Pacific Coast Psychiatric Associates (PCPA) started offering telehealth services in response to patient needs, finding that 35% of visits are now conducted via video. The document discusses how PCPA implemented their telehealth program, addressing concerns around safety, technology, and patient/provider buy-in. It also provides feedback from patients and providers on their experience with telehealth and areas where in-person visits are still preferable.

1. Let’s VSee!
How to Implement Telemedicine Into
Your Practice
Anisha Patel-Dunn, DO
Pacific Coast Psychiatric Associates

2. Objective
•Evolution of Telehealth at PCPA
•How to implement & utilize Telehealth
•Resolving patient trust, family
involvement, emergencies via a
telehealth platform
•Methods to engage participation while
improving patient life and work
outcomes

3. Pacific Coast
Psychiatric Associates
 PCPA started in 2006
 SF, Walnut Creek & LA
 About 100 providers, Psychiatrists and Therapists (General Adult, C&A,
Psychosomatic, Addiction & Geriatrics)
 Started as a psychiatric group - Collaborative Care
 We have staff of about 15, reception, office management, billing and
recruiting
 Population – C&A, Adults &Geriatric Population. Working class, 95%
Insurance
 SF - Younger adults, a lot of patients in the IT industry
 Walnut Creek and LA - Higher number of C&A patients as well as older adults
 Psychiatric Evaluations, Medication Management, Therapy - Individual,
Couples, Family and Groups

4. PCPA’s Telehealth Program
• Developed organically - Travel, college, medical illnesses, doctor
moving, Doctor on Medical Leave
• Offered to all patients, about 10 psychiatrists and 5 therapists -
Telehealth exclusively. Most other providers some % of Telehealth.
35% of all visits are Video.
• Started a trial with UBH then approached other insurance
companies. Facebook Primary Care Clinic reached out.
• Completely electronic and paperless office - Transition was easy
• Registration, Forms, Messaging, Billing
• “Security” of physical offices

5. PCPA Website

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16. Vsee Virtual Waiting room

17. Vsee Virtual Waiting room

18. Vsee Virtual Waiting room

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23. Vsee Virtual Waiting room

24. PCPA Website

25. Organizational “Buy-In”
Overcoming both patient and provider concerns and biases
Safety concerns
Electronic prescribing
Data
 Patient Feedback, Continuity of Care, Provider satisfaction and well
being
Access to psychiatrists in with varied specialties and
experience
Recruiting

26. Wrinkles to Iron Out
Setting Limits - Privacy and Safety
Technical Limits
Provider Isolation
Patient Education - Video

27. Appropriateness
Acute Mania or Suicidality with Difficulty Est. Rapport
Severe Psychosis (Paranoia, Blunted/Sign Reduced Affect)
Severe Eating Disorder (requiring weight & body composition)
Actively Cutting or Engaging in Self-Harm Behaviors
Active Substance Use
Too Many Tech Issues for Patient
Patient Preference/Comfort
Avoidance of Treatment
Work Arounds: Collaborating with PCP/Therapist/Family

28. Provider Feedback
In my three years at PCPA, I have only had one patient that I "banned" from
video appointments. There were definitely safety concerns and benzo
dependence so I only refilled her Ativan at our weekly appointments. I never
would have agreed to see her on Vsee in the first place but one day she called
stating she was unable to come to the office and reception offered her Vsee
w/o checking with me first. The patient then fell in a pattern of calling right
before or during every appointment, asking to switch to Vsee. Essentially she
was avoiding engaging in treatment but just wanted her benzo’s.
In my experience, treating eating disordered women is really tricky especially if
they come in wearing heavy clothing or try to manipulate the angle of the
camera so that it is really difficult for me to know what's really going on.
Similarly if someone is actively cutting or engaging in self harm behaviors
including active substance abuse, I'm unable to pick that up via camera.

29. Patient Feedback
“Transitioning to tele psychiatry has been a seamless experience. The technology works great and
was easy to set up. Being able to quickly hop on a video call with my doctor without going to the office and having to take
more time away from work is great and has made it much easier to keep my appointments.”
”Easy to log in, and very clear audio & video make it an ideal way to communicate. The session was just as
effective as any in-person session I've had.”
“…The chat program used is reliable and I am able to have chats on both my laptop and
cell phone so it is nearly impossible to miss my appointments.”
“I love Tele-Psychiatry! As someone with anxiety issues, even trying to get to my appointments on
time can be anxiety producing. Now all I have to do is find a quiet place with an internet connection and I'm
set. No more rushing and worrying that I am going to be late. It is a wonderful convenience that I so
appreciate having access to. Thank you!”

30. Future Projects
•Groups
•Testing
•Access to Other States

31. Anisha Patel-Dunn, DO
Pacific Coast Psychiatric Associates
www.pcpasf.com