CPA Conference, April 2013 - Building a Successful Telepsychology Practice


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Marlene Maheu gives a telehealth workshop to the California Psychological Association (CPA) conference in April 2013 in Newport Beach, California. She presented on the topic, "Building a Successful Telepsychology Practice: Quick Start Guide to Legal, Ethical, Technical & Practical Strategies.”

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: You will also receive notices of our bonuses and discounts for professional training for CEUs and CMEs.

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CPA Conference, April 2013 - Building a Successful Telepsychology Practice

  1. 1. I Z ‘ig5_= ,.*. l.5.‘l :1; : ,=; r}; i:n , . ( I § . ura- [~. r.lI3i4.Il(c Building a Successful Telepsychology Practice: Quick Start Guide to Legal, Ethical, Technical 8-. Practical Strategies CALIFORNIA PSYCHOLOGICAL ASSOCIATION Institute April 11,2013 Marlene M. Maheu, Ph. D. ("-j't. ':f‘? i’i. ',§'? 'Cr‘. .i“{.
  2. 2. I , :5-= .*, 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 «.3,
  3. 3. l , |gn: §,I_: m;! :~1;[s. x:: ,, (( " " ' _ mun‘ II: no , 5. I, , l Learning Objectives 1. Participants will be able to name 3 ethical issues related to telepsychology. 2. Participants will be able to name 3 laws relevant to telepsychology. 3. Participants will be able to identify 3 evidence-based models for success as a telepsychologist. 3'. ‘ 7 {"5 ‘NJ-
  4. 4. Ll The Future I ‘: :'-f''‘‘-**' *‘**‘~'= -‘* . :-— ~v, ".». . '(¢. »‘. .-; ‘.- ~vv-. 'v‘. ,*v. ‘*r’ ‘~" 7 xv/ —.~'. <~-wnw a+; s~ce: <~*’»; g¢’z. «3/, r«. _ __ _ __ __ -4:-w. '<l“/ :‘6*Zs*’3'éA‘. ~’*’x«§9_ ' cw" ** "W" V I ‘ "4' ‘ll : IX)’ " 9”" ‘-31,; ~f— Y‘-’ ,
  5. 5. L ‘mi: -:<: .>Il‘iI ri T‘ —‘ ‘ Copyright 2012 TeIeMentaI Health Institute, Inc, All righs reserved.
  6. 6. CHANGE Change is good you go first. — Dilbert
  7. 7. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  8. 8. ll: 2007 by Randy Glasbergen. www. glasbergen. (om a’; R‘ “How can I trust your information when you’re using such outdated technology ”
  9. 9. Coming next. .. 6 The Past The Present The Future C . ' . ‘:. - l-l—I. l.I win. .." I I . - -. .-.5 I
  10. 10. "I I= .*= .‘ ,5 ' : ,, , 5'f’l‘_"'A, 1f“ ‘ullumzr-Ilii. .-Iv "*’ _‘F. ‘a, . ‘ . “ ' II "V / '7‘ I . 4 , _ --— gr? ’ 1.'2;--. n.‘. y,{( ‘I. i _ . I v. :5‘- . . 1! ! I. I I / .Q' -‘So ' . . ' l - " I 1 I. . . ‘ l V‘ ¢s71~«- _ *7.‘ ‘ ' u -‘~ ll . V ' ' ll. ' w. ’ :1 E‘ II Li; I . ' -4‘, "F 3 d " I r ’ . 'r " O ‘1 - I g ‘A- ‘ ' q, . ’I2,_. .: :. 0." ‘‘I f ': )7»; 2 Q L‘ ’ fx_ . m': ‘.‘_ F ’ ": 'Q ‘ 1 f ‘ ll-l u . - . ;-“. ‘ * -4. J. ‘-. *‘_, ' T , «I v ' ‘ ~ , "°. ';'«_l1l. l_. '.‘-, f'_, .. ‘Jw: H _. ’ . — ‘ _ _- -4‘? 7‘ . -3 x. . ~>r*r? i l. . - - ' ‘h . . ~ , . » -- . ‘ ~ »->_'; I ", >‘4 x. ~ > 1 I ~’: , ‘ ’i= ~ir? ~?= x2*«—: * . .' 4 -: -‘~*-«:1— S I ~f. l.1-l-. .;fi‘_T‘r*—_1:§4-u. u‘4.>'? .e. i. All -'I'7’f1"'7'. -.‘: I.. ‘:'. ~ -. 4 :11 ? “°= '-"”"" . _, .. _. ,. n,
  11. 11. rs wmm sum ((( IL“ 7 I g fr teIeheaIth. org TELEPHONE-BASED CARE
  12. 12. 'V‘gll“; ‘_l[. i:l_"-I"fl _: ."w§"yE I’ ll : H”L‘I, Coming next. .. 6 The Future has Arrived C . ' . ‘:. - I-I. r.I. I win. .." I I . - -HIV? I
  13. 13. 1 , I§_! §.‘, l3Pl'; i_ : ~1;Vsi‘-I3: , , ( I s _ (JI: lii: r.IllI. .-iv Telehealth vs. Telemedicine Telehealth Regional Health Health . professions Information Education Sharlng Consumer ° ° Ed t' . . . Telemedicine ”” '°“ Administration Public Evaluation Health Research Homeland Security arr»: *; -=; ._: ~: : ,1.
  14. 14. ' : .=‘il= ‘ Ll : ~1;V*- : I , l"""“£ll ‘ i miaIi~. .». iIli. .-iv Rea| —Time Telemedicine . ‘ I 7 ‘(I ; — :7’ A‘{ l“ iii: I l < ~ '3! l ll‘ -91: I * or : ’x_‘. ‘.‘T'''___«-''. -;'‘'‘— ‘Tl ls ~: -,. -~. —-<-- . .‘. .- III LA. .. . " ' ‘. l‘.5._, , I . ' , »‘; «~ I, _- I. F1. o“. ‘.A. sr- ‘ - r‘--II. I-W , . ll l is $9 l. :"; I.. i‘ _- . - Lil L'mb'‘ -. 3] ‘. ‘‘'. t'' ' lllv 4" l"’Fl I iy’ V. ;? ,=2'__, , *5 -as 4 J , » Patient in rural ER gets benefit of local care plus remote consultation with specialists. Remote doctor examines a patient’s inner ear from a remote location. w. in
  15. 15. I. I 7*-. F. i=_': ‘_Jl}. I §_= ,ll"i)i”I:4=lli’i'}; -‘ii! ‘} H
  16. 16. Future of Telepsychology, Telehealth, and Various Technologies in Psychological Research and Practice" from "Professional Psychology: Research and Practice, " Vol 43(6), Dec 2012, 613-621. Downloadable copy: www. te| ehea| th. org/ future Future of Telepsychology, Telehealth, and Various Technologies in Psychological Research and Practice Marlene M. Maheu Myron L. Pulier Joseph P. McMenamin Les Posen
  17. 17. 4-. T lx ll‘ Random People Vampires Animals Robots Vehicles _ll " I__ L45’ lfi°%"E
  18. 18. VIRTUALLY B THE CLlNlC Bnnging Interactive Technology to Behavioral Healthcare for Treatrn nt and Training News Avatars May Help Children With Social Anxiety Overcome Fears Cllll I Virtual reality battles PTSD The Daily | Treating tear of flying with 3-D simulators University of Alabama adds VR Exposure to School of Social Work Bama Prof Amy Traylor isn't a new-comerto using VR in social work and sehavior: -il health She's been working with ‘I/ BI colleagues like PEllflCl-’. BOlCll'1|CK_ and former CEO Ken Graap for years So VBI is proud to confirm that we Wlll be delivering a system to Alatiarna for use in the School 0fSOClal WorI<. Check out the details, here. VR~based Treatments get "Exposure" on Fox 5 virtually‘ Better welcomed Krista Lit‘lIefieId_ from Atlanta's Fox 5 news. Iastweeklor a feature on 'v‘R based treatments Thanks Krista! Atlanta News, Weather, Traffic. and Sports| FO1«' 6 PRODUCTS COMPANY ADHD: Not just a school problem. Difficulties with focus, overactivity: impulsive behaviors. and increased emotional reactivity‘ are common symptoms of ‘l‘lel1l| Ol'l~ Deficit. -‘Hyperactivty Disorder (ADI-ID). These and other ADHD symptoms can wrealr. havoc in school However. school grades and behaviors are notthe only areas impacted. andthey are oflen not even the most negatively‘ effected Children with this disorder are also more likely‘ to sufier from speech
  19. 19. 3" __ Wearable Computers (Google Glasses) inn: I': *.. _i-‘I’ ujj.
  20. 20. ((< TELEMENIAL HEALIN telehealth. org
  21. 21. Reviews News Download CNETTV How To Deals f '* Log In | Join s, I~Isu~G The Next Big Thing For Business Is Here 3 % I ‘V war: IZZNET News Crave i, r’I' SAMSUNG Confirmed: Gioolg| ei Glass arrives The lle>_<t Big Thing in 2013, and under $1,500 §’[, §§; S‘"eSS -Googles atigiitented-realm specs are ahead of schedtife Are you react). ‘ V I ‘Eat >1 ricm to get *, ‘OLlrS€lf fitted for a set7 EricMacl<. - . i‘I IINII /43 Q‘) ; _3 f Follow 55"‘ fi I. » I 3:- W. » E; H I; : r'vllDlB’I ; r:, . i: '. Comments 98 HottestRoIioI_. _Is ‘ iPhone 5: Finally, everything we hoped it would be -8 I. mI. ,;. —IIs199.99 ( gt _ 7 ‘, *k>‘<*~k~k J Microsoft Surface Pro: Smart almostlaptop nearly nails it ‘IIii‘«i. -If: Ill 5899.99 ‘k*)<>'~1 Ctiromebook Pixel: Brilliant touch Possibly the ‘must—have‘ gadget forthe 2013 holiday season (Click the image for a Google Glass slldeshow. ) screen, hefty price (Credit Google) Regular people will be able to purchase Google Glass eyewear by the end of 2013 for less than r- " I HTC One wows with stunning $1.500, sources have confirmed to CNET , & (l6$lS“I Pfemlum PMS Google originally targeted 201 -1 for a consumer release when it revealed Project Glass last year,
  22. 22. ((( TE‘Lé_'. Mfi”A’:1‘t‘WH telehealth. org! ‘ IR‘'<3 Persona| Robots Group mi! media lab r‘, .w: «J llc. " " t Home Welcome to the Personal Robots Group ej 5'l, l?l‘: l.F§. i‘. (=)I€l: fll’MIh'I. l§fI-‘. 'l' ‘v .3“"“"‘5’I>.
