of confidentiality should be developed and provided to clients at the start of the professional relationship, The statement should inform clients of the standard limitations (e, g,, child abuse reporting mandates), any state-specific requirements, and cautions about privacy problems with broadcast conversations (e, g,, ovemeard wireless phone conversations or captured internet transmissions), ll 6. Clinicians should thoroughly inform clients of what they can expect in terms of services offered, unavailable services (e. g., emergency or sin 9 for our E-mail List psychopharrnacology coverage), access to the practitioner, emergency coverage, and similar issues. I! 7 If third parties are billed for services offered via electronic means, practitioners must cleany indicate that fact on billing forms, If a thirdeparty payer who IS unsupportive of electronic service delivery is wrongly led to believe that the services took place in vivo as opposed to on-line, fraud charges may RELATED UNK5 ultimately be filed, License Venfication
  • 12. Skip ll] Content l Footer l Accessibility DepartmentofCansumerAffairs . -GOV Board of Behavioral Sciences Search BBS Home Board Activity CONSUMER RELATED TOPICS . ... ... ... -_ D D D D V QUICK HITS >) >) >> >) >> D >) >> >) >) is 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 e. .i. enai. .. I Eat iHn- / /IAAAIIAI 1-: nru/ Coiisiiiiieis App| icantJRegistrant LPCC Exams Licensees Forms/ Piibs Contact Us ’. ‘-: -i“. al ~93 ti‘ '-/ ‘<‘l‘3’f: “‘ . ..C<. .>. i.i§». i.J. i1i. <.= .!. iiifraifiiiiiiisiii. !§9ssrs! iiis.9ii1iii§. i?§xsh9f1israpy . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Notice to California Consumers Regarding Psychotherapy on the lntemet 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 licensure 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 hilly 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, pnor 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 inforrriation 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) '0nginating 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) Telehealth’ means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, om-iomiuio Ml. ..--iii. » IIFIIII iv. -ui-uumuuio and flnl‘ n. -m-umnuuio .6 R . .-ioimtom in-iloi. 1--Inn iuhlln aim n-ioimii in no «In nrlnin-Minn . -‘.9. -um cl. .. I. ..‘-mi. lllllfl . m.. .;A. u in -in -. Al. -o-mo pin.
  • 13. Center for Connected Health Policy sign up for ‘/ National Telehealth Policy alerts 8. n ’ About CCHP What is Telehealth? CCHP Projects IHEALTHBEAT 4.03.13 <i>JAMA<li> Viewpoint: EHR Systems Not Capable of Handling ‘Big Data’ )) 4 03.13 $12.78 in EHR Incentive Pay Doled Out Througi February, CMS Says » 4.03.13 Report Cites CMS for Poor Oversight of Health Plan Comparison Portal » 4 03.13 White House Launches Brain- Mapping Project Requiring New lTTools » 4.03.13 Bill Would Exempt Pathologists From Meaningful Use Criteria » Home Telehealth Advancement Act Signed Into Law LEGISLATION TO UPDATE CALIFORNIA TELEHEALTH LAW AND REMOVE POLICY BARRIERS TO THE USE OF TELEHEALTH SERVICES WAS SIGNED INTO LAW ON OCT. 7 BY GOV. JERRY BROWN. AB 415, authored by Assembly Member Dan Logue, R—| Lake Wildwood, and sponsored by the California State Rural Health Association, will update legal definitions of telehealth, streamline medical approval processes for the delivery of telehealth services, and modernize the state's health care system by broadening the types of telehealth services that can be provided. The bill garnered broad bipartisan support. The bill's four co—authors are Assembly members Wesley Chesbro, D~North Coast, Cathleen Galgiani (D~Livingston), Dr. Richard Pan, D»Natomas, and V. Manuel Perez, D-Coachella. AB 415 drew from CCHP‘s Telehealth Model Statute Report, which recommended modernizing state telemedicine and workforce laws, to encourage more robust adoption of telehealth technologies. The report, released in March, identified policies to promote greater use of telehealth technologies, to maximize their benefit to all Califomians. CCHP provided technical support to AB 415's author and sponsor. AB 415 incorporates report recommendations to create parity among clinical services, regardless of whether they are delivered in person or via telehealth. The bill will: I» Replace the outdated legal terminology of "telemedicine" with "telehealth; ” «I» Update the definition of telehealth to reflect the broader range of services in use today, and apply the definition to all licensed health professionals;
  • 14. V = «.i.4»-‘4'I. =-I ; ~fiF71 §_= ,ll'iIii: ':r= .llii'; jt'iri! _‘} The bill will: Replace the outdated legal terminology of “te| emedicine" with “te| ehealth; “ Update the definition of telehealth to reflect the broader range of services in use today. and apply the definition Change the need for an additional written patient consent specifically for telehealth services to a verbal COTISCDII Remove the Medi-Cal rule requiring documentation of a barrier to an in—person visit before a beneficiary can receive telehealth services; Include store and fon/ vard technologies as viable for all types of telehealth services; Remove a twice-extended sunset date in Medi~Cal on store and forward services reimbursement for teledermatology, teleopthalmalogy and teleoptometry. Eliminate restrictions on reimbursement of services provided via email or telephone; Eliminate restrictions on the type of settings, such as doctors’ offices or hospitals, where telehealth services may be provided. What AB 415 does not do: It does not replace the health care provider with technology. Rather, it preserves and enhances the provider- patient relationship, and enables health care professionals to make use of available technology to better serve their patients; It does not change the scope of practice of any licensed health professional; It does not change interstate licensure laws; It does not change or dictate agreements between health plans and providers. Health plans/ insurers and providers retain the ability to make decisions regarding appropriate utilization controls and procedures.
