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CiMH Behavioral Health Information Management Conference, April 2013
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CiMH Behavioral Health Information Management Conference, April 2013



Marlene Maheu gives a telehealth workshop to the California Institute for Mental Health (CiMH) conference in April 2013 in San Diego, California. ...

Marlene Maheu gives a telehealth workshop to the California Institute for Mental Health (CiMH) conference in April 2013 in San Diego, California.

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



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CiMH Behavioral Health Information Management Conference, April 2013 CiMH Behavioral Health Information Management Conference, April 2013 Presentation Transcript

  • Behavioral HealthInformationManagementConferenceSan Diego, CA 92120April 4, 2013 1
  • We Are Re-tooling 2
  • Telehealth vs. Telemedicine Telehealth RegionalHealth HealthProfessions InformationEducation Sharing Consumer Telemedicine EducationAdministration PublicEvaluation HealthResearch Homeland Security 3
  • Video Teleconferencing (VTC) Copyright 2013 TeleMental Health Institute, Inc. All rights reserved.
  • Reach & Benefits of Telehealth• Increased client satisfaction• Decreased travel time• Decreased travel, child & elder-care costs• Increased access to underserved populations• Improved accessibility to specialists• Reduced emergency care costs• Faster decision-making time• Increased productivity / decreased lost wages• Improved operational efficiency• Efficacy is on par with in-person care for many groups• Decreased hospital utilization 5
  • Recent Supporting ResearchBackhaus and colleagues (May, 2012) reported in their abstract of a meta-analysis that:• 821 potential articles were identified, and 65 were selected for inclusion.• The results indicate that VCP is feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face-to-face psychotherapy. – Videoconferencing psychotherapy: A systematic review. Backhaus, Autumn; Agha, Zia; Maglione, Melissa L.; Repp, Andrea; Ross, Bridgett; Zuest, Danielle; Rice-Thorp, Natalie M.; Lohr, James; Thorp, Steven R. Psychological Services, Vol 9(2), May 2012, 111-131. doi: 10.1037/a0027924
  • The Is Video Teleconferencing (VTC) Effective?• Yes – Medicare & Medicaid required to pay • Outcomes are relatively comparable, especially for follow-up care (intakes are still a matter of state law) • Literature for specialty groups is sparser, but positive (pediatrics) – Also effective for supervision – Can improve some ways service is rendered – See www.telehealth.ORG/bibliography• BUT, traditional VTC isn’t the same as Skype Copyright 2013 TeleMental Health Institute, Inc. All rights reserved. 7
  • Skype • No audit trails • Poor Reliability • Video platform or social media platform? • Hacked 11/14/2012 • http://heartbeat.skype.com/2012/11/security_issue.htmlCopyright 2013TeleMental Health Institute, Inc. All rights reserved .
  • Existing Guidelines -- Many Cover Far More than Telehealth• 1998 American Psychiatric Association – Telepsychiatry via Teleconferencing• 1999 (2005) American Counseling Association – Ethical Standards for Internet On-Line Counseling• 2000 American Mental Health Counselors Association – Code of Ethics of AMHCA, Principle 14, Internet On-Line Counseling• 2000 American Medical Association – Guidelines for Patient-Physician Electronic Mail• 2001 National Board of Certified Counselors (NBCC) – Center for Credentialing and Education The Practice of Internet Counseling• 2001 Canadian Psychiatric Association (CPA) – Telepsychiatry Guidelines and Procedures for Clinical Activities• 2004 (2010) Australian Psychological Society – Guidelines for providing psychological services and products on the internet• 2006 National Association of Social Workers & Association of Social Work Boards – Standards for Technology and Social Work Practice• 2008 (2010) Ohio Psychological Association – Telepsychology Guidelines• 2009 Canadian Psychological Association – Ethical Guidelines for Psychologists Providing Psychological Services Via Electronic Media• 2009 American Telemedicine Association – Evidence-based Practice for Telemental Health – Practice Guidelines for Videoconferencing Based Telemental Health 9
  • 10
  • 4 Key Aspects of Risk Management• Know the Applicable Standard of Care for Your Patient Population and within Your Discipline• Legal Code• Ethical Code• Malpractice insurance 11
  • Risk Management• Save all proof of training or consultation to prove you’ve “sought the advice of your peers”• Record Keeping: – Document, document, document • Protocols Followed • Time in, time out • Dropped connections • Intrusions • Lighting • Adaptive Equipment • Assess progress Copyright 2013 TeleMental Health Institute, Inc. All rights reserved. 12
  • OCPM Step 6: Direct Clinical CareExplain & sign informed consent documentConduct a formal intake – no shortcuts Meet in-person or video, take full history, medications, illnesses, abuse, stressors, support system, use of other technology, drug/alcohol use, suicide/homicide intent, mental status Decide if, then which technology is appropriate Obtain names of all other key providers, get all appropriate releases 13
