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T 3 Reasons Skype May be Risky to

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Marlene M.  Maheu,  Ph. D.
TeleMental Health Institute,  Inc. 
www. TeleMentalHealth. com
Phone:...
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MARLENE MAHEU. SKYPE Webinar. June 6 2011

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Webinar: 3 Reasons Skype May Be Risky to Your Practice &amp; How to Remedy by Marlene M. Maheu, PhD from the TeleMental health Institute, as interviewed by Joe Bavonese from Uncommon Practices

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MARLENE MAHEU. SKYPE Webinar. June 6 2011

  1. 1. T 3 Reasons Skype May be Risky to ri; ~A;1.3 Your Practice & HOW to Remedy A A I. A Te1eMenta1 Health Institute, Inc. & Uncommon Practices, Inc. June 6,2011 Marlene M. Maheu, Ph. D. as interviewed by Joe Bavonese, Ph. D.
  2. 2. Goals for Today 0 What’s happening in Telehealth 0 Video Chat (i. e., Skype) VS. Traditional Videoconferencing — 3 Problems — 3 Solutions
  3. 3. Who I Am & The Focus of This Webinar T: Started in 1994 with SelfhelpMagazine & APA «: The content of this Webinar covers a number of " developing areas where the technology is evolving rapidly, and the law and ethics codes are still relatively unclear. Therefore, it is impossible to give definitive advice many large association. 4:» I am not an attorney, IT professional or engineer. 1 am a psychologist, practitioner and ethicist 4:» Focus of this Webinar is only Video Chat (i. e., Skype)
  4. 4. «gr: A 4i? » Disclaimer 0 No Warranty, guarantee, or representation is made by me, my company, affiliates or any of our associates regarding the accuracy or sufficiency of the information contained herein. We and our independent consultants assume no responsibility in connection herewith.
  5. 5. W hat I’ s happening‘? We are re-tooling along with the rest of the World by adopting technology into every arena Copyright 201 1 TeleMental Health Institute, Inc. 5
  6. 6. : - e-tooling W hat’s Hap ening v V
  7. 7. ing : Re-tool ing hat’s Happen
  8. 8. 9 6.4 i3.! ‘=T5‘. ’+‘. !". ' —xT wag. .. Copyright 201 1 Te1eMental Health Institute, Inc.
  9. 9. -. -:= ?T“i: ’.-'. .L; ' I — J. »- .1‘-' , ~.v . ~‘ ‘. " . II-' " L ' ~ : ‘I V. L _ _ ; _‘. 's ' e . ‘~. ;.. :.‘. -. TT V T 4 . «, M, A » T . a‘. - _T. ‘., ..T. _ X ‘ . ... .. .2 —_«- L'. T.. .-. ..i‘__. .-. -«>~‘“‘- ' . ,_ . ... ~———. .- ' ‘(R ~. . . ‘“ ‘- -'. '‘''m 5 M ». ' . “I. ‘ _. V. VT“; .‘T. I‘ . f._, . . . ,
  10. 10. What’s Happening J '3. _ 9 Telehealth is a mainstream industry "H — 10% growth in U. S. telehealth annually — $500 million a year spent in U. S. alone — Insurance plans are starting to market interactive video to large employers — U. S. Federal government is spending $1 billion on a year to study telehealth and technology — Telehealth is the future of healthcare, and it is here today
  11. 11. Boundaries of Competence Copyright 2011 TeleMental Health Institute, Inc. 11
  12. 12. Ethical Considerations 9 All Existing Legal/ Ethical Rules Apply — The APA has created no rules prohibiting telemental health. — Com laints are handled on a “case-by- case asis” — APA directs clinicians to the “Boundaries of Com etence” standard of the 2002 APA Et ical Principles and Standards (aka: ethical code)
  13. 13. Z 1 What’s Happening with SKYPE wt‘ 9 Video chat (i. e., Skype, Google Talk, “ Oovoo) uses very different, — less reliable and — less secure technology than traditional telehealth technology as developed since 1959 — Traditional requirement is 384 kbps, as per empirical research. See ATA Practice Guidelines for Videoconferencing-Based T elemental Health (2009) — Video chat, on the other hand is much slower, because uses Voice Over Internet Protocol (VoIP)
  14. 14. Video Chat Risk #1: Security & Privacy T '5 HIPAA & HITECH — Rules - Transaction- records & billing ° Security ~ Encryption vs. — Compliance Statement - Privacy ~ PHI Copyright 2011 TeleMental Health Institute, Inc.
  15. 15. Video Chat (SKYPE) & HIPAA : ; p We are mandated to use HIPAA '3 I compliant technologies (and processes) — Confusing to most health care professionals — Skype doesn’t claim HIPAA compliance, only mention encryption - (SKYPE offers 256 bit encryption, which is > than HIPAA mandated 128 bit)
  16. 16. VoIP Video Chat Problems «J International Companies / Acquisitions _ «J Frequent security breaches — Even with HIPAA compliant companies, HIPAA violation reports are common a Mandated by HITECH Act — US Federal government just beginning to crack down Sizeable fines (up to 250k per infraction) — — Americans routinely get notices of HIPAA breaches
  17. 17. Video Chat Risk #2: Reliability -5.31.‘ ‘ ‘ 1. l$ W W — —---V’- '--. r:; ‘' Copyright 201 l TeleMental Health Institute, Inc.
  18. 18. Reliability of VoIP Calls 1 «J Dropped calls «J Degraded video “ «J Degraded audio M‘ - I ' — Articulation l « 1, — Robotic Voice I : - — Walkie talkie effect «J Not conducive to psychotherapy’s sensitive moments «J Sound vs Video