  23. 23. nsl M O The World 5 Most Advanced Humanoid Flobol AS(MO v NEWS EDUCATION V TRAVELS ASIMO TV v GALLERY DOWNLOADS ASIMO IS DESIGNED TO HELP PEOPLE l 0 tr turn sound off 43)) EXPLOIE UVE SHOW 3 ‘ FEATURING » g. ; ‘ GALLERY 2 V" AS| MQ TV High Quality Photos ofASIl. lO DOWNLOADS Official ASIMO downloads for your Mac, PC or SEE ASIMC UVE 4, lNNOVATlONS 3 vroeo HISTORY «) 5'T'a”°"°"e _ y _ TRAVELS got; ytos can siedgsrmo See Tglw rooots in b Cnetcgout Honda 5 mogflrtynh finegkiout : )Vt: dED mstoryhot Vem of ASIMOS “Wm Amencan Tum captured In ms 8| 8 lSllEy ll EVE pmen now Cfill flflg W00 DGSGNIDOWEFE W 0!! ESFO 0 CSVSSEBFC nomdournal out the best In us in the future ASlt. l0-derived technology D ""“"‘°" HONDA Facebook ! hnPowmu1DmorrI
  24. 24. uldrizr-llli. ,-iv Electronic Health Record 32' 7 3*: 2:1.
  25. 25. T I-1:Vi: lL , . _ ‘;1l'>, I[. 'r']| n'4VI". APA Proposed Society for Technology & Psychology COMMUNICATION 8: Practice °°"; ','; "T‘, ’,]‘, ',f, ‘,‘J5'°“ Science (e. g., Internet, Blogging, Social media; Cybernetics [e. g., Blosensing/ Feedback]; Social networking) COMPUTING METHODOLOGIES , (e. g., Artificial Intelligence; TELECOMMUNCATIONS ————— . Natural Lang. Processing; . . 4 ~. Robotics; UserCom uter (E-Eu EIECWDNIC M3”; PM LC" L‘= lCA : “ “Vfl= l[<V Interfaces [e. g., Comqauter Telepsychology; Remote l Vision Tracking, Haptic Sensing; Wireless, 8: Training J Interfaces]; Computer Technology; Telephones [e. g., Slmulatlons [E-Eu Vilma] Mobile Phones, mHealth, Human Agents/ Avatars 8‘ Messaging]; Video Environments]; Conferencing; Interactive Voice Microcomputers; SD Imagmg; Response) Software [e. g., Video Games] Education Public Interest HEALTH IT 8: INFORMATICS (e. g., Big Data; Controlled Vocabs [e. g., ICD-10]; Decision Making 8- Support; Data omen TECHNOLOGIES Mining; Electronic Health and ll « (e g Biotechnoiogy ‘ Personal Health Records; Ngnotechnolo ' Electronic Data Privacy, Nanomedicing/ ' Security and Integrity; Health Information Exchange; HITECH; Information Storage 8: Retrieval; Interoperability l Copyright (c) 2012 by Marlene M. Maheu, Ph. D.
  26. 26. Primary Focus: Not the technology, but rather, the service we deliver However, Different Modalities Require Different Skill Sets - | n—person - Text (email, chat, texting) - Audio - Video
  27. 27. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  28. 28. lELEMENlAl. HELlH ((( I 5 V I _ ‘_ ' teIehealth. org Myths vs. Realities ° Not same ° No research ° It's too expensive ° No reimbursement ° It's illegal or unethical - All telecounseling involves direct care ° No guidelines Doesn't need to be 1000s of articles Saves SS Reimbursable Legal and ethical Se| f—he| p can be developed Many guidelines exist
  29. 29. ((< ll-LE-MENIAI HEAL IH I telehealthorg lr. , 'l, 'I Telemental Health Standards & Guidelines American Medical Association. (2000). Guidelines for Patient—Physician Electronic Mail American Counseling Association. (1999, 2005, 2013). 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, Inc. , 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
  30. 30. (' r; g=, i,l__= ;rrtl_ : .:m; .x: : , ( I g _ (JI: hi: r.lllI. .-Iv Competence e (i) A psychologist shall not practice outside his or her particular field or fields of competence as established by his or her education, training, conti nuing education, and experience. Cal. Bus. & Prof. Code 2915. cwmmmyrnrnwwg.
  31. 31. ((( EEEEEEEE Al. HHHH LlH I. -., i 'l. 'I teIehealth. org OCPM Step 1: Training ° Boundaries of competence —Limits of technology ° Authentication ° HOW & when to respond, and when to use telephone instead
  32. 32. TELEMENTAL HEALTH l telehealm-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.
  33. 33. (' r; g=, i,l__= ;rrtl_ : .:m; .x: : , ( I g _ (JI: hi: r.ll3I. .-Iv OCPM Step 1: Training Know how to find and follow peer-reviewed research protocols before offering services t0 consumers 4 _ — http: //telehea| th. org/ bibliogr I. _ phv ‘I " ‘ 9 Look at: — funding sources — meta—ana| yses arr»: 2-= ;._: -er «.3,
  34. 34. ’3.’5,"‘I5". '~"; "~‘-‘f’3“~? "' zar: II_-. .=rizs. ;IIae‘~. APA Ethical Standard 6: Record Keeping L‘ 6.01 Documentation of Professional and Scientific Work and Maintenance of Records Psychologists create, and to the extent the records are under their control, maintain, disseminate, store, retain and dispose of records and data relating to their professional and scientific work http: //www. apa. org/ ethics/ code/ index. aspx
  35. 35. tttttttttttttt IH ((( I ___I I I I _ II I telehealth. org OCPM Step 1: Training ° Choice of Communication Channel (modality) — Responsibility of Professional? ° Technology specific training/ proficiency for each modality + combination of modalities ° Confidentiality for each modality ° Client authentication for each modality ° Practitioner authentication for each modality
  36. 36. TELEMFNIAL HELlH ((( I I_ I I I _ II I telehealth. org OCPM Step 1: Training ° Training for each technology ° Training for dealing with boundaries between multiple Internet technologies: — Email / Chat Rooms — Telephones / Cell Phones / ”Apps” / Texting — Videoconferencing (Public / VPN / Cloud) — Websites / Forums / Social Networking ° Which technology for which patient —— and when?
  37. 37. TELEMFNIAL HELlH ((( 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 ° 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
  38. 38. CLINIQAL MQQE IF IQ] FOR SUCCES§ . .-_a’-. a~r—a- SUPPORTED BY TH "—I"l'I | |f- EVIDENCE BA_§§ I ~-—— -s. : F’) Coming next. .. Which models Are supported by research?
  39. 39. IELEMENIAL HEALTH ((( N S I I II I I telehealtlmorg I I -Nursing Homes
  40. 40. 1.’ " / ' _ J ‘- I ,4‘, I P‘ I I. -_o- ‘kt : ( ' ‘I 2?; . , .
  41. 41. Hospitals
  42. 42. Rural Hospitals
  43. 43. Correctiona Facilities
  44. 44. Home Health t
  45. 45. Military & Veteran's Administration l / ‘ 7 Y , .4 4"’ 2. I r ' , / -, / . 1 I I . A X , I ' I .
  46. 46. I I fl _ ’ Opinion 62° Sundayu June 17‘ 2012 Last update: 8:28 pm. NEWS POLITICS BUSINESS HEALTH SPORTS OUTDOORS LIVING OPINION DBITIZARIES EVENTS _I_-RRY)IE CONTACT H-: —.‘. : item cur [CllTi"'->_li’ill State J An: N *3J_l§Ll'3-I3 l Ban-; t:<rl Drzmn East it Hani: i:n: F’ : Lewisti Aiuaurn I l. llCi’—li: l3lfl-E‘ l Ilill3C‘: !aE'€ 1 Pen . r»: itl F‘isi: ataQuis l Portland . Search this site : i:; i:m: Prewous story: Next story: -- Republicans are moving Maine backward ALBERT . -_I]STIl' DI, 'I'TO. ' >> Eorroms 3" ‘ is: GET NEWS EMAIL UPDATES Surviving war to die in Maine T % T . ‘ ' " ” News .1 . ~,c- 1. 2o~_‘earAold Appalachian Trail hiker drowns in pond in remote tOTISi1ip 2. 4 motorcyclists die in crashes across J‘_ _; ,c13M , mi NH at start otbike week AS‘LVlte national antlteni was played. .Iaine‘s 'orld War II veterans and other meirbers 02 the mi1ir. ar_' and 3. Police identify man killed in Amherst -d thousands of spectators as they saluted the I_’. S. flag during the 2010 is. banqordailvnews. com/ pmmc “ash
  47. 47. ValueOptions and American Well Partner to Deploy the First National Behavioral Telehealth Network f -~-3 fisher: g*1i NORFOLK, Va. and BOSTON, June 27, 2012 / PRNewswire/ — VaIueOptions®, a health improvement company that specializes in emotional wellbeing and recovery, and American Well” today announced a partnership to bring critically-needed behavioral healthcare to patients wherever they are, whenever they need it. Using American WelI's industry-leading Online Care telehealth solution, ValueOptions will transform behavioral healthcare by offering members immediate, live and clinically meaningful consultations. With American Well technology, ValueOptions will develop a first-of-its-kind, national network of telehealth-enabled providers. Through Online Care, ValueOptions members will have secure and private access to skilled behavioral specialists from home, WOl’k or any location where they have lntemet connectivity. Telehealth removes many barriers to healthcare such as distance, mobility and time constraints and can help lessen the stigma sometimes associated with behavioral health. Online Care provides ValueOptions an efficient and convenient solution to dramatically enhance behavioral healthcare access and quality for its diverse membership, which includes both commercial and public sector employees and their families; military servicemen and women and their dependents; as well as Medicaid, Medicare and dual eligible populations. ‘With over 130,000 provider locations. we have one of the nation's largest behavioral health networks. However. the reality is that there are still not enough providers to serve the growing demand for quality behavioral health services in every comer of the United States. Access to care is an issue for many, " said Heyward Donigan, president and CEO of ValueOptions. "Growing demand for telebehavioral health services is evidenced by the speed at which reimbursement is accelerating. Today, 34 state Medicaid programs have recognized the need and the value of telehealth services. These 34 states already reimburse for such services, and 14 states are mandating telehealth reimbursement. Additionally. we continue to witness increased demand for telehealth in the Federal marketplace as well as a growing interest in our commercial business segments. " "OnIine Care telehealth allows us to bring behavioral health directly to our members, " adds Dr. Hal Levine, chief medical officer of ValueOptions. "Whether location or transportation inhibits access, or perhaps a member is simply having trouble taking that important first step toward engaging available services, telehealth enables us to connect with the member where they are — not just where they are located, but where they are in mindset when it comes to seeking treatment. " ValueOptions will harness telehealth to reduce the rate of missed appointments and increase compliance. Moreover, with Online Care, ValueOptions will build a more efficient, more convenient model for care delivery that will complement existing in-person services, lead to better health outcomes for members, enhance the bottom line for providers, and eventually, reduce costs for the system of care.