  • 15. an in I ‘ L‘ teIeheaIth. org Relevant California State Law/ Bills - AB 415 - Telehealth Advancement Act ° AB 809 -- February 21, 2013 ° Logue. Existing law requires a health care provider, as defined, prior to the delivery of health care services via telehealth, as defined, to verbally inform the patient that telehealth may be used and obtain verbal consent from the patient for this use. Existing law also provides that failure to comply with this requirement constitutes unprofessional conduct. This bill would delete those provisions. ° htt : WWW. /8 in 0.ca. ov ub 13- 14[bi/ /gasmgab 0801- 0850[ab 809 bill 20130221 introduced. htm/
  • 16. Home Topics > Perspectives > Features > Data Points - Special Reports Most Popular > . d Congress Tenth . a__ Health IT Su. n1:: u! National Harbor, Md. Ccuference -an Heath 1:‘ l'{e. <~arch Technologies Boston Conference on 1 7 Interactive Health Care ' '3 for Patients San Diego ‘~/ l»: —‘t». v All Events FROM THE FOUNDATION Scanning the Telehealth Horizon The Center for Connected Health Policy has released a 50-state scan of telehealth laws as well as videos on how telehealth improves quality and access to care for less money. The Wisdom of(‘rowds As more consumers tum to social media to research purchasing decisions, how do sites like Yelpcom compare with traditional sites for hospital quality Thursday, March 21. 2013 States Not Keeping Up With Telehealth Advances by Rebeoca Vesely. il-1ealthBeat Contributing Reporter State laws on telehealth are antiquated, contradictory and confusing. according to a recent comprehensive report on how all 50 states oversee the use of technology to deliver health care remotely No two states are alike in how telehealth is defined and regulated. according to the report by the Center for Connected Health Policy. an independent not-for-profit telehealth planning and technical assistance group based in Sacramento. Calif "Generally speaking. the policies and regulations that govern telehealth are not keeping up with where telehealth is today, " said Mario Gutierrez. executive director ofthe CCHP. which is partially funded by the California HealthCare Foundation CHCF publishes eaIlhBeal Meanwhile, the number of US, residents using telehealth services is expected to reach nearly 1A3 million by 2017 -- a nearly six fold increase over 2012, according to a report by ll‘. /IS Research released in February The main drivers of telehealth are expected to be federal rules including hospital penalties for 30-day readmissions and demands from providers. payers and patients. according to the IMS Research report CCHP Report Highlights The report sheds light on telehealth laws related to Medicaid and the private sector in all states as of December 2012, The survey focused on 11 policy areas. including reimbursement. consent, service location. online prescribing and licensure. The report will be continually updated at a new website scheduled to launch in March Among the key findings - Forty—four states have some form of telehealth reimbursement for Medicaid programs, - Live video was the most prominent form of reimbursed telehealth services. with 44 states paying for live video sessions: E Print 3 Email El Share E Facebooi: Twitter Goog| e+ G Linkeciln RELATED STORIES o3/19;"2o13 Telehealth Helps Boost Access to Stroke Care in Rural Areas. Study Finds 03,/12/2013 Study: Telehealth Visits Feasible Alternative for Parkinson’s Patients 03/‘ or/2013 Telehealth Not Boosting Quality of Life for Those With Chronic Conditions 01/ 281' 2013 Georgia Aims To Expand Telehealth Technotogy to Clinir: Across State Already a Subscriber? E"", ‘§l' , A‘, ’,‘, ’,, ’?§5 Password [I] Remember rrie . ,.Ll: Im_c Forgot your pass‘. '.‘r. n'. "" Register for an account V- in: iHeaIthBeat Register now u-"—: -». -iris: MOST POPULAR ARTICLE S Vlewod E . ".| '1". .i More Doctors Starting To Prescribe . Iobile Apps for Chronic Conditions Growing Use of Health IT Creates Challenges for People 'ith Disabilities Report: Effectiveness of Health IT-Based Diabetes Loterventions Is Limited lnternel Biological Computer Could Detect‘ Fight Disease More Physicians Suing Over Negative Online Re'‘ie'ws. lawyers Say
  • 17. l ’ ', ‘Ign: ii_: ‘ir; v : -=; rj, |:: , g, l ’""' ‘k’ , ('v1l'*‘I[. 'r‘1|n'4I"-. http: //www. ihea| thbeat. org/ featu res/2013/states-not—keeping-up-with-telehealth- advances. aspx? goback= .gde_4172177_member_227665726 Ameng the l»= :ev findings: Fertv—feur states have seme ferrn eftelehealth reimbursement fer lvledinzaid pregrams; Live videe was the meet preminent ferm ef reimbursed telehealth servin: :es, with :14 states paving fer live videe sessiens; Seven states previde lvledinzaid reimbursement fer remete Ten states require infermed sensent; Nine state medical beards issue special licenses erizertifinzates fertelehealth: Sixteen states have laws that affect reimbursement ef private papers; and Thirteen states have legislatien pending en telehealth.