  19. 19. Video Chat Risk #3: Lack of Step-by-Step Information . ° Deceptive Nature of Internet ° Lack of Analysis / Training about: ° how patients are at risk ° how we are at risk ° Information about our obligations (legal/ ethical) ° Licensing ' Specific technologies Copyright 201 l TeleMental Health Institute, Inc.
  20. 20. Risk Management , 9 Licensing board/ ethics committees rely on "9 your ability to demonstrate: — knowledge and application of basic ethical principles (i. e., training) — your clinical plan & your risk analysis, as evidenced in your documentation (i. e., records & rationale - scientific literature) & consultation 9 Training & documentation are often more important than the clinical outcome of your case
  21. 21. Licensing Infraction 6;’: Penalty «J In 2009, a Colorado doctor was found guilty of practicing medicine without a license in California after prescribing an antidepressant via an online pharmacy to a 19-year-old student. The student committed suicide. The doctor was given a nine- month jail sentence. «: http: //www. usatoday. com/ yourlife/ healt h/ healthcare/ doctorsnurses/2010- 1 1-19- 1Ateledoc19_ST_N. htm? csp= usat. me
  22. 22. Risk Management: Licensure & 9 For most U. S. states — INIES: Illegal to practice in the state of residence of any patient without a license — 0U TIES: Illegal to practice out of state — T WOSIES: Many states require both 0 No malpractice coverage if you practice illegally — beyond the scope of your license in terms of duties and geography ‘ A ‘ F! O u. ’ . _. . . . ‘g _f_ T. , ‘ - _ . * ' .1.. . . ‘ . It . .~- . *2 ‘ 4 . ' '1 _ ‘ . I , .. _ , . . I9 3 -v_ I, 1,9,4 go": T l
  23. 23. Solution #1 % Err on the Side of El Caution: III K Mute
  24. 24. Audio vs. Video «: Non-verbals: DSM Assessment Environment — window into the home Physical manifestation of mental health symptoms — Depressive mask — Glazed eyes «: Relationships
  25. 25. Q: Muting 9 T elehealth literature w/ videoconferencing: — audio is essential — video helps convey emotions that we just can't get through voice — helps convey confidence
  26. 26. 393%. Muting / Disclosure / Licensure ha? 9 Mute Skype / Use telephone for audio — Doesn’t address potential breaches, but keeps communication line open 0 Fully disclose potential reliability and security problems in informed consent discussion / document — “Outside the standard of care” — “Skype (or Google Talk, etc. ) may be listening” 9 Obtain proper licensure
  27. 27. 1, But some large groups are using ; Skype ff: 0 Yes, and they have referral networks that send ' them full medical records with their referrals — Admins who do full intakes & process forms, — Nurses who touch the patient & take vital signs — They have IT specialists who prepare the client and the professional — Malpractice coverage that won’t drop them — Many other “standard of care” buffers 0 What do we solo practitioners have?
  28. 28. Solution #2 Follow the Law 100% A Guesswork
  29. 29. Follow the Law 100% -- Use Disclosed ; ' av , . . ’ ~89‘ HIPAA & HITECH Compliant Vendors 0 Only buy services from vendors who fully 9 disclose their HIPAA compliance 0 Use vendor who abides by HITECH Act -- and get 1 proper documentation 0 Document your own HIPAA compliant policies 0 Select clients from existing case load 9 Work from home (start 1 day per week) 9 Rent your brick and mortar office — $$ to pay for HIPAA compliance technology
  30. 30. >- Solution #3 Obtain 1:1 . Required Training
  31. 31. Solution #3 Professional Training C Literature calls for training 0 «J Clinicians in large organizations have protections and adjunctive staff to handle problems that independent practitioners don’t C APA Monitor article: — A New Emphasis on T elehealth, June 2011, V0142, No. 6 http:1/www. apa. org/ inoiiitor/ 20 1 l1/06/teleliealth. «: TeleMental Health Institute programs
  32. 32. 0" Other Risk Management Training «J HIPAA — compliant processes «: Licensing & H «J Equipment I «J Authentication — Patient / Practitioner «J Assessment «J Clinical Protocols «J Handling High Risk & Emergency Situations «J Billing / Reimbursement Rules
  33. 33. Telelvlental Health Institute 0 Most comprehensive available today — Multidisciplinary — Based on empirical evidence 175 «J Multi-modal leaming environment for your comfort and convenience «in Available online 24/7 «in 5 years to get CEUs
  34. 34. .. ~,"'? -'—«>‘. _,. l_f"‘, _a Tr —v--v- -‘rv-1* < V < I‘ < V ’—~ 0 / _f: _f: :-: -.'. "'5 1 ‘— 7‘/ ‘fT“‘/ “ “/ ‘ A l J 3 VI .4- v 4-. .- 41-. .‘- .4- J-lgI4l-.1-.4-4l-.1-.4-$« (J U 3 L) 4-. .‘- «3 Basic Training: Regular fee: $975 C 50% Discount for 48 hours only - $487.50 — In exchange (Honor system) for: 5 feedback emails to us & 15 Questions / Answers (posts) BP Leaming Lounge C Use this coupon code in TMHI shopping cart: SKYPE50
  35. 35. Questions? 3., Marlene M. Maheu, Ph. D. TeleMental Health Institute, Inc. www. TeleMentalHealth. com Phone: 619-928-2627 Email: drm@telementalhealth. com

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