  48. 48. ll-LEMENI/ ii Htfillh (( _ I W ,1 teleheaIth. org 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 ° Considertheir diagnosis ° Take the time to prepare them . Plan in-person sessions at ______, . _ regular intervals ° Do not work through their . . secretaries or others
  49. 49. Definition of Terms ° Behavioral Telehealth Telehealth vs. Technology? - Eheahh ° Telehealth ° Telemedicine ° Telemental Health - Telepsychology - Online Counseling ° Online Therapy - mHea| th - Telecounseling
  50. 50. H telei'iea| th. org 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
  51. 51. I H telehealth. org 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
  52. 52. 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
  53. 53. ((( irlrriw EEEE L HEAL TH teleheanhicrg 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
  54. 54. 1 , i55:, ‘,l3riy; i_ : ~:i; n.i: : , , ( I g _ rJl: lii: r.lllI. .-iv 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 ° Progress toward establishedl goals arr’: r
  55. 55. rim : -1;V_l-I3: , ' _ KQl'—}I['-7-Iulufll‘ Inter-jurisdictional Issues (practicing over state lines or national borders) Practitioner must be Hcensed: 6 In a state 6 In the local state of patient it Both Government House of Representatives Approve Internet Doctor Treatment State Representative Dan Winslow (R-Nor1olI<) who represents Medfielo saw his proposal to ease Access and reduce medical costs pass the House this past week June 16 2012 , !’Tweet 0 Email Print 6 Comments Editor's note The following was submitted by the Dan Winsloiv Committee In a move that could revolutionize the delivery / ‘ access and cost of primary healthcare in Massachusetts. the House of Representatives ~ ’ approved a plan to allow doctors licensed ’. . . anywhere in the United States to consult ‘ e T , ' / M ‘, . Y" . 4 diagnose and treat Massachusetts residents by I ‘ ‘ , ‘ I" ' inlernet video examinations V P [ I “Telemedicine will allow qualified physicians to be immediately available 24/7 and as near as your computer or smartphone "said Medfield's State Representative Dan Winslow (R—Norfo| k) who sponsored the legislation "It approved by the Senate and signed by the Governor this new technology will be a godsend to worried parents in the middle of the night to seniors who are confined to home to residents in rural areas who lack convenient access to primary care physicians and to anyone who can't wait a tew days or a week to obtain a prescription " said Winslow (3) Upload Photos and Videos Under the plan as approved by the House Massachusetts‘ Board 01 Registration 01 Medicine will develop and implement standards for a "telemedicine" license for which physicians licensed in any state will be eligible to apply Massachusetts is home to a number of high tech companies that are developing Ielemedicine technology including Americanwell com which provides more than 100 iobs Telemedicine can range trom computer or sman prione consultation to high tech video booths at drugstores that include blood pressure and temperature sensors Telemecl doctors can expedite referrals to specialists and in person exantiriations when needed Related TUNES: DBTI VVli'lSl0‘iV HOUSE Oi REDFBSEUIBII‘/85 and Internet DOCIOI
  56. 56. I ' , |_: _I: ,‘l_= i‘| I;‘‘: ~:1;V>l-l: : y. ' ' "‘ ' . ldl’-III‘--’-ll'l4.'H‘ , 5 . lv , Benefits of Traditional Video-Based Te| ehea| th* ° Increased client satisfaction ° Decreased travel time ° Decreased travel, child & elder-care costs 6 Increased access to underserved populations * Improved accessibility to specialists 0 Reduced emergency ca re costs * Faster decision-making time ° Increased productivity / decreased lost wages it Improved operational efficiency Maheu, Pulier, Wilhelm, McMenamin & Brown-Connolly. (2004). The mental health professional and the new technologies. Erlbaum, New York. s': t,'z* i': =;. _i-‘I u_‘; .
  57. 57. ieieMmiAi. >ie-itiii ((( I 5 V I _ ‘_ ' telehealth. org The ls 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. te| ehea| th. ORG/ bibliography - BUT, traditional VTC isn't the same as Skype
  58. 58. 1 , |55=j, l_3riy; i_ : ~1;V_i‘il3: y. ( I A _ (Jl: hl: —>. lllI. .-Iv l Recent Supporting Research * Godleski, Darkins & Peters reported in April of 2012 that hospital utilization in psychiatric populations at the Veterans Administration were decreased by an average of 25% since the use of telehealth. It is worthy of note, however, that: — This study focused on c/ inic—based, high—speed videoconferencing and did not include any home telehealth encounters. Mental health patients were referred for telecare by clinicians. Typically, telemental health services were provided remotely at community—based outpatient clinics by mental health providers of all disciplines located at larger parent VA hospital facilities. Equipment consisted of either room or personal desktopvideoconferencing units transmitting at 384 kbps or greater. Godleski, L. Darkins, A. & Peters, J. Outcomes of 98,609 U. S. Department of Veterans Affairs patients enrolled in telemental health services, 2006-2010. Psychiatric Servcies, 63(4). 383-385. 2:2»: I‘; -=; ._: ~: : ‘._‘; .
  59. 59. ieieMmiAi. >ie-itiii ((( _ N ' telehealth. org | i'», l Recent Supporting Research Backhaus 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: 10.1037laOO27924
  60. 60. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  61. 61. I_: _!? .‘, l__= _g! l ulaiii: ->-IIIL, -iv OCPM Step 2: Referrals or Internet Marketing (IM) * Provider lists it Colleagues with telehealth training 0 Professional websites, blogs, apps All iPhone Apps tor "mental health" .4 tr .1, . ... ... ... ... ... ... ... .. ~. mm, . --. - i; .1 : ( 4 mm | ; :>. _. - nl cr N . ‘e: . ii: I J ii , 1 . -.. . . ... . ‘ ‘ 51". ‘ i': =;. _:-*: : ,1»).
  62. 62. TELEMENIAL HELlH ((( I H V I g _ H I telehealth. org OCPM Step 2: Referral Solutions — Only give referrals to professionals you trust are following state and federal legal (civil court — tort law), regulatory (state board) and ethical (professional association) codes — If your colleagues can't discuss the required codes related to telemental health intelligently, and are using technology for their practice, they probably aren't following them carefully — How much liability are you prepared to accept?
  63. 63. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  64. 64. Ml ‘ uldiizr-llli. ,-iv E I I ,4; . {’. "'-’~ 4. i I _.4‘ s Discuss risks and benefits of email communication in your informed consent process 9 Outline how your mandated duties to report/ warn will be handled 51?’? i': =;. _:~: : ,1»).
  65. 65. l(- wwiiii HELlH ((( ILII I I I IV I telehealth. org Clinical Email ° Acquaint your patient with technology's limitations — Speed of response — Language skills of both participants ° Admonition: Not for emergencies — 911, ER, local provider — Emergency back-up can be difficult to arrange and all but impossible to assure — Extract a written pledge
  66. 66. I H teIehealth. org Clinical Email, 2 Joe Friday: Just the facts, ma’am — Not the time to be clever, flippant, cute, amusing, humorous Proof your email by re-reading before sending Check the ”To” line
  67. 67. 3 , igg= ,*, i_5rir; i_ : ~1:V_i‘il: : I. ( I I _ Kiliill‘ ll: -iv l Patient Education Email / Texting Social networking File exchange Computer repair Clinical records Insurance Reports Lateness / Missed sessions Non-compliance/ Avoidance 3'. ‘ 7 . I:-*. ' 2:1.
  68. 68. IELEMENlAl. HELIH ((( I I_ I I I _ IA I telehealth. org APA Ethical Standard 9: Assessment ° 9.01 Bases for Assessments ° 9.02 Use of Assessments ° 9.03 Informed Consent in Assessments ° 9.04 Release of Test Data ° 9.05 Test Construction ° 9.06 Interpreting Assessment Results ° 9.09 Test Scoring and Interpretation Services ° 9.10 Explaining Assessment Results - 9.11 Maintaining Test Security
  69. 69. 1 , igii: §,i_: rir; t : ~1;ii. i:: I. (( " " ' , (Jl: lil: —>. lllI. .-Iv l OCPM Step 6: Direct Clinical Care ti Explain & sign informed consent document 9 Conduct a formal intake — no shortcuts 9 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 9 Decide ifi then which technology is appropriate 4 Obtain names of all other key providers, get all appropriate istrir 1'; -'a. _i-‘I ‘i‘. {(—
  70. 70. " ii i—i{~i“iL. 'H I I l. 'eietiealtl‘i. org i l 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/ i: ode/ index. aspx
  71. 71. ii ixiwixi HEi‘iLi‘H ILII IV I I telehealth. org I Risk Management Have an addendum to your informed consent — Include a social media policy Communicate often in writing to your local, state and national professional associations Have written emergency plans
  72. 72. i; g=I. ‘,_5ii iii : ~17;i/ i‘-I1: uiaii~. .». illi. .-iv APA Standard 10: Informed Consent ‘i 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. i*i*l', 'z' i': *;. _i"i' ujj.