  • 18. ATA Wiki — (Perhaps we can have such a wiki at our CPA website? ) an: -rxmrv 3, ll]: ,7’ ‘ nu . -11- man -um Califomia atawiki = --"--- I Rom: -mu n-uumu lunch I VLeIj5lllDIo -non naviaif-on 2 Pr: -III murance co-pup re-nx-u-9-sr-mix in am: new alums Duo-am -an am vnnuiascwc 4 rsiwoanu I-csnauo ' “‘""‘ ""“ 5 YNQVNM MVOKJI: ' “""‘ """"" *5'<9oiwIs mun ' : ;°“""" rccqanonAwna. -.1p6<rosrasouvm 99”‘ Recon! news‘ pending action :1.’ sum Loolslallvokfion mm. —. sz'rr~ : i:r. n~. a . . : mp . m. ... ..-. .r. Puma. .. . my-: my-9.. . am-n-oe- . vmunn -emu» . cw: -nu n . Fotruary u 29:) AB us '4 n Runwu on no (In nwnumou mu gmum m. couugi nllulodanuslry vul stun zvdbmrc undo: than gun - Febuury 20 2073 ~ A8 613.’ I Is 5 b-I tellled HI leimulh and unvwrlg hullhcte but” 6 Wlevnns . Fonvuary 21 20!] - AH 509 i, ms 2 B: can was we-pa ma unarmed cot-wli mzuwveu ruuolohoamu Pun . Felrully 2n12 - A5 1113: ii a ml/ oduced lu spam, mm Ihe xnuxxame Hun: can S«. w-Le PM An unhmmun on «mm-ng o-person (onmcl use notes In other new: CD: am-ce nlln r. o-(inns «us me Slale Deamrv-. -rn anew: Cave semcu nu sen-us Imoer Ihe | le¢Cal pwqnm wbw, supported noplms nthev ms. Me6C: l and Im serous aasunnl xu the Pvugaa-VI at NH: -clusn Ca: rm "re sue-iy av upmamg Ihe scooe at . (run: the HI mun «pun . sisenmamea emu prognm - Ouch-2:7 7011- (‘autumn ammo a cawullmrsul law in In am: -as can-vvsmn adorn signing try ma Gauguin! AH 415 av: unammnuuy appvma try me | nwlaim , ! :9. : l.'! i . I4 -g . ) mm. ‘ rm. wv. m-- :0 r«1-rmw-" i'= '~ -KIWI» 9 0»! M- ln- . Reptxu ma mango Iegi xumunniogy at '1e| eme¢: ma' nah wpiehum-‘ . wanes the twtmhm at releneuih In tried the mom: rungs av somus m use loan and any me onnmon to ul In ennui rum pvotessrrms . Qlnges mu reed lav an loénnnd vaflen pwbanl caused spmrua-, Iu «gamma sevvoce-5 to u my tansonl - Rernov. -s run Mama (tuna-mu 5 Mu¢r. au ungum; m| e mmnq oocuvmniaon or a harm In an -II-petsim an helm a mvmcum nu! rec»-e men-. -an wvces 0 Rornous n Iwco uxlcndnd urn: an H! Modrcal an mm and lnmard nwrns mmun-mu Im modurvruuningy mu ‘ ‘ i r 1 . an-an rvslnclrms an mmbusemeua n1 aerate: wormed vu am! at xulepouone . Enmnxn rn: In<r. ms an mu pr, -sat I-xxnun such 2: doctors aim: at hosgxau Mm: ul-nnln n-mcu why an uwndod . Mans Cdrbmtl M79313: In an new laderl mics to man anally uuflsh mefinl crrdemii: dtulelvealh Vvvflus - Mach 1 2011 7 1»: Come: lor Conn-am Mann PM-cy mused a human monnl siauu h Canaan»: lhil Itccmnmnds moavmzmg stalk idornsdcino nna workforce was In «(aways mm mum amxzm condemns: Iermalogasllw 6 TM man uaiun ranofl nu-res U in-nmvunnanom n A rateaon-as . Ru-yum In me sule s Telemedzrnu Dealovmzm ha M1996 btusmg nrvmauiy on Cur-ctInccr1.re: -nu crhvvned cavsm - Fiecovrnenomuvrs I0 w-(orpoma late? -edrn min Mate uomoue law . szuumy -ecmm-mu-ma ca pmmole -nle-vnpulbilly onecrn-mg; Ind (onsumev «mum
  • 19. ,-: iiii‘RNlal. ilVARlVI‘J' . ll ‘- Health Care Services . HOME SERVICES INDIVIDUALS PROVIDERS & PARTNERS FORMS. LAWS 84 PUBLICATIONS DATA & STATISTICS l—li: i'ne > E'= .r. ‘i > Rural Health iiriijiari Health Rural Health > State Office ofRural Health ~ California State Office of Rural Health = ‘ I The California State Office of Rural Health (CalSORH) collaborates with public and private entities statewide, and at the regional and national levels to increase rural access to health care. This program provides an institutional framework linking small rural communities with State and Federal resources. 0 California State Office of Rural Health Flex and California Access Hospital Grants 0 Small Rural Hospital Program Grants The following is a list of Ca| SORH program contacts and information regarding Rural Health Links and resources. 0 Ca| SORH Drogram Contacts 0 Power Point Presentations at California State Rural Health Association o California Rural Health Update. November 15. 2011 (PDF, 3.3 MB) NEW! California Rural Health Update, November 10. 2010 (PDF) California Rural Health Update. November 19. 2009 (PDF, 4.9 MB) California Rural Health Update. December 3, 2008 (PDF) California Rural Health Update. December 4. 2007 (PDF) California Rural Health Update. December 5, 2006 (PDF) 00000 I Rural Health Links and Resources - Ca| SORH Webinars - NEW! 0 Childhood Obesitv in Rural California. June 2~'1,2011(PDF) ': DHCS Implementation of ACA Requirements for Provider Screening and Enrollment (PDF) “- Rural Physician Recruitment and Retention Assessment Program -PDFji 0 United States Department of Agriculture Rural Development (PDF) Home Services Individuals Providers & Partners Forms, Laws &Publications Data & Statistics : ll*u, s,i, a Qfiii. ‘ Back to Top | Comments I Conditions of use I Privacy Policy I Accessibility | Contact Us I Site Map I Help I Download Free Readers Copyright i‘_§i 2012 State or‘ California