  • Boundaries of CompetenceRacial, Linguistic, Gender, Religious & Cultural Diversity 14 Copyright 2013 TeleMental Health Institute, Inc. All rights reserved.
  • Risk Management:Research-based Protocols &HIPAA-compliant Platforms 1000+ Reference Bibliography http://telehealth.org/bibliography 50+ Video Platforms http://telehealth.org/video Copyright 2013 TeleMental Health Institute, Inc. All rights reserved. 15
  • 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 2013 TeleMental Health Institute, Inc. All rights reserved. 16
  • Inter-jurisdictionalIssues (practicingover state lines ornational borders)Practitioner must belicensed:• In a state• In the local state of patient• Both 17
  • Duty to Report / Duty to WarnCalifornia State Law• (v) Failing to comply with the child abuse reporting requirements of Section 11166 of the Penal Code.• (w) Failing to comply with the elder and adult dependent abuse reporting requirements of Section 15630 of the Welfare and Institutions Code. CA Business and Professions Code Sections 4989.54 (cont.) 18
  • Risk Management• Communicate often in writing to your local, state and national professional associations• Have written emergency plans 19
  • American Telemedicine AssociationVideoconferencing 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 20
  • American Telemedicine Association Videoconferencing Guidelines – Emergencies (2009)• Determine outside • Be familiar with local emergency coverage civil commitment• Establish guidelines for regulations and have determining at what arrangements where point other staff and possible to work with resources should be local staff to recruited to help initiate/assist with civil manage emergencies commitments 21
  • American Telemedicine Association Videoconferencing Guidelines – Emergencies (2009)• Emergency protocols shall be created with clear explanation of roles & responsibilities in emergencies 22
  • Coming next… Which models should we follow?Copyright 2013 TeleMental Health Institute, Inc. All rights reserved.
  • 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 24
  • Integrated Model
  • •Nursing Homes
  • Schools 27
  • Hospitals 28
  • Rural Hospitals 29
  • CorrectionaFacilities 30
  • Military & Veteran’s Migration ModelAdministration 31
  • Home Health 32
  • Online Norm vs. Standard of Care• Mostly Email & Chat vs. Video• Anonymity / No Patient Records• Avoid Responsibility w/ Website Disclaimers• No Clear Channels for Mandated Reporting 33
  • Online Norm vs. Standard of Care• No Contact with Other Treating Clinicians• No Authentication of Consumer / Professional• No Emergency Backup Procedures • Misunderstanding of Clinical Processes (suicide) • Operating w/o Needed Research for Unsupervised Settings 34
  • mHealth (mobile health)• 55% of Americans owned a smartphone in March 6, 2013 (comScore) • Up from 36% in 2/2011; Up 29% from 10/2010• Reimbursement will soon make geography a non-issue Copyright 2013 TeleMental Health Institute, Inc. All rights reserved. 35
  • Today’s teens usemedia an average of:• 10 hours and 45 minutes• every day• 7 days per week*• Americans are already looking to their smartphones for health care 36
  • Health & Behavioral Care in 20 Years• Mobile devices and peripherals will deliver most health and mental health care – Sensor-based information gathering • Mirrors, scales, vests, chairs, mattresses, steering wheels, exercise equipment, etc. – Self-report 37
  • Health & Behavioral Care in 20 Years• Mobile devices will be networked into central database that will correlate all real-time data with your genetic profile: – as reported by you, family members, friends and neighbors who share your environment; and – demographics of people who share your habits, lifestyle, and personal preferences for food, drink, exercise; – medical conditions and medication; – combined with latest empirical evidence about each source 38
  • Health & Behavioral Care in 20 Years• Data will be complied into recommendations that will deliver medications, foods other ingestible substances and behavioral prescriptions in ways that will help remedy diseases and problems before they can even be noticed now. 39
  • Wearable Computers (Glasses) 40
  • Weight LossThe BodyMedia Core 2 Armband (theBiggest Loser / 24-hr Fitness / JennyCraig) but now has "jewelry-like"customization• Sensors: skin temperature, heat flux, galvanic skin response, and a 3-axis accelerometer (pedometer)• Optional add-on: a continuous heart- rate monitor using dry electrodes• Bluetooth Smart connectivity allows BodyMedia data to be uploaded to BodyMedia’s smartphone apps• Waterproof, can be worn for swimming / Size of iPod Nano• To release in August for $119 - $149 41
  • Muse to Control Emotions • InterAxon Muse • monitors your brainwaves and transmits the readings to your smartphone • “brain training” software designed to help people gain more control over their thoughts and emotions • The device will sell for $199 when it launches in 2013 42
  • Marlene M. Maheu, Ph.D.TeleMental Health Institute, Inc.Phone: 619-928-2627Email: drm@telementalhealth.com 43