  73. 73. ((( Ii-Lt» AAAAAAAAAAA LIH . ii. I ~i, 'i telehealth. org 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/ code/ index. aspx
  74. 74. ' I i5ii: IiiI: ~iy; i : -:; i;ii: i I. (( ' ’ "“ ‘ iiJl: !ii: ->-lliui. -iv , i i iI , Conduct a Search for Your Own Name in Google l. la. il&ii»: lil3"i>: -ii ' - §'l. —Z in I r‘ rs’ Il f) J “ ---l- at ‘J’ o l Marlene Maheu) martene maheu marlene maheu phd marlene maheu online therapy marlene maheu telehealth martene maheu san diego ca marlene maheu san diego maheu marlene m phd maifene m maheu marlene m. maheu ph. d dr. marlene maheu Google Search l‘rn FEel'l'lg Lucky r;
  75. 75. IELEMENIAL HELlH ((( I ___I I I I _ II I telehealth. org Social Media Is Not Private ° ". ..assume that anything you post will be seen, read, and open for comment. Anything you say, post, link to, comment on, upload, etc. , can and may be used against you by your peers, colleagues, employer, potential employers, fellow members, and so on. ” - APA http: //www. apa. org/ about/ socia| —media—po| icy. aspx
  76. 76. English ~ Near (Address. Neighborhood. City, State or. San Francisco, CA Search for (e. g. taco, cheap dinner. Max's) Real people. Real reviews. 5 Find Reviews Welcome Aboutue WriteaRevlew FlndFriends Messaging Talk Events don't miss TODAY'S deal from Arar Keely Kolmes, PsyD Category: Counseling 8. Mental Health [Edit] 220 Montgomery Street {if} Suite 400 (between Bush St& Pine St) San Francisco, CA 94104 Neighborhood: Financial District www. drI<koImes. com Hours: 9! Appointment Only: Yes Mon 1 pm - 7:30 pm Tue-Wed 11 am- 7 pm Thu-Fri 11 am — 5 pm View Larger Mapil Edit Business Info Browse Neamv: Restaurants | Nightl 4 Write I Review Deals Nearby 0 10% on Ayurvedic consunations at Ayurveda for Balance - Debra Riordan CAS fell: Ad 575 f0; 5 . _‘ 6 (€i'l§li'S . Magnoli: ,yelp. com/ map/ kedy-icolms-psyd-San-francisco lifestyle recommendations and seasonal cleansing with , "" I 33" Fla‘
  77. 77. lELEMENlA1.HELlH ((( I K V I b _ L I telehealth. org Rating Sites: Yelp (Keely Kolmes, Psy. D.) - Your right / Gently discourage for these reasons: 1. The American Psychological Association's Ethics Code states that it is unethical for psychologists to solicit testimonials: Principle 5.05 ”Psycho/ ogists do not solicit testimonials from current therapy clients/ patients or other persons who because of their particular circumstances are vulnerable to undue influence. " Since you may decide to return to therapy with me at a later date, I do not request testimonials from people who have ended therapy with me.
  78. 78. lELEMENlA1.HELlH ((( I K V I g _ L I telehealth. org Rating Sites: Yelp (Keely Kolmes, Psy. D.) - 2. Unlike other business owners who may respond to their Yelp reviews, as a psychologist, I must provide confidentiality to my clients. This means I am restricted from responding in any way that acknowledges whether someone has been in my care. Thus, I do not intend to respond to any reviews.
  79. 79. ;«_ uiduizr-IIIL, -iv Rating Sites: Yelp (Keely Kolmes, Psy. D.) * 3. I hope that if we work together, we can discuss your feelings about our work directly and in person. This may not always feel comfortable, but the discussion of positive and negative reactions to our process can be an important part of your therapy. If it is simply a matter of poor fit, I ’m always happy to help you find a therapist who is a better match. in, am»: .~: ~;. _:-*: «.3,
  80. 80. iiiiiiiiiiiiii IH ((( I II I I I _ II I teIehealth. org Rating Sites: Yelp (Keely Kolmes, Psy. D.) ° 4. If you still choose to write something about my practice on Yelp, remember that this is a public forum and you may be sharing personally revealing information with a wide range of readers. To preserve your privacy, consider using a pseudonym that is not linked to your regular email address or friend networks.
  81. 81. I H telehealth. org Internet Ratings: Where are we going? ° Expect ratings and quality surveys by healthcare providers to become standard operating procedure by smartphone app users. ° Yelp — They can rate you but you can't fully defend yourself without violating confidentiality
  82. 82. It is ethical to have a "Time| ine” Page on Facebook or a similar advertising page on Goog| e+ 1 , |55=j, l_3rly; l_ : ~:l; Vj: l:: (, ( I I _ (Jl: hl: —>. IllI4.-lv ? 'T, l!l': l:'l! lI]t- . -:— : ' ‘ l ; e:. .: , la: e,-: ' ,5 .4 ; _», ,'_, _.a. -. . ;.»l. :.l 'l-7‘-- Tl- ( ‘ Telemental Health Institute Tlmefine " Now ' Highlights ' Admin Panel Te| eMenta| Health Institute 3,. .. think —i lresearch. .. " — M ¢, ""~s_' V _ , s'EbhiIcaI%§i§le“; fiZ. “. , u _. -4 __I_m- . . ..”, . . :5 ; _,n l: ;,t; :t: ;~_s; .«». ,} . .9A6'e§? tto§@nll, i1ephtée| zl1fil. ==l29t§ 1» :4 I; __: :.: _.. _ . .._LY§§e£arg_§r; a_nU°nelié| F$lEsG'Elf'%un§v$. ,|n Wgtélélgggzz- A “f‘°“~""“"*braining§ g‘w. .., ... ' E IIIII I 5b_elemedlcl_ne pi"acb| cgmI __y‘__I; _vI'II-I, >I~; I.n_ O , 9 — l ‘r 49-52% - 1 services work‘ - ,4 * l . . . 'e'. ’.vu$o; $.Tr(‘. /F~l_ / psgchologlsbé 5 §Securll1g, _‘. %:': .,, ?,_, ,,s(. .«. , g , ,,, _; mI__ _ . 5 I U) E Telemental Health Institute -5 like it -v I I ll (T Researdmsased Professional Training for Telehealth, "’, _II3_ ' y Telemental Health S Online Therapy . I N @164 l v as fix ca I *'¢‘-W‘ F‘hoto~: (welcome Lite»: status it Photo / Video Event, Nllestone + ( 'lelen1entalHEalth Institute: ’ : ’ — ‘l"l '— - : :—l , l — 3 Easy I-loblle Securl Tips, Telel-Iental Health ews, August _ II V 28, 2012 , '_; '‘, T Make A Fan Page A success Goodtherapy. org
  83. 83. 3 , |gn: i,l_: rlr; l : -:m_. ~.x: : , (( " ‘I ‘I . ulau~. .». lllu. .-lac APA Ethics Code — Standard 5 C 5.01 Avoidance of False or Deceptive Statements —— ads, endorsements, resumes, CV5, published materials C 5.02 Statements by Others —— we remain responsible, do not compensate media, clearly identify paid ads — webmasters and plagiarism < 5.03 Descriptions of Workshops and Non—Degree—Granting Educational Programs — accurate < 5.04 Media Presentations — based on literature and practice 6 5.05 Testimonials — not from current clients C 5.06 | n—Person Solicitation — protect others from our undue influence 25:2»: r: '~; ._: ~: «. j§.
  84. 84. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  85. 85. All Existing Legal and Ethical Rules Alololv 32' 7 . I:-*. ' 2:1.
  86. 86. Business and Professions Code Section 2290.5 (a) For purposes of this 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) ‘Telehealth’ means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. (b) 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. (c) The failure of a health care provider to comply with this section shall constitute unprofessional conduct. Section 2314 shall not apply to this section. (d) This section shall not be construed to alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law. (e) All laws regarding the confidentiality of health care information and a patient's rights to his or her medical information shall apply to telehealth interactions. (f) This section shall not apply to a patient under the jurisdiction of the Department of Corrections and Rehabilitation or any other correctional facility. (g) (1) Notwithstanding any other provision of law and for purposes of this section, the goveming body of the hospital whose patients are receiving the telehealth services may grant privileges to, and verify and approve credentials for, providers of telehealth services based on its medical staff recommendations that rely on information provided by the distant-site hospital or telehealth entity, as described in Sections 482.12, 482.22, and 485.616 of Title 42 of the Code of Federal Regulations. (2) By enacting this subdivision, it is the intent of the Legislature to authorize a hospital to grant privileges to, and verify and approve credentials for, providers of telehealth services as described in paragraph (1 ). (3) For the purposes of this subdivision, ‘telehealth’ shall include ‘te| emedicine' as the term is referenced in Sections 482.12, 482.22, and 485.616 of ‘Ftle 42 of the Code of Federal Regulations. lfyou believe you have been treated unprofessionally by a BBS licensee, either through treatment over the lntemet, or by any other means, review our information on filing a complaint llndatr-rd‘ Januanl 73 701?
  87. 87. J’ L to l'{ r TOOK THE ‘:3 l-' LAST cup ' OF C0FFE, E r TOO MUCH e? r.°es2'—5 -< MAKE A I U / wfiieqsers Kpueu oooz «:5: 6m9 WHITE COLLAR CRIMES
  88. 88. ((( let EMENTA. HER; W‘ telenealthorg Duty to Report / Duty to Warn ° (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. )
  89. 89. Practicing Over State Lines
  90. 90. ( ’3,!3“. ‘i5‘: ’."f“""‘f'3“‘§"; ‘ if-It’; -3it_= I'-llliq’-r'(9‘: Essential Functions Of Licensure Public Safety — Consumer Reporting — Prosecution of ’’evil agents” — Financial solvency of boards — Protecting one’s turf
  91. 91. 3 ' , l_= _|3i‘l, =‘| l;‘i : -:r; i_r. r:: ,. (C ' ’ "T ' _ (Jl: hr~. r.l| iI4.Irl' , 5 . lv . The 7 Most Alarming Truths About Most of Our U. S. Licensing Boards 1. State boards are not under a mandate to work collaboratively with other state regulators across U. S. states. 2. State laws are contradictory across states and even within states — and more so across national borders. 3. State laws are antiquated and have not adequately kept up with technology. For example, while some focus on email, mobile health issues are rapidly accelerating. Many mobile devices have evolved into medical devices, which involve the FTC. How many of us have had medical device training? This catch—up problem is worsening with time. jars»: 7i‘i -«; .», .
  92. 92. 3 ' , I5I= .‘l, =‘rr;1i: -:r; i_i. r:i , . ' ' "“ ' . urarrznrliui. -rv , £ . . The 7 Most Alarming Truths About Most of Our U. S. Licensing Boards 4. Most state regulators have never received formal training to understand the research related to using telehealth, and much less other forms of advanced health core technology (such as mHea| th, robotics, virtual reality and other significantforces poised to alter healthcare in the next 5 years). 5. There are turf wars occurring between states that make it practically impossible to get things changed. Need more collaboration, but some states refuse to compromise on some issues. 1. How to reconcile the different types of credentials currently required in different states Who will bear the cost and work involved in enforcement of infractions? 3. Who will absorb the short—fall when professionals licensed in several states only pay for licensure in 1 state?
  93. 93. lt-LE-MENTAI HE: LlH ((( ‘ _ g V I teIeheaIth. org The 7 Most Alarming Truths About Most of Our U. S. Licensing Boards 6. In the marketplace, we face competition from coaches and other groups that are completely unregulated or have equally poor regulatory systems. Restricting us won't work in the long run. 7. State regulation is largely an honor system. Enforcement is very lax, but improving.