  • 20. 1 , I§! §(‘, l§_? l'; l_: ~1;Vjil: : 1 ( I A _ uldii‘ lllu -m l Telemental Health & HIPAA (1996 - 2013) & HITECH (2011) 32' 7 3*: 2:1.
  • 21. ".4.Nl/ . EFUH ' L H _‘ teleneaIth. org ((( iii
  • 22. .'i‘iE l. !.3rl9ri-9 lilEl'l‘§l_l " i: ii l!3rlei'ie"‘ i ll‘ Ficflle l l_‘: lL; :iUl F'sychiatricTime5 P§"37“5hiatricTimes Risk Assessment News Current Issues Blogs Special Reports CME Conferences Home )9 EMAIL PRINT PDF REPRINT SHARE Q ~ l I‘ (:1 Lii -E Be the first of your friends to like this. TECHNOLOGY IN PSYCHIATRY Telepsychiatrjz The Perils of Using Skwe By Marlene M. Maheu, PhD and Joseph Mclvlenaniin, MD, JD I March 28, 2013 Dr lilaheu is the Executive Director of the Telelilental Heatth Institute, Inc. She is the lead author of eHeaIth, Telehealm and Telemedicine (Josey Base; 2001) and The Mental Health Professional and the New Technologies (Roufledge; 2004). Dr Mclilenamin is a Principal Consultant with Venebio Group, LLC, in North Chesterfield, Va, and an Adjunct Professor of Health Law at Virginia Commonwealth University, Richmond. Va, '5 First released in 2003, Skype offers free, worldwide video access to any patientwith an Internet i ‘}t L connection, either by mobile device or desktop computer. What it does not offer, however, is a it“ ‘ T ii"? { ‘it means of communication cleany suitable for clinical services—especialIyin mental health. iii I $ According to estimates reported by groups such as the Institute for Healthcare Consumerism, : i. ii‘ ,3‘ itelehealth is poised to grow by 55% in 2013 alone, and 6-fold by 2017.12 Wisely or otherwise, :31‘; i some ofthis growth will likely occurvia Skype. Thus, it is prudent to considerthe issues. The Health Insurance Portability and Accountability Act Ordinarily. neitherfederal nor state law is designed to regulate specific proprietary entities such as Skype and its competitors. Video«chat platforms were developedlor marketing to the general consumer, and notfor health care. The Health Insurance Portability and Accountability Act (HIPAA) holds professionals responsible for conducting their nent, the professional : rictimes. com/ borderline—personality/ content/ articIe/10168/2134149 mm. one coumake Resources . _u EEC: Searchluledica nieciiiue Drugs Search Careers Multimedia About Us . ,/*9t/ /// : Lfrmide nmnizy-savim offers to help you help your patients. i sin. -tum. . "v~'~, L_ . ,‘ , l Nuln RL‘plE: i:IItfll'Ix. Z ‘— ‘~ Cymluitfl lduluxetine HCI, delayed release cansules) as indicated lur the iieatmert ii‘ naior tlepiessr-'e disorder [VDD) The aliicacy ul Cyribalta uiasresteblishecl ‘in lDU' ShDli-lE"| 'i and one maintenance tiiai in ad; is Available in 20 mg, 35 mg, and 50 mi; napsu 25 lm ortnnl Szilety Inform; -ition About Cylnballd gr . ... ... ... .. . ... ... .,. ... .. ... . ors—AIilldeprcssants Increased the risk or uiicidal than his and behavior in children. Idolescenls. and young I lllll Ill short-lerm studies. These xludizs D Prescribing Information D Medication Guldc TOPIC INDEX Addiction Medicine Health Care Refonn Alzheimer Disease Major Depressive Anxiety Disorders Disorder ADHD OCD Bipolar Disorder Personality Disorders Child 8. Adolescent Schizoaffective Psychiatry Disorder Dementia Schilophrenia Depression Sleep Disorders DSM-5 Somatotonn Disorders Geriatric Psychiatry All Topics 33" ‘~ ~ — — i
  • 23. III HIPAA requires an ”audit trai Skype doesn’t provide audit trails — and isn't obligated to M; T o ‘ i. /‘ ‘‘ it .3’. ~ ‘ * __ ‘ t / _ '. “= - "9 ‘F’ #9 V i ” / . a‘ : 1 v F
