Rebecca K. Rucker, LPC‐S, LMFT Board Certified Coach- BCC And Brent LoCaste‐Wilken, LCSW, CEAP Manager, EAP

1. mental
Efficacy, Ethics, and
Design

2. Introductions
Rebecca K. Rucker,
LPC‐S, LMFT
Board Certified Coach ‐ BCC
Private Practice
5959 West Loop South,
Ste. 205
Bellaire, TX 77401
713‐443‐2741
rkrucker2@aol.com
Brent LoCaste‐Wilken,
LCSW, CEAP
Manager, EAP
Texas Children’s Hospital
1919 S. Braeswood Blvd.
Suite 1301
Houston, TX 77070
832‐824‐2155
brlocast@texaschildrens.org

3. Objectives
DesignEthicsEfficacy

4. Definition
A 2007 literature review identified 104 peer‐reviewed
definitions.1
The authors concluded that, in summary, telemedicine uses
1Sood et al. (2007) What is Telemedicine? A Collection of 104 Peer‐Reviewed Perspectives and Theoretical Underpinnings.
Telemedicine and e‐Health, 13:573‐90.
“communications networks for the delivery of healthcare services and
medical education from one geographical location to another. It is deployed
to overcome issues like uneven distribution and shortage of infrastructure
and human resources.”1, p.573

5. Current Trends
67%of healthcare professionals use some form
of telemedicine now, or are planning to in the next
few years
>70% of consumers would rather have an
online video visit to obtain a prescription than
travel to their doctor’s office
91% of healthcare outcomes were as good or
better via telehealth

6. Projections for the
Future
THE NUMBER OF PATIENTS WORLDWIDE USING
TELEHEALTH SERVICES WILL RISE FROM
LESS THAN 350,000 IN
2013
TO
7,000,000 IN
2018
IHS "Telemedicine Report 2014"

7. THE GLOBAL TELEMEDICINE MARKET IS
PROJECTED TO REACH
$36,300,000,000 BY 2020
Worldwide revenue for
telehealth devices and
services is expected to
reach
$4.5 BILLION in 2018
up from
$440.6 Million in 2013 0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
2013 2014 2015 2016 2017 2018
Billions

8. Regulatory Advances
57 Bills in the 113 Congress alone were introduced to change
current policies
MEDICARE TELEHEALTH PARITY ACT
Phase 1: Expands Coverage
Phase 2: Extends Telehealth to
Metropolitan Areas and home health
services
TELE‐MED ACT
Allows Medicare providers to treat patients
across state lines without needing to obtain
multiple state medical licenses
TELEHEALTH ENHANCEMENT ACT OF
2014
Greatly expand Medicaid coverage for:
 Critical access and sole‐community
hospitals
 Home‐based video care services at
hospices
 Home dialysis patients and homebound
seniors
 Women with high‐risk pregnancies
21st CENTURY CURE ACT
Requires telemedicine services to prove
cost neutrality, if not savings, in order to
seek reimbursement.

9. For
Clients/Patients
For Clinicians
For
Organizations

10. Policy Barriers
Program and
Administrative
Barriers
Clinical Barriers

11. Efficacy

12. Effectiveness
Delivers services for broad
range of mental health issues
Equally effective as face‐to‐
face
Clinical and quality of life
outcomes are similar
Improved mental health
scores and decreased
symptoms
Not as effective for:
some forms of therapy (ex.
Exposure Therapy)
Patients with particularly
severe conditions
Individuals not familiar with
technology

13. Client
Satisfaction
Consistency in Treatment Follow Up
High Levels of Acceptance and
Satisfaction
Effective Component of
Client/Provider Relationships
Reduced Travel Time, Less Work Lost,
Shorter Wait Time, and Availability of
Expertise
Client
Adherence
Generally Positive Adherence
Higher Levels of adherence in online
mental health are not associated
with improved outcomes
The quality of interaction appears to
have a stronger correlation to
improved health outcomes
No Complications or concerns with
patient/client safety in the clinical
application of videoconferencing

14. Provider Outcomes
• Satisfaction and
acceptance
• Efficiency and
effectiveness
• Clinical confidence
and reliability

15. Ethics
Regular ethics
standards apply
Practitioner
Videoconference
Competency
Ability to Address
Limits of
Technology
Client
Appropriateness
Adequate
Emergency Plan
Encrypted
privacy and
confidentiality
Ethics

16. Ethics
Differences and Special
Considerations
• Technology moves ahead of
legislation
Regulations
• State lines‐ inconsistent
guidelines across states
• HIPAA
• Encrypted hardware and
software
• Business Associate
Agreements
• American Telemedicine
Association guidelines for
best practice

17. Ethics
• Licensing and credentialing
• Exceptions – Guest licensure
provisions
• Malpractice liability insurance
• Informed Consent
• Privacy and Confidentiality
• HIPAA
• Further Reading
Medical,
Legal and
Regulatory
Issues

18. Professional Practice
1. Professional Conduct
2. Confidentiality
3. Informed Consent
4. Quality Clinical
Standards
5. Assured Competence
6. Standardized
Documentation
7. Empirical Evidence
8. Integrity of
relationship
9. Safety of Client
10. Legally Authorized
Services
Ten Interdisciplinary Principles for Professional Practice in
Telehealth

19. Design
Strategy Infrastructure Partnering
ConfigurationImplementationSustainability
This model draws upon and expands the work of Jay Shore and Spero Manson, from an article entitled A Developmental
Model for Rural Telepsychiatry (Shore & Manson, 2005)
and Mark Vanderwerf, AMD Global Telemedicine, 10 Steps for a Successful Telemedicine Program.

20. Strategy
Model
Access to
Care
Cost Savings
Market
Know
The numbers
The
Community
The
Organization
The
Regulations

21. Technical Aspects
Determine
technological
needs
Identify
resources
Assess
technological
infrastructure
Local services
and potential
partnerships
Locate places &
people
Locate
complimentary
services
Infrastructure

22. Partnering
Partnerships
Reach out to
resources
Keep lines of
communication
open
They advocate
for you
Determine
Who is willing to
participate?
Are they
knowledgeable?
What resources
the offer?
Is it a good fit?
How much time
they are willing
to commit?

23. Configuration
Process
Delineate roles and
responsibilities
Written protocol
(Manual of
Operations)
Emergency
Procedures
Patient/Client
qualifications
Environment
Effective sending
room
Effective
receiving/consulting
room
Instructions
regarding technical
failures

24. Implementation
Training
Communication
Technology
Clinical
Technology
Diagnostic
devices
Workflow &
Documentation
Trouble
Shooting
Small‐scale
Pilot
Create plan
Expect delays
Assess feedback
Communicate
technical issues

25. Sustainability
Marketing
Know needs and
wants of users
Understand why
some people
might resist
Claim success
and set public
expectations
Tell what you’ve
done and what
is next
Publish or
Perish
Present/publish
results
Teach or share
knowledge
At least one time
per year