  94. 94. L‘_ (Jl: l|l: -*-lllinllv Cross—Border Practice 6 Licensing Boards that may assert jurisdiction: — The one in your state(s) of licensure — The one in the client/ patient's state of residence/ location — Both 6 Safest: — Provide services only where licensed — Require client/ patient to attest to his or her location on every call 3'. ‘ 3' . f"i' ‘i‘. ({—
  95. 95. 3 , I§n: ,i, i_: rr; t : ~:r; V_i‘-r: : , . (( " " ' _ (draw Iii Irv , i 5' . l Cross—Border Practice * Decline clients where you are not licensed — Use authentication services ~ Biometric — Iris — Voice — Thumb — Use traditional proof of residency “ ISP? — Driver's license, registered to vote, utility bills 3'. ‘ 3' . f"i' ‘i‘. ({—
  96. 96. 3 , :5-= ,*, i__= mit : ~:r; i_i. x:i , . (( " ‘I ' urq. .». ili. ,,. i.. i Telepsychology Legal Review 50—S'tate review of Telehealth (http: //www. apaprac'ticecen'tra| .org/ advocacy/ state/ 'telehealth—slides. pdf) APA Good Practice Summer 2010 air»: 3'; -'~; ._: ~: i; §.
  97. 97. American Psychological Association Practice Directorate, Legal & Regulatory Affairs Telehealth 50-State Rev] CW March 2010 State Psvchologlst General Telehealth other Notable Temporary I Guest Penaltles for Vlolatlon Telehealth Provision Provision Activities License Availability although no specific statutory fromthe time the application is rules EXl5l onthis issue) approried - Requires a laceto-face - Licensed out-of-slate consultation between a patient practitioner must be supenised and physician whenthe physician by a licensed Texas has notseen the patient following psychologist an initial telemedicine sen/ ice - Texas has created pilot telehealth prograrrs for other health professions (Tex. Goii‘t Code §531021T1) UTAH No Yes (U. A.C. R432-100-32) ”* Establshes rules Yes (Utah Code Ann. §58-1» 3"‘ Degree Felony (Utah Code Ann. governing reimbursemert 307) §58-61-501) - Grants hospitals the right to policies when telemedicine engage in telemedicine practi; s heath care sen/ ices are - Licensed out-of-state - Possible line up to $5C00 dollars - If a hospital choosesto use proyidedto patients (Utah practitioners may practice inthe AND/ OR telemedicine, the hospital itsell Code Ann. §28-18-13) state ony it called tor a - Possible imprisonment up to 5 must develop and implement consultation by an indnridual years governance pr’ - licensed in Utah . » Services performed must be limited to the consultation Penalty for both Utah and Vermont ihnme pE. "'°d '3 ”°t "3 mead , e duration olthe consultation IS harshl mm - No specific language requiring advanced notification to the board VERMONT Yes (26 l. S.A §3018) No i - Yes (CVR04-030-270) General Misdemeanor (3l. S.A. Psychological Examiners §127, 26 VS A. §3002) - Psychologists who proiiide website for disclosure - Licensed out-of-state sen/ ices via electronic requirements (per Rule practitioner may practice lor no - Possible line up to $5600 dollars means are deemed to be 3.10) for psychologists who more than 10 days or80 hours AND/ OR enggging in telepractice provide sen/ ices via the in any 12-month period - Possible imprisonment up to 1 Disclaimer. This document does not constitute legal advice and should not in e relied upon, as it is not routinely updated and was prepared with information Rom other sources, whose accuracy was not independently verified by APA APA strongly encourages the reader to independently verify the infomiation contained herein andlor consult with independent legal counsel if the reader intends to use or otherwise rely on such infinrmatton. Because the lawand related infomiation continually change and because APA rehed on other sources to compile information contained herein, APA cannot guarantee the completeness, currency or accuracy of this document.
  98. 98. American Psychological Association Practice Directorate, Legal & Regulatory Affairs Telehealth Revlew March 2010 State Psychologist General Telehealth Other Notable Temporary 1 Guest Penalties for Violation Telehealth Provision Provision Activities License Availabilitv Jarotessionals MASSACHUSETTS No No See policy on No General Misdemeanor (ALM GL ch. Massachusetts Board ol 112, §122) Registration ol Note that Section 123 exempts, Psychologists website: inter alia, persons eligible lor - Possible fine up to $500 ANDIOR http. //www massgov/ ?page licensure under section 1 19 who - Possible imprisonment up to 3 | D=ocaterminal8.L=8&L0=H provide corsultative seniices for months ome&L1=Licensee&L2=Div a tee no more than one day a ision+ot+Prciessional+Lice month from penalties for nsure+Boards&L3=Board+ unlicensed practice outlined in ot+Reg‘ctration+ol+Psychol Section 122. ogists&L4=Statutes+and+R egu| ations&L5=Board+Poli cies-and+Guldelines3isid= Esticky Note 9/6/2010 8:56:25 - ctronic SEnI| CES&l3|[l= ElJC n mam-'"e"‘ahe“ Opt'°”5 ' 2 . ‘ :7‘ : H = ’i‘~1 ; ,f phone calls MICHIGAN No No k : L §333.16294) o tine and/ or ant penalties MINNESOTA No Yes (Minn. Stat. §147.032) ”* Mental health senrices ' Yes (Minn. Stat. §148.916) Gross Misdemeanor (Minn. Stat. provided by two-way §138.941; $090341) - Grants licensed out-of-state interactivevideo are - Licensed out-oi-state physicians who annually register covered lor insurance psychologists may practice in - Possible fine up to $100.) AND/ OR with the state board the rightto purposes (Minn Stat. the state for no more than 7 - Possible imprisonment up to 1 practice telemedicine 25630625) calendar days year - Cannot open an otlice within the ‘* Same rates appy for - May practice up to 30 days per state, meetwith patients in the insurance repayment as if year it apply tor a guest state, or receive phone calls in the lace-tolace seniices licensure state lrom patiems? provided - Application for guest licensure - Not subjectto tel@neTficine must be received at least 30 re istration re uirements when da s before the ex ected date 01 Disclaimer: This document do es not constitute legal advice and should not b e relied up on, as it is not routinely updated and was prepared with information fi'om other sources, who se ac curacy was not independently verified by APA. APA strongly encourages the reader to independently verify the information contained herein and! or consult with independent legal counsel if the readerintends to use or otherwise rely on such information. Because the lawand related infomiation continually change and because APA relied on other sources to compile inforrration contained herein, APA cannot guarantee the completeness, currency or accuracy of this document,
  99. 99. "3.’5y*"l5". ;i’. "f'~‘-‘f'3“~? "‘ ‘(= ll’= )ir_= z=llli. ,{-i‘(9‘: Limited Licensure Enforcement Why We've Had Only Limited Enforcement to Date — ”Honor System” System had been adequate until telehealth Many regulatory decisions being made now All of government is involved, from state to federal to international ' The ”ax” is already falling on some licensees 1’ Goes far beyond geographic limits of where we can practice
  100. 100. /try Question What harm am I doing ifl practice over state lines? 2:2»: 2-= ;._: ~: 2,1»,
  101. 101. Question Can licensing restrictions be put aside if no money is exchanged? ; ".': ;c1w‘i', "f 7;‘1._f*( 2,1»,
  102. 102. What if you just I ask a consumer to sign a disclaimer? You can ask, but most courts will not support your having asked a vulnerable patient to sign away their basic U. S. rights —— such as the right to privacy.
  103. 103. What if I claim Beneficence vs. Malfeasance? ° Are you in an emergency situation? - Did you document your rationale adequately to defend yourself if something goes wrong? - Did you run your rationale by your own local attorney? - Did you describe your rationale in writing to your licensing board, ethics boards and other colleagues? ~ Are you sure your malpractice carrier will cover your civil as well as regulatory risk? Get it in writing.
  104. 104. Question l’m ok if my malpractice carrier says they cover me online, right? 2:2»: 2-= ;._: ~: 2,1»,
  105. 105. Licensure How Much Land Does a Man Need? — Leo Tolstoy
  106. 106. 3 , ngg= ,*,13rir; «_: .:; w;. x:: , ( I g _ midi! ‘ Ill: -m l Telemental Health: HIPAA & HITECH arr’: t .9‘: 24:.
  107. 107. .. :. :j : l v; '____—. V' l 3 Levels of Security 1. Consumer I 2. Health Care (H| PAA& HITECH l 3. Mi| itary(FIPS) . ;;(: ; 57- ‘W%77 - . ‘i I I , 3'" fill ¥‘£| / l ll» I I l ‘l I _ _ ill.
  108. 108. ;«_ (diam: ->-Illi. .-iv OCPM Step 3 Legal Issues: Which Technologies to Use? uvsr - u | I L . ,, No Guesswork Needed HIPAA Compliant Handoff S ' any Device eQS, Sel? ';: $C‘: :Vt‘L‘I1 . Sweeping. etworlx 32' 7 3*: 2:1. T4‘
  109. 109. "' 3:‘ ;1I: :;I: ,. , '3!‘= j'l"_'l'1"_l"'l"l ut-4nI~. :.IIi'. ..-Iv Internet-based, VTC Companies* Claiming HIPAA Compliance (go to www. te| ehea| th. org[video for 50+) - Access Psychiatry _ Interactive Care - Adobeconnect _ I-rel - Behavior Imaging Solutions _ IVE (cloud) ' Breakthrough - Lifesize (Logitech) - Brighter Day Health _ MyTherapyNet ' California LiveVisit - Pass ' Cope-l-oday - Revation ' Consult a Doctor - Secure Telehealth - Counsol. com - EasyShareVC - Secure Video Conference - Shepell fgi ' ecounselmg - Smart House Calls - E Mental Health Center _ Soltrite - Forefront Teleca re _ Wag ' GEMS - VisHea| th (Visual Telehealth) - GoToMeeting _ Vsee - iCouch * 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.
  110. 110. ((< IELEMENIAL HEALTH Ir. I -I ‘I f). V. teleheaIth. ong —. —a. .
  111. 111. *¢i)( - K433. .5 .12.‘. I . '_l_I I I :11 rah ift‘*‘* ig; ~‘: ' Igt“, )iEI'II Email Relative lack of literature when compared to video teleconferencing (TVC) Most insurances won't reimburse Reimbursement is usually based on time intervals — email work IS time consuming Lack assessment and intake tools Perhaps most useful when client is known to a system, EAP, VA, corrections
  112. 112. 'iie-. IwI/ I. >1I~‘«; 'l< _ teIehea| th. org Email - A 2009 study by the American Psychological Association showed that 9.8% of psychologists polled reported using email for clinical purposes with clients (Jacobsen & Kohout). * Is such use appropriate without training? * Jacobsen, T. 8i Kohout, J. (2010). 2008 APA Survey of Psychology Health Service Providers: Telepsychology, Medication and Collaboration. APA Center for Workforce Studies.