  • 24. I 7 | gn: §,i_: rir; t : ~:mr. |:: . ‘ " "I ‘A I Kfllilll‘--’-l“l4.'H‘ Skype’s Most Recent Hacking — November 2012 ~". n.: :I@‘r: i-olifzu: l U) By Leonas Sendrauskas on November 14. 2012. [UPDATE:14I11I2012@15:28GMT] Early this moming we were notified of user concerns surrounding the security of the password reset feature on our website. This issue affected some users where multiple Skype accounts were registered to the same email address. We suspended the password reset feature temporarily this morning as a precaution and have made updates to the password reset process today so that it is now working properly. We are reaching out to a small number of users who may have been impacted to assist as necessary. Skype is committed to providing a safe and secure communications experience to our users and we apologize for the inconvenience. V es»: t: '»: :l. “E5-lC'. lCIl“IS
  • 25. I ‘ V .5n: ji_: rm : ~:m~-i: : , . (( ‘A 3. (Ql: lIl~. .>. ll3I4.'lv internet VTC Companies Claiming HIPAA Comp| iance* Handoff Sessions betw non www. telehealth. org[video W°eVl5es»‘31i'p? £‘. §~“"‘“°'* _ hm Companies we at TMH Institute now use (both are . developers for Vidyo): * Soltrite '* SecureVideo * TMH Institute has partnered with some of these companies and will receive a referral fee if you mention us. You may also get an added discount/ bonus. ; *:= , 21:»: 7;-= ;._: -‘r 2,1»,
  • 26. ' | :n: §i_: m;l : ~:; ~. i:: . "' ' '" ' ". urau~. .». illu. .-iv . 5 l . , . l-l| PAA and Email Hackers can find copies of email on: — laptops — mobile devices — the exchange server — the recipients‘ exchange servers — the recipients‘ laptops or mobile devices — all those to whom the messages were forwarded i»*r, 'z' l': *;. _I-‘I wgq.
  • 27. 1 , |gn: §,i_: m;l : ~1:V’i. l:: . (( " " ' _ Kdldll‘ ll: -iv . at . , . l Secure Email ° Be aware of technical jargon and symbols that can be used to communicate client information, e. g., SMS text messages and email characterisations. ° Clients are encouraged to confirm that clients have received the clinician's email ~ Avoid using the ‘Reply-to-all’ prompt 51,": l': *;. _i-‘I u_‘; .
  • 28. lf-Li-Ml>Nl/ l Hmm ((( __ I _‘ V‘ telehealthorg Commercial Email Companies - Neomai| box. com ° Hushmai| .com - 4securemail. com - Luxsci. com - Send| nc. com
  • 29. ((< 7%. E ‘.4&NlI. -“rfi. W‘ Get a Secured Email Account telehea| th. org : i.i= . i-_ _ Califomia Redwood MedNet provides health information exchange services in rural Northern California. The Redwood MedNet Direct Proiect pilot has one goal: to deploy directed secure messaging for production data delivery in support of meaningful use measures. read more rt‘ The #directPruje<t on Twitter RT @Cemer: Interested in 1¢Dire<tProje<t goings—on? Follow ®greg_meyer93 for new developments and announcements. #hea| thlT #FF Interested in kDirectProjec! goings-on? Follow ®greg_meyer93 for new developments and announcements. =healtlilT : xFF RY @DataMotion: Excellentll httD ft co il(zaZ1DSvl<. '4 @(| audiawil| iams 3¢DivedProjed 1lI'l(EfGp€I’al.3Illt)' Jab . cti; rP9'. e @ahier @DirectTrustorg thx Brian! refresher on bundles 8: why they enable vscalabletrust l¢DirectProjec1 http ilT. LOlLl| (UOl'| lri5T1 ®ONC_Hea| thl'l flil E'e; _-ll! RT @ahier: One way that ! ¢DirectProject Wlll scale: 1tDirectTrust Anchor Bundles http ‘Y :0 16Ic. iL. voqKL Nice work @Greg_Meyer93 81 @DireCtTrustorg learn‘. lyl : .: l RT @ahier: One way that ! ¢DirectProject will scale. #DirectTrust Anchor Bundles ‘nttp , ‘ ‘t :0 i16lC'. lUOqlL NICE work @Greg_Meyer93 81 @DirectTrustorg team‘. §-D, =verl. C~ilper
  • 30. mewumi HELlH ((( I_I I _ I_‘I telehealth. org HIPAA ’’Final Rule” January 17, 2013 ° Department of Health and Human Services (HHS) final modifications are effective March 26, 2013 ° Compliance deadline: September 23, 2013. ° Business associates of covered entities are directly liable for compliance with HIPAA Privacy and Security Rules’ requirements. Includes contractors, subcontractors and business service companies working for health care providers, (e. g., companies providing electronic health records software, teleconferencing, data back—up and storage, billing, transcription and other IT services). ° Raises the maximum penalty for data breaches from a previous cap of $250,000 to a maximum penalty is $1.5 million per violation.