  113. 113. 1 , |gn: §,I_: rir; I : ~1:V’i‘-I3: (, (( " " ' _ uidii‘ iii -iv 1 I. RV , l 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,": I’; -'a. _i-‘I u_‘; .
  114. 114. 1 , |gn: §,I_: rir; I : ~1:V’i‘-I3: (, (( " " ' _ uidii‘ iii -iv 1 I. RV , l Secure Email ° Internet, email, SMS and other telecommunications from clients are not forwarded by psychologists to others without the consent of the client. ° Psychologists are particularly aware of ‘strings of messages’ contained within communications. 51,": I’; -'a. _i-‘I u_‘; .
  115. 115. Ii EMENI/ I us» In ((( _L‘_‘ I _lL fl‘ teIeheaIth. org HIPAA 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
  116. 116. r ( zams; _~. .=iiz; .,~»ae‘~. HIPAA 8». Email The system must have strong auditing capability. All activity on the platform must be logged and monitored for possible breaches of security. The system must have auto time-out capabilities. The system must have business intelligence capabilities for data mining and quick access to important information. Secure email system must leave small footprint while delivering messages and documents to recipients. Confidential information, whether encrypted our not, should never reside on devices or the company exchange servers. Confidential emails and documents should be sent, received, archived and accessed on the exact same ecosystem.
  117. 117. The HIPAA Compliant Email Companies - 4securemai| - Hea| thB| ° m. accounts - Luxsci ° Sendlnc -- offers free accounts
  118. 118. Solutions Company Blog Sendinc Product Email Encryption Compliance Firms today have to face a minefield regulations that must be carefully understood and thoughtfully implemented. Sendinc has been designed to help firms address many of the email compliance challenges that companies must address. Learn how Sendinc helps organizations achieve compliance with: o HIPAA (Health Insurance Portability and Accountability Act) 0 SOX (sarbanesaoxley Act] 0 GLBA (Gramm—Leach—B| iley Act) a Data breach notification laws Sendinc can help ensure compliance with the HIPAA standards that affect email. These standards can be found in the Technical Safeguards group of the Security Rule: over a network, this standard has two implementation specifications: Encryption and Integrity Controls. These two are easily met through Sendinc's hallmark features ~ end~to»end military»grade encryption. Not only are unauthorized users prevented from modifying the contents of your email, they also have no way of viewing what's inside. Person or Entity Authentication standard - Sendinc can verify whether people seeking access to ePHI are really who they claim they are. Here's how: When you send a Sendinc-encrypted email, what is delivered to the recipient's inbox is a randomly-generated encryption key in the form of a link. When that link is clicked the user must verify they're your intended recipient by logging in to their own Sendinc account. Audit Controls standard - Sendinc's Pro and Corporate editions already come with a message auditing feature that will allow you to track message events. Corporate Edition subscribers may even view other relevant usage information such as a list of recipients, subjects, and the total size (text body and attachments) of each email message. Want to know more about the HIPAA and HITECH Acts and how Sendinc can help you achieve compliance’-‘ Read our post: How to achieve email compliance with the HIPAA 3: HITECH Acts. SOX To guide businesses in achieving email compliance with the Sarbanes-Oxley Act, the SEC and PCAOB are advising CEOs and CIOs to adopt an IT-focused control framework. In turn, most companies have turned to COBIT, the most widely-accepted control framework when it comes to business risks associated with IT issues. Sendincs features can help your organization align with the COBIT control objectives that impact email, most notably: Send a Secure Message Now! 0 FAQ 7 What is Sendinc? Why should I encrypt my email? why should I use Sendinc over other solutions? Sendinc has two distinct advantages over other approaches: 1) It's easy to both send and receive, 2) There's no software or hardware required. With traditional desktop solutions there's typically software that must be downloaded, purchased, and installed on both your system and your recipients' systems. Additionally, there are often encryption keys that must be generated, published, retrieved, and maintained. And then what happens if one of your recipients wants you to use a different software solution or doesn‘t want to use your solution? with Sendinc anyone can send and receive secure messages with zero software required. If you know how to use email you already know how to use Sendinc un. .. An I “and = g. .-. .-.
  119. 119. l-ii: ir= i.e I Billing l Liogratle About l Services l Contact US | Help Hushmail I Sign In: I: Sim '7‘ r‘ 9 : ' lnbox(24)—Timmy K. (timi . . . Finally, a private email account with no ads, first class technical support and unlimited email aliases. (- C Q Hush Communications Canada, Inc. Home [ Mail l Billing Hushmail I Eflcheckmail Select: Al_l, ~. ,.. .,& -0 Sent 8' Anna Lee I_‘ _N__' Peter Taylor Looking for HIPAA-compliant private business email? " ‘V "'- 5| " I‘ 6 ea "ui' C u U 3’ cf‘. - ’. adresswith yourcompanysdomain nameandaton ofother great features Leam about Hushmail Business Every day, thousands of people make the switch to Hushmail. " *. —‘. i -is v, : “ ’i" . ~ i i‘ i i l. ',, i Copyright © 1999-2013 Hush Communications Canada Inc. ' Fclbw ehushmafl Ternis of S-: «:vice [ Prii. =a. :ii Policy l Disclaimer System status: All a ‘s are stable and runniii
  120. 120. SECUFE Mall HOSIIIIQ Bllfl SECUFE Hllfill ACCOUHIS H‘OIll 4bECUl‘€MfiIl Q ; ~ ' if : , Send secure mail to any email address V" with RSA SSL encryption. Easy to use with no software to install. Free spam filter & anti-virus protection. Account Logln Help FAQ Why Choose Us Try for Free Compare Service Plans d ‘I h . h I . I‘ How It Works 0 Our secure encggte eman usest e same security tec no ogies ' ' . employed by banks and healthcare providers. CF13] n Take A Tm" 0 128-bit V ' 'gn SSL/ TLS encryption with nothing to download, no sgmn sum‘, Privacy Tools Webmasters Get Free Account About Us 0 BLOCK SPAM 100% with user-configurable challengdresponse system -. i (Lin: B and advanced spam filter. 0 Completely anonymous headers that are virtually untraceable with NO local 1P addras information. 0 Works with any web browser and most standard email clients, including Outlook, Mobile phones, etc. secure email compatibility 0 New fast Si efficent "Web 2.0" webmail interface with style text. 0 No pop-ups or other annoying advertisements displayed while accessing your mail. Your privacy is maintained, guaranteed. Personal] Professional Email Plans Domain‘ Hosted Email Plans 0 Email Accounts with SSL Security 0 Email Hosting with SSL Security a No Set-Up Charge 0 Use Your Own Domain Name a Securevault Encryption o Securevault Encryption 0 Spam Filter and Virus Protection I Spam Filter and Virus Protection n Your. Nan1e@4SecureMai| .com n Your. Names@YourDomain. corn n Customize with your own logo Privlg I Sitomag I Contact Us I Secure email provider I 9 2004-2013 4SocuroMai| LLC Secure Email Hosting By 4SecureMail LLC 'l°°°""N‘-""9" 5395 Secure Email Accounts. Send Secure Mail To Any Email Address. I"t“"'°“°“°' . . . . . . 4SecureMai| is a full-service If you are looking for a secure email account for yourself or family, we offer individual “cm ‘mil pmvidm with and group accounts from as low as $1.39 per month. service available in 15° _ _ . . _ _ . tri . If your business is looking for secure email hosting under a company domain, we provide mu" 95 an complete email server solution with fully managed email domain hosting — branded Our staff is experienced. using your own domain name - with volume plans under $.50 per month per user. using having provided email service our secure technology helps your company comply with HIPAA regulations. to over 50,000 HIPPY customers. Get rid of SPAM: All 4SecureMai| email accounts include a powerful anti-spam feature that indudes Spam-Assassin and an automated challenge/ response whitelist feature. Stops spam at the mail sewer - before you ever see it. Anti-Virus: All 4SecureMai| secure email accounts are protected by an ICSA-Certified
  121. 121. - L U X S C ‘9 Secure Email, Web and Form Solutions Blog Status Login 1 Sales: *1 339e368-5641— Support: +1 300.441.6612 C0fli3Ci ' Securesend Solutions Security Learn Pricing Free Trial 0% Clear communication is essential to Isilfcess. Mobile | HIPAA | Archival | Bulk I SecureForm a Customer Support Security 2;. Privacy Focus API 9 Account Tools Managed Migration 99.99“. -.+ Uptime SLA Dedicated Servers Small 8. Medium Business Large BusinessiEnterprise Domains 8. DNS Secured , ‘ ‘ by I ‘ Mckfee Auilioriu-Net
  122. 122. 4%: -A -: v ‘'4 . - vnuuiovming Cave M. ‘Ini'ii]vmnriI riuougri Innovation / /o/ no . .; - L; Secure Email Gateway is . ;. Interactive Voice Recognition :4 Text Messaging Cae Coordination lnfonnation System iffi F) Healthcollaooraie“-‘ l5 the leading care coordination, care transition and patient engagement software in health care. Healtncollaooratem enables yourorganizalion to coordinate patient care while giving patients a L‘. Secure Mobile Messaging App Healthcollaooratem is the leading HIP/ -‘~A< compliant enterprise-messaging suite in the market. Healthcollaooratei" W'lll enable your organization to securely communicate. collaborate and share documents with So/1/I/ b/75 / loot/ I / Vows & Eye/ its *“~: Health Ell offers Business Intelligence architecture to unity reporting, data analysis. and real~time monitoring for Care Transition The Healthcollaoorate Care Transition Bl tool IS a complete performance and quality
  123. 123. meMm1m. nsLm ((( I K V I b _ L I telehealth. org HIPAA 8: Email ° Data must be kept in a secure and HIPAA compliant data center. ° Server infrastructure must be built in a way that it is nearly impossible to access data from outside of the production environment. ° The data must be invisible to those who support the systems. ° Data or traces of data should never reside on support staff's devices. ° The encryption must be at least 128-bit, preferably 256-bit or higher. Access to the messaging solution must only be possible by tight user authentication. - All user information must be accurate and extensive. - http: //www. prweb. com/ releases/2013/1/prweb10316103.htm? goback= .gde_2246364_m ember_215017512
  124. 124. 3 , |gn: .i, i_: rir; ! : -:; w_. ~.x: : y, (( " ' ' _ (Jl: hI: r.IllI. .-Iv . 5. . , , l Questions to Ask Email Vendors 9 Where exactly will messages and documents reside? 0 Explain the data center setup. 9 Explain the data security infrastructure. ° What kind of encryption is used ? ° What kind of auditing capabilities are provided? G Explain system redundancy and availability strategy? * Provide HIPAA compliancy documentations. * Explain how customers are protected against mishandling of data by recipients of messages ° How much experience does the vendor have in developing solutions for healthcare? 51.": .': *;. _i-‘I ‘V. {(—
  125. 125. mewnim HELlH ((( I I‘ I I _ I I teIehealth. org Email ° Have clients go to Practitioner's secured website (HTTPS) — Leave an email on website — Website generates an email to Client email box informing them ”A message is waiting for you” on Practitioner's website ° Security Certificate for $100- $300 per year
  126. 126. « ' , l§I= .‘l__= i‘lr;1 : .:. y.i: .i , . I "' ‘I ‘ I (dldii: ->-Illu. -iv l Mobile Security 6) Mobile phone security and the rise of mobile malware Only a fraction of smartphones and tablets are protected by security software, despite a rise in the amount of malware targeted at mobile devices. Estimates for growth of mobile malware (includes viruses. worms and malicious software used by hackers. such as code inserted into compromised mobile apps) vary greatly, but all expects warn that it is growing very fast. - Bul| Guard identified a staggering 2.500 different types of mobile malware in 2010. - | Bl. l X—Force named 2011 the year of the security breach. predicting that ‘exploits targeting vulnerabilities that affect mobile operating systems will more than double from 2010'. Yet most smartphones and tablets have little security protection: - Canalys (October 2011): Only 4 percent of smartphones and tablet computers shipped in 2010 had some form of mobile security downloaded and installed. - Juniper Research (August 2011): Less than 1 in 20 smartphones and tablets have third-party security software installed in them. despite a steady increase in threats. This is expected to change, let by sales to business: - Canalys: US $759.8 million will be spent on security in 2011 alone, growing at 44 percent annually to be worth US $3 billion in 2015. - Juniper: By 2016.277 million mobile devices will have some kind of protection installed. costing mobile users a collective US$3.6 billion. 69 percent ofthis investment will be made by corporations concerned about corporate data is stored on mobile devices. Further reading: - The insider's guide to mobile security - Mobile security — implications for your business
  127. 127. C :11: l-l—M-1‘. -l-tvr. "
  128. 128. :rictimes. com/ borderline—personality/ content/ article/10168/2134149 : i!. ‘.. Pi-: lil-': l LC PsychratricTimes P§§? °EhiatricTimes . Rl5k ASSGSSITISIH NEWS Current ISSUGS Blogs Special REDOHS CME Conferences Home it PRWT PDF REPRIIIT SHARE Q - l 3 (21 Lil E [I Be the first of your friends he like this. TECHNOLOGY IN PSYCHIATRY Telepsychiatry: The Perils of Using Skype By Marlene M. Maheu, PhD and Joseph McMenamin, MD, JD I March 28, 2013 Dr Maheu is the Executive Director of the Telelrlental Health Institute, Inc. She is the lead author of el-realm. Telehealm and Telemedicine (Josey Bass; 2001) and The Mental Healfll Professional and the New Technologies (Routledge; 2004). Dr Mchlenamin is a Principal Consultant with Venebio Group, LLC, in North Chesterfield, Va, and an Adjunct Professor of Health Law at Virginia Commonwealth University, Richmond, Va. I ‘E First released in 2003, Skype oflers free, worldwide video access to any patientwith an Internet I ‘Ii connection, either by mobile device or desktop computer What it does not offer, however, is a l ‘$_I { ' means of communication clearly suitable for clinical services—especially in mental health. if $ According to estimates reported by groups such as the Institute for Healthcare Consumerism, I. t V la ‘ I I _ M telehealth is poised to grow by 55% in 2013 alone, and 6-fold by 2017.12 Wisely or othen/ vise. rffl ‘.1. I ‘’ some ofthis growth will likely occurvla Skype. Thus. it is prudent to considerthe issues. i ‘< . .~. The Health Insurance Portability and Accountability Act Ordinarily. neitherlederal nor state law is designed to regulate specific proprietary entities such as Skype and its competitors. Video—chat platforms were developed for marketlngto the general consumer, and notfor health care. The Health Insurance Portability and Accountability Act (HIPAA) holds professionals responsible for conducting their nent, the professional ility. ’ One couldtake cu EEG Searchhledica lileclliiie Drugs Search Resources Careers Multimedia About US . _7L; '7l%/ / I :1 I r figérmride niuncy-saving: offers Iv‘, ,, ~_' to help you hetp your patients. I : ;.E: *.: :;: :;; ..; ... $2g%~ ~ l Cyrntialta‘* idiiluxeline HCI. delayed release cansulesl is Indicated lor the freatmerr. a‘ maid: depressi-re disorder N00). The e"ii: acy ol Cyribalta [as esleb| _ishe~: l in lour shore-le"n and one mirntenance lriai ll'l atliits Araliatile in Ztl nip, 39 mg, and 50 mi; capsu es lriiportarit Safety Inform; -itiori About Cyinbalta . ... . . . . ... ... ... .. . ... ... ... .. . ... .. Bell it or: —— Antidepressants Increased the rliik oi suicidal thou his and behavior In children. ldoleseenls. and young I oil: in shortrlerm studies. These studies P Prescribing Information D Medication Guide TOPIC INDEX Addiction Medicine Health Care Refomi Alzheimer Disease Major Depressive Anxiety Disorders Disorder ADHD OCD Bipolar Disorder Personality Disorders Child & Adolescent Schizoaftective Psychiatry Disorder Dementia Schilophrenia Depression Sleep Disorders DSM-5 Somatofonn Disorders Geriatric Psychiatry All Topics ‘ L
  129. 129. 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
  130. 130. I‘ L‘ Do you see well enough? °| mage Resolution - ATA Guidelines Are you conducting an intake or follow-up? ° Most of the scientific literature described VTC as being used for follow—up care after a primary physician or other licensed professional does an intake. - Can you properly assess glassy eyes, tremors, gait disturbance, sweaty palms, body odor, other signs of poor hygiene?
  131. 131. Is Skype Reliable? Its free, but then again, so is a park bench is a park bench adequate for your work? Skype tiles & pixelates, the audio gets tinny, echoes develop, and often calls drop entirely. Sometimes consumers can see you and hear you, without your awareness. How will the most dysfunctional of your clients and patients react to a dropped call? Do you have a back-up emergency plan, and full knowledge of local resources in case you need to act immediately? Most of the literature has a ”champion” in the local community of the patient.
  132. 132. Is Skype a video platform or a social media
  133. 133. JUST RELEASED: The New Forbes iPad app o 5- 2 ) I 62k 10k ‘ ' Tweet Download . lx“r: .rv: ~*‘. _='ifi‘:3. your FREE Issue now u I V EC‘. -EF ‘I to I ”‘ -0- Follow n. . INVESTING ’, ; ,n¢| ].iik1.i jg- It's Terrifying And Sickening That Microsoft Can Now Listen In On All My Skype Calls E; E J; l 43 comments, 15 called-out There was a wildly terrifying story ublished late Friday on Slate that didn’t get much attention because of the time of the week it was released. In it, the author — Ryan Gallagher — lays out how Microsoft (MSFT) seems to have made some subtle and (to most) imperceptible + Comment Now + Follow Comments Microsoft CEO Steve Ballmer and Skype CEO Tony
  134. 134. I 7 | gn: §,i_: m;i : ~:mi. |:i , . ‘ " "I ‘A I (Jl: hi: —>. lllI4.-iv 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 ew: r: 'i: :i. “E5-lC'. lCIi“IS
  135. 135. 3 , :5-= .*, i__= rw : ~:m_i. x:i , . (( " ‘I ‘A . urau~. .». illu. .-iv I What is Microsoft Doing to Improve Skype’s Security & Functionality? is For developers, the . NE T Framework provides a comprehensive and consistent programming model for building applications that have visually stunning user experiences and seamless and secure communication. htt 2 www. microsoft. com net arr»: i': ~;. _:~: wgi»,
  136. 136. Three HIPAA Rules: Transmission, Privacy, Security -. ._ . . . ~ “ 3” ’ / ' ii‘ .4 . , , A r ‘V. ‘ Q. , 7 [u_ ) ' ‘ V"; _, I rah , , . I r » I _ . , I . I' I ‘_ ‘*4
  137. 137. !l. ~e‘l. _Ir-aim-“int: -iiii ! l|“: lEl": ll. ill'tf' : l|lI'IlElI>*e'l‘slI‘n! l'. -l: ‘i Isearcnl azudii . °.| nloi:1 -. ;llI: I:I. ' HHS H0|'flelHHS NEWSIAPOIII HHS Font Size ' T Print ; Download Reader '-‘_ . . g » . . N N H llmlnvlfiuIiir; Iir;5llii; .., -nlfsijy_2iirila'1;lIl-ilsflirgivvltiiirsilfani 1 Health Information Privacy Office for Civil Rights Civil Rights Health Information Privacy OCR Home :7 Health Information Privacy : : Understandinq HIPAA Privacy " For Covered Entities For Covered Entities and Business Associates HIPAR _ The HIPAA Rules apply to covered entities and business associates. ‘ ' Understanding HIPAA ) HHS announces a E P'l"acV Individuals, organizations, and agencies that meet the definition of a oovered entity under HIPAA must comply with E that l'T'Ple”'e"t5 3 F0, c, ,,. ,., ,,. ¢,, number of provisions of the HITECH Act to strengthen the privacy and security protecfions for health infonriation established under HIPAA. the Rules’ requirements to protect the privacy and security of health infomiation and must provide individuals with certain rights with respect to flieir health infonnalion. If a covered entity engages a business associate to help it cany out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly iable for compliance with certain provisions of the HIPAA Rules. 9 For Covered Entities Special Topics Related Links Summary of the HIPAA Privacy Rule : ""‘"§“"; {°| ”"° ""’“ If an entity does not meet the definition of a covered entity or business associate, it does not have to comply with °“"'ty " E the HIPAA Rules. See definitions of “business associate” and “covered entity” at 45 CFR 160.103. Training Materials HIPAA Administrative Simplification Statute and Rules _ _ _ A Covered Entity is one of the following: Enforcement Activities & Results How to File a Complaint _ A Heanh care News Archive A Health Care Provider A Health Plan aearinghouse Frequently Asked Questions _ _ _ I _ 4 I This includes entities that process PSQIA This includes providers such as. This Includes. nonstandard neaim information 0 Doctors 0 Health insurance com anies they receive from another entity Understanding PSQIA . clinics . HMOS P into a standard (i. e., standard C°""‘l“""‘*"‘V . electronic fonnat or data content), 0 Psychologists 0 Company health plans . PS0” Slam“ 8‘ Rule 0 Dentists 0 Govemment programs that pay or vlce velSa' Enforcement Activities 0 Chiropractors for healfli care, such as 9* R€5"l‘5 0 Nursing Homes Medicare, Medicaid, and the now to Fne a connnann 0 Phamiacies military and veterans health