  • 31. 3 , ign: §,l_: rir; i : ~1;V_i. l:: . (( " ' ' . (Jl: iil: r.lllI. .-iv , l, .I . l HIPAA Enforcement The most common types of covered entities required I 5, . I, to take corrective action: “ C it Private Practices ‘I _ I * General Hospitals ‘ §_ ° Outpatient Facilities ,2 J‘ I‘-(___I "’. I/‘_I_I_’-I—I. :., ;~; -' * Health Plans (group health I ‘lie J‘ - plans and health insurance issuers) and e Pharmacies http: //www. hhs. gov/ ocr/ privacy/ hipaa/ enforcement/ highlights/ inde x. htm| inn. ‘ . ':*; ._i-‘I 1;. _‘; .
  • 32. l Ia! e.‘. l.= _»: II’rT 7 in which using Skype differs from traditional telehealth 1. Choice of technology is ours, not a hospital's 2. Supportive evidence base 3. Techno| ogy—specific training re: clinical issues 4. HIPPA compliance (confidentiality, audit trails, history of hacking, etc. ) 5. Client/ patient authentication 6. Practitioner authentication/ certification 7. Insurance reimbursement 8. Risk management (liability protection, etc. ) inn. ‘ . ':*; ._i-‘: u. _‘; .
  • 33. TELEMENTAL HEALTH I telehealth-org I N S T I Y U Y I APA Ethical Standard 2: Research—based Protocols ° 2.04 Bases for Scientific and Professional Judgments Psychologists‘ work is based upon established scientific and professional knowledge of the discipline.
  • 34. TELEMENIAL HELiH ((( I ___I I I I _ II I telehealth. org Clinical Competence Client/ Patient Selection ° Study the evidence base (research) ° People with almost all diagnostic symptoms have been treated with traditional telehealth, but those with severe anxiety, flagrantly psychotic symptoms or suicide/ homicide intent may not be optimal choices while symptom patterns are exacerbated. - Treatment to the home has not yet identified which groups are too risky ° Understand differences between treatment of individuals in 1 setting vs, another (hospital vs. car, park, bed etc. ) ° Consider compliance problems
  • 35. Luxton. D. D. . 0’Brien. K. . McCann, R. A. . & Mishkind. M. C. (in press). Home-Based Telemental Healthcare Safety Planning: What You Need to Know. Telemedicine and e- Health. Home-Based Telemental Healthcare Safety Planning: What You Need to Know David D. Luxton, PhD. . Karen O'Brien, PhD. . Russell A. McCann, PhD. . and Matthew C. Mishkind. PhD. The National Center for Telehealth & Technology Keywords: in-home. telehealth safety, telemental health ("nrrpcn fflf‘1-fl U 3IIflIfiI"
  • 36. meMm1m. nsLm ((( I K V I g _ L I telehealth. org Client/ Patient Selection ° /5 the c/ ient/ patient comfortable with the technology you are using? — assess patient perceptions of the appropriateness and safety of home-based TMH care by discussing the topic with them prior to initiating TMH care and — reassess this during the course of treatment Luxton, D. D. , O'Brien, K. , McCann, R. A. , & Mishkind, M. C. (in press). Home-Based Telemental Healthcare Safety Planning: What You Need to Know. Telemedicine and e-Hea/ th.
  • 37. TELEMENIAL nsum ((( I K V I g _ _ I te| ehealth. org Client/ Patient Selection ° Inclusion of screening measures or questions during each treatment session may be beneficial ° Evaluate whether technology might limit the capability to observe essential nonverbal behavior during the delivery of care — video may not be optimal due to screen size or connection speed Luxton, D. D. , O'Brien, K. , McCann, R. A. , & Mishkind, M. C. (in press). Home-Based Telemental Healthcare Safety Planning: What You Need to Know. Telemedicine and e—Health.
  • 38. meMm1m. nsLm ((( I I_ I I I _ IA I telehealth. org Clinician Issues ° What are your expectations regarding home- based TMH care? ° What is your comfort level with TMH home- based care given the population you serve? ° How comfortable are you in established safety plans? Luxton, D. D. , O'Brien, K. , McCann, R. A. , & Mishkind, M. C. (in press). Home- Based Telemental Healthcare Safety Planning: What You Need to Know. Telemedicine and e—Hea/ th.
  • 39. (' , n; g=, *,I_3riru_ : .:m; .x: : I. ( ulduwlllu -m I OCPM Step 4: Liability Insurance * Likely to be nullified if practitioner is practicing criminally (e. g., w/ o proper license or improper billing practices, depending on state) * For benefits to apply, must have: — a formal client agreement for clinician to be considered as providing professional services ° Often can have ”coaching" added to policy for additional fee if certified by recognized group 2:2»: n-= ;._: -*: : ,1.