  138. 138. '-i: : , ‘ (Ql'-lIl'--’-l"l4.‘lI‘ (« | i!ai‘il_= ;£| l:‘ http: //www. hhs. gov/ ocr/ privacy/ hipaa/ understanding/ coveredentitie s/ index. html l HIPAA Administrative Simplification Statute and Rules A Covered Entity is one of the following: Enforcement Activities & Results How to File a Complaint A Health Care A Health Care Provider A Health Plan . Clearinghouse News Archive Frequently Asked Questions V V _ V _ This includes entities that process PS M This includes providers such as: This includes: nonstandard health information Q . . they receive from anoflier entity Understanding PSQIA ' 3|9c. t°'5 ' nilagth msurance compames into a standard (i. e., standard 7 V V 3 0 . C°"f'de“"a"tV Imcs . 5 electronic fonnat or data content), I I Psychologists I Company health plans or vice versa PSQIA Siatute & R" E 0 Dentists 0 Government programs that pay ‘ Enforcement Activities 0 Chiropractors for health care, such as 5 RESUHS 0 Nursing Homes Medicare, Medicaid, and the How to File 3 complann 0 Pharmacies military and veterans health - care programs . ..but only if they transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard. Are You a Covered Entity? View an easy-to—use question and answer decision tool. _ Guidance Materials for Small Providers, Small Health «I ‘ A Plans, and other Small Businesses
  139. 139. Ii’: -5 .7 ui-an~. .». ilii. .-in. http: //www. hhs. gov/ ocr/ privacy/ hipaa/ enforcement/ examples/ Ha‘. ! iiiilaili -l»"'= l:-hlliii il| liih| i~ ~ —lI'fl! (el: ‘ V I : Es‘ * [vii ‘f N; 1 1iimni'lIu_iiiiii; -iumllf, .,-mini) guiilnits! /-‘<ji; I1iyri)i; im; i.‘trg I , , HHS Home| HHS News| About HHS Health Information Privacy Office for Civil Rights Civil Rights Health Information Privacy OCR Home Health Information Privacy Enforcement Activities 84 Results Case Examples & Resolution Agreements Case Examples and Resolution Agreements F; -gggaggwmg HIPAA ; d d_ These examples show how covered entities can effectively comply with the requirements of the Privacy l’ A” Case Exam '95 grivgztan "'9 HIPAA and Security Rules. Periodically, we update this page with case examples of the corrective actions that " j——9I35e EXam Ies b OCR obtains from covered entities through our enforcement efforts. Cwered Em”: HIPAA Administrative " C359 Exam '95 '3 155‘-‘E Simplification Statute and Rules . se Examples Enforcement Activities at Results Case Examgles Organized by Case Examples Organized by Enfcircenierit Process Covered Entig Issue r. .r. ... ... ... ..i. i.. _.i. .. ' General H05 -tals 1 Health Care Providers Authorizations I I Health Plans [ HMOS Business Associates I Outpatient Facilities Conditioning Compliance with the Privacy I I Enforcement Data Case Examples & Resolution Agreements pnarmacles Rule Private Practices Confidential Communications Disclosures to Avert a Serious Threat to Health or Safeg; Audit Prograiii State Attorneys General How to File a Complaint Imgermissible Uses and Disclosures News , ,,(l. ,., e 1 Nonce Frequently Asked Safe Uards , L Questions PSQIA . Resolution Agreements Understanding PSQIA c°"fide""a"tV Resolution Agreements and Civil Money Penalties —A resolution agreement is a contract signed by HHS and a covered entity in which the covered entity agrees to perform certain obligations (e. g., staff training) and make reports to HHS, generally for a period of three years. During the period, HHS monitors the covered entity's compliance with its obligations. A resolution agreement likely would include the payment PSQIA Statule & Rule Enforcement Activities 8: Results How to File a Complaint of a resolution amount. These agreements are reserved to settle
  140. 140. ., « ir-m. ls= w». - | -1E"L7‘r4 fig ‘| f‘ telene: .alth. org HIPAA Enforcement The most common types of covered entities required to take corrective action: ° Private Practices ° General Hospitals ° Outpatient Facilities ° Health Plans (group health / _ 0 plans and health insurance issuers) and - Pharmacies http: //www. hhs. gov/ ocr/ privacy/ hipaa/ enforcement/ highlights/ inde x. htm|
  141. 141. l ‘ N ‘ I fl K " tele: <h»ealth. a.rg PAA Enforcement Case Examples Organized by Covered Entity ° Hospital Implements New Policies for Telephone Messages ° Public Hospital Corrects Impermissible Disclosure of Protected Health Information in Response to a Subpoena ° Radiologist Changes Process for Disclosures Related to Workers Compensation - Physician Revises Faxing Procedures to Safeguard PHI
  142. 142. 3 , |gn: §,i_: rir; ! : ~1:V_i‘-I3: y, (( " " ' _ (JI: hi: r.IIlI. .-Iv ‘ ii . , l HIPAA Enforcement Case Examples Organized by Covered Entity ° Entity Rescinds Improper Billing for Medical Record Copies . . . ‘I * Private Practice Im lements _~ 1 ix; Safeguards " - 6 Private Practice Revises 7' _ Process to Provide Access to I if. . , ""2 , " ‘ " -11 "I I Records V «I "= - pr» . . . 1 ‘Tia’ 1—. ,_. ,.. w si: —- '1”: ~ Private Practice Revises , Z r--_ h D j 1 - ‘$3.; J: Access Policy 6 Private Practice Ceases Conditioning of Compliance with the Privacy Rule 51,": I’; -'a. _i-‘I ‘i‘. {(—
  143. 143. Business Associates and HITECH All Business Associates in health care must sign an agreement stating their adherence to HIPAA standards Not a matter of opinion 9 it is now enforced by the HITECH ACT 1! J;
  144. 144. TELEMENIAL nsum ((( H I _ ‘fr teIeheaIth. 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.
  145. 145. lELEMENlA1.HELIH ((( I I_ I I I _ IA I teIeheaIth. org HIPAA ’’Final Rule” ° Individuals have the right to a copy of their electronic health records. ° When treatment is paid for completely out of pocket, patients now have the right to request that their health care providers restrict disclosing that treatment to their health insurance companies. - Infrastructure, documentation, and procedures for information privacy and security, and data encryption and disposal will have to be evaluated and brought into compliance. ° Companies need to provide formal security training to all employees, designate a security official and implement appropriate business associate contracts with their own subcontractors.
  146. 146. IELEMENlAl. HELlH ((( I I‘ I I _ I_ I teIeheaIth. org HIPAA ’’Final Rule” ° When HIPAA was first passed in 1996, most health care practitioners, hospitals and insurance companies scurried to bring themselves into compliance with the new standards. In the face of these final rules, business associates will have to engage in the same process. - HHS is stepping up enforcement efforts. ° See Federal Register available online at ° http: //federalregister. gov/ a/2013-01073, and on FDsys. gov
  147. 147. TELEMENIAL nsum ((( I II I I I _ I teIeheaIth. org n ine Therapy Companies & APA Ethics Code ° 11 Psychological Services Delivered to or Through Organizations (a) Psychologists delivering services to or through organizations provide information beforehand to clients and when appropriate those directly affected by the services about (1) the nature and objectives of the services, (2) the intended recipients, (3) which of the individuals are clients, (4) the relationship the psychologist will have with each person and the organization, (5) the probable uses of services provided and information obtained, (6) who will have access to the information, and (7) limits of confidentiality. As soon as feasible, they provide information about the results and conclusions of such services to appropriate persons.
  148. 148. iELEMENlA1.HELIH ((( I I_ I I I _ IA I teIeheaIth. org Legal Suggestions ° Put everything in writing ° Counsel each other & document those conversations ° Don’t refer to people who you know are practicing illegally or unethically Communicate often to your local, state and national professional associations Write to your malpractice carrier and ask them to clearly tell you what will happen if you are found guilty Don’t be surprised if they try to imply that you are stupid for asking your questions
  149. 149. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  150. 150. iELEMENlA1.HELIH ((( I I_ I I I _ IA I teIeheaIth. org APA Ethical Standard 9: Assessment ° 9.01 Bases for Assessments ° 9.02 Use of Assessments ° 9.03 Informed Consent in Assessments ° 9.04 Release of Test Data ° 9.05 Test Construction ° 9.06 Interpreting Assessment Results ° 9.09 Test Scoring and Interpretation Services ° 9.10 Explaining Assessment Results - 9.11 Maintaining Test Security
  151. 151. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  152. 152. Your Computer is Your ”Office” 9 Understand the features of your equipment, lest you show the wrong image - White board - Access desktop or web - Access to your camera — Supervision — Secured email — Instant messaging — Cloud storage, etc.
  153. 153. TELEMENIAL HEALTH ((( I II I I I _ II _ I teIeheaIth. org OCPM Step 6: Direct Clinical Care 9 Conduct a formal intake — no shortcuts 0 Meet in-person or video (if your state law allows) 9 Take a full history, medications, illnesses, abuse, stressors, support system, use of other technology, drug/ alcohol use, suicide/ homicide intent, mental status 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
  154. 154. 1 , |55=j, I_3i‘iy; i_ : ~1;V’i‘-I3: I. ( uidiwillu. -iv l OCPM Step 6: Direct Clinical Care 9 Contract for short, protocol-driven tx 9 Authenticate & set ground rules at every session 9 Enforce boundaries (privacy, family, social media) 9 Have backup emergency plan 9 Evaluate at regular intervals 32' i' . I:-*: ~c: ;.
  155. 155. ,3». 51- 9 ,1 o ~ —. b an -; _ ‘___ _ *' - J‘. ".’ t ‘ I :4. ; . l 3. Hg: ii D‘. ‘II "'I -0 :1 I"; -3'. ’ ". ‘ I Know technical aspects (camera position, lighting , audio, noise, clock, etc. )
  156. 156. TELEMENIAL HEXLIH ((( 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
  157. 157. 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
  158. 158. 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
  159. 159. 1 , |55=j, l_3r| y;t_: ~:m3.x: : , , ( umulzrlllu -iv l OCPM Step 6: Direct Clinical Care 4» Contract for short, protocol-driven tx 9 Authenticate & set ground rules with introductory protocal at every session § Enforce boundaries (privacy, family, social media) ¢ Evaluate at regular intervals 9 Document progress » Have backup emergency plan 2:2»: 2-= ;._: ~: 2,1»,