  • 40. 1 , |55=j, I3r| y;t_ : ~:m; .x: : I. ( I I . (JI: h[: —>. IllI. .-Iv I APA Standard 10: Informed Consent * 3.10 Informed Consent (d) Psychologists appropriately document / written or oral consent, permission, and assent. — http: //www. apa. org/ ethics/ c ode/ index. aspx ll 3': 7 . I:-*. ' 2:1.
  • 41. mewnim HELlH ((( I II I I _ I I teIeheaIth. org APA Standard 10: Informed Consent ° 3.10 Informed Consent (a) When psychologists obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code.
  • 42. IELEMENlA1.HELIH ((( I I_ I I I _ IA I teIeheaIth. org Mention Initial Protocols ° Prior to session, obtain the direct phone number for emergency services for the location of client/ patient — Test the non—emergency (non-911) number for that area to confirm — Discuss ”code words" ° Initial protocol — Identify yourself and ask them to do so, including their geographic location at the time of contact — Important not only for emergencies but also for state licensure requirements — Scan your room with your camera and ask patient to do the same
  • 43. TELEMENIAL nsum ((( I II I I I _ II I teIeheaIth. org Informed Consent ° Represents a ”meeting of the minds” — Information is influenced by many factors, including ° Client/ Patient's capacity for absorbing information ° Time limits ° Clinician's schedule — Subject matter is often complex and technical — Clinician thinks she is speaking English — Client/ Patient may be under stress (or may assert so later) — Mental illness - Document only serves as important evidence
  • 44. I . |55=I. ‘,I_3riy; I_ : ~1;V_i‘-I3: I. ( I I . (JI: h[: —>. IIlI. .-Iv I I * Specific statutes govern * Who's state law controls? ° Solution: assume that the s More conservative Informed Consent: Function of State Law informed consent in telehealth law of the client/ patient location will most likely be applied -. ,.»-‘ approach is to determine the law in both your and your client/ patient’s state and follow the mandates of the more stringent law arr»: I‘; -=; ._: -rs 2,1.
  • 45. 1 , |55=j, _3r| y;t_: ~:m3.| :: >, ( I A _ uldn‘ Iii: -m V 3 Informed Consent Issues that Need to Be Covered 2:2»: *; -=; ._: -*: 2;;
  • 46. 3 , :5-= i,I__= rw : ~1;V_-‘-1:: I, (( " ‘I ‘A , umu~. .». IIlu. .-Iv I Name Other Parties ° Obtain information regarding medical and psychiatric services that are nearby to make appropriate referrals ° Obtain name and contact information for the patient’s medical provider during a crisis situation — Send letter as you would with local clients upon intake rt: # .5: -»; ;.
  • 47. (' n; g=, *,I__= ,rnru_ : .:m, .~. x:: , ( _ umulzr-Illu. ,-iv Informed Consent Documentation Basics ‘I Date * Diagnosis * Outline of intervention -* Risks and benefits of each technology used -= Risks and benefits of competing approaches — Including no service ° Emergency Plan including names and contact information for local, trusted person(s) to be contacted at the discretion of the clinician 2:3»: I‘; -=; ._: ~: «.3,
  • 48. Imwuwu Hmm ((( _ _ _ ‘ V ‘ teIeheaIth. org I Consent Documentation Basics ° Signature of Witnesses if available ° Confidentiality and limits thereof as related to mandated reporting (suicide, homicide, abuse) ° Fees, if any Statements similar to: - My questions have been answered to my satisfaction in language I understand ° As of the time of my signing, all blanks have been filled in
  • 49. TELEMENIAL HEALIH ((( I ___‘ V I g _ U _ I teIeheaIth. org Informed Consent Documentation Basics ° Err on side of listing infrequent and minor risks — Might discourage some who would benefit ° Some risks may not yet be unknown ° No physical exam ° Identify both the clinician's & client's/ patient’s physical location ° Must rely on information provided by the client/ patient and by any on—site practitioners or other sources ° Potential problems could arise with electronic transmission in telepractice: — distortion, delays, interceptions, interruptions
  • 50. |; g=, ‘,_5I: n “i: ~17;V7I'-I3: uiahlzr-Illi. ,-iv Safety Issues Have an addendum to your informed consent — Include a social media policy H 7/’ '{ q 2:2»: I‘; -=; ._: ~: I ,1.
  • 51. IELEMENIAL HEALIH ((( I N 1 I I V U 7 I teIeheaIth. org Safety Issues to Consider Addressing* - In home-based care, is there access to firearms? ° Discuss firearm ownership, safety, and the culture of firearms ° Be prepared to negotiate firearm disposition with patients and consider involvement of family members when You may want to reflect these appropriate _ _ ° Use of trigger safety lock agreements m Ongomg devices is an option informed consent documentation
  • 52. 1 , |55=j, I_3r| y;I_ : ~1:VVi: l3n‘ I, ( I I _ (JI: h[: —>. IllI. .-Iv l Safety Issues to Consider Addressing * Discuss potential technology and infrastructure issues prior to initiating the delivery of care — adequacy of bandwidth (the rate of data transfer) — reliability of telehealth equipment (computers, monitors, video cameras, audio equipment, etc. ). — loss of connection due to inadequate transmission bandwidth or other equipment failure during a clinical crisis situation — insufficient camera resolution or environmental problems (adequacy of room lighting and microphone placement) 2:2»: I‘; -=; ._: -‘r nag.
  • 53. 3 , :5-= i,I__= m;I : ~:r; I_I. x:I I, (( " ‘I ‘I . uIau~. .». IIlu. .-Iv I Safety Issues to Consider Addressing * Identify and use of a local collaborator such as a family member or close friend of a patient — Enter name and contact information into informed consent document — Stipulate under which conditions these people will be contacted — Outline emergency procedures and when collaborator will be notified — Clearly define expected roles and responsibilities of local collaborators — Consider discussing these issues with family members directly am»: n': ~;. _:-‘I nag.
  • 54. IELEMENlA1.HELIH ((( I I_ I I I _ IA I teIeheaIth. org Safety Issues to Consider Addressing ° Local collaborator can be helpful for: — providing information about the patient’s history — monitoring mood and behavior — assisting with treatment planning and coordination — coordination with local 911 service when needed — provide an additional mechanism for contacting patients if a connection becomes lost — provide on-site technical assistance — provide support to a patient during emergency situations
  • 55. TELEMENIAL nsum ((( I H V I b _ H I teIehealth. org Safety Issues to Consider Addressing ° Assess when using a local collaborator may not be advisable: — Safety of local collaborators must be carefully considered — may be best to rely on trained 911 responders — Be cognizant of potential deleterious effect of disclosures made during emergency management on patient confidentiality and relationships, especially in small communities
  • 56. ssssssssssssss m ((( I H V I b _ H I teIeheaIth. org Safety Issues to Consider Addressing ° Discuss the technical requirements with the patient prior to initiating treatment ° Consider the level of technology experience of the patient (train if needed) ° Have a back—up plan if the video connection is lost — telephone —— landlines are best, but cell phones are better than nothing
  • 57. V telenealtrnorg I Emergencies (write your policy) How will you handle? What's “°t °k? ° Not willing to handle - Am willing but need resources - Not sure
  • 58. ,3». F? ,_: 9 , . O - ‘I ~; ’ " . ‘ _ V A. 7&4:-_3-_ _’. I , Vi“ I . , . _ K ‘C’ - . “x: .‘- .1 . ~ I _ L hlu, ’q4?’J I *2} _, L 5- I-. . , ‘ A "‘: “-3'. ’ ". ; You will be in a locked room and will arrange your room so that I can see you adequately, as per my comfort level.
  • 59. iELEMENlAl. HELlH ((( I II I I _ I_ I teIeheaIth. org OCPM Step 6: Direct Clinical Care 0 Conduct a formal intake — no shortcuts 9 Decide ifi then which technology is appropriate 9 Obtain names & contact information for all other key providers 9 Obtain all appropriate releases to contact them
  • 60. tttttttttttttt IH ((( I II I I I _ II I teIeheaIth. org Boundanes 9 Contract for short, protoco| —driven tx 9 Authenticate & set ground rules with introductory protocol at every session 9 Enforce boundaries (privacy, family, social media) 9 Evaluate at regular intervals 9 Document progress 9 Revisit backup emergency plan as needed
  • 61. TELEMENIAL nsum ((( I I_ I I I _ II I teIeheaIth. crg American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) ° 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 ° Emergency protocols shall be created with clear explanation of roles & responsibilities in emergencies
  • 62. TELEMENIAL nsum ((( I II I I I _ II I teIeheaIth. org 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
  • 63. TELEMENIAL nsum ((( I II I I I _ II I teIeheaIth. org American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) ° Be aware of the impact ° Be aware of safety issues of remote care on with patients displaying provider's perception of strong affective or control (or lack thereof) behavioral states upon over the clinical conclusion of a session, interaction, and how and how patients may this might impact then interact with provider's management. remote site inhabitants
  • 64. IELEMENlA1.HELiH ((( I II I I I _ II I teIeheaIth. org Your Availability ° Specify the limits of your availability (9 am — 5 pm) ° Boundafles — Office hours — Unplug — Answering email or text messages - What's the norm? — Get input from community of like—minded pros
  • 65. ll The Future l ‘: :'-f''‘‘-**' *‘**‘~'= -‘* . :-— ~v, ".». . '(¢. »‘. .-; ‘.- ~vv-. 'v‘. ,*v. ‘*r’ ‘~" 7 xv/ —,~'. <~-wnw a+; cce: <~*’»; g¢’m‘*z, r«. _ __ _ __ __ -4:-Y3“/ :‘6*Zs*’3'éA1~*’x«§9_ ' Wt" ** "W" V I ‘ ‘'4' ‘bl : IX)’ " 9”" ‘-31,; ~f— Y‘-’ ,
  • 66. ((( 7l. E‘.4E>; llI. -“rd. 'l‘ l -, l l Questions? mi éouf telehea| th. org Marlene M. Maheu, Ph. D. - Te| eMenta| Health Institute, Inc. ° Phone: 619-255-2788 - Email: mmaheu@te| ehea| th. ORG - www. te| ehea| th. org

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