Integrating Telehealth Into Your Psychiatric Practice

During the pandemic and social distancing, many health care professionals embraced remote appointments to see patients. Nowhere was this more evident than psychiatry, where over 90% of providers used some sort of telehealth mental health services. This service wasn’t novel, as remote care has been around since the days of pagers and phone call consultations, but the direct to patient aspect was, and even though the pandemic is no longer a factor the entire field of medical care has changed. Offices have gone to hybrid care models or even entirely online as regulations have changed and understanding telehealth having a strategy is key to moving forward.

Adding Telehealth is Not Optional but a Necessity

Having been through the changes of the pandemic, psychiatrists and psychiatric nurse practitioners no longer find that remote care is just optional but rather a patient expectation that they can’t afford to miss. Many of the negative issues with outpatient psychiatry are removed with this remote care model, and the benefits to the patient and provider are too high to ignore. They include:

• An easier experience integrating care as a remote care model can be integrated into existing primary care offices
• Better flexibility and scheduling as providers can work at multiple locations or from multiple locations which can increase access for patients, especially those in underserved populations
• The removal of the stigma of going to a psychiatrist or psychiatric nurse practitioner as appointments can be done entirely remotely
• A higher show rate as clients no longer have to travel to reach an office, leading to an improved continuity of care

These factors put the “care” back into health care, which ensures the field of behavioral health telehealth is here to stay. At the same time, this only works when there are clear expectations and understanding telehealth services, as there will be challenges when you implement these services which can risk losing patients if you fail to do so without essential telemental health policies in place.

Programs Can Be in House or Outsourced

If you’re a medical provider who is not a mental health specialist or a clinical director, you’ll be adding additional staff onto your virtual team. If you’re an existing mental health provider with your private practice, you may do the work entirely by yourself or looking for additional help. Since the key is to make sure patients can be seen, it’s important to look at whether you will add outsourced staff.

Many factors are involved in deciding whether to outsource mental health care, and major telepsychiatry companies such as FasPsych can better provide resources for the benefits and downsides of adding outsourced care. In general, the deciding factor should be determined when looking at whether you want to only add accessibility or also want to add capacity.

Steps to Take for a Successful Implementation

There are six primary steps for a successful telemedicine implementation:

1. Review of Program Needs – before you start a major project, it’s important to make sure the goals and needs of the program are set. What you want to accomplish with your telehealth program, whether you’re going to work only on your own or outsource, whether you’re familiar with any regulations in your state and can meet them, whether you can keep your patients on controlled medications if you go to an entirely remote environment, and what changes you need for your payors are important things to review before instituting a telemedicine program.

2. Decision of Integration Format – the next decision to make is whether your setup and staffing will be done solely by in house employees or whether an outsourced group. As discussed earlier, both options have benefits, and this can always be changed after going live. The key to deciding is going back to what your program needs are and researching companies that can help you with the scope of your needs, whether it’s just an IT consulting group or a comprehensive ongoing locum tenens solution.

3. Creation of Policies – practice guidelines are key for successful telehealth services. before you move to purchasing or installing any EHR or hardware, it’s vital to set parameters as to what you’re going to do within your telehealth program. Questions can include whether you’ll handle acute cases, whether there will be patients which this may not be appropriate for, how to escalate emergencies, and how your staff will be involved in day-to-day issues (an obvious example is if a patient can’t connect to video calls for care delivery). How medication management will be handles, how clinical documentation will be ensured, and the entire nature of psychiatric care need to be addressed in a direct manner to make sure virtual therapy sessions are effective.

4. Purchasing and Integrating an EHR, E-RX, and Video – this is where you begin to research telehealth technology, and finally get to the actual heart of the video calls. once you know your goals, key considerations include how you’ll move forward, and what the scope will be you’re ready to move forward with any purchases. In some cases, you’ll find that major EHR software already includes health records, e-prescribing, and video built in meaning you need to make no changes; in other cases, you may need to purchase new software, and major vendors include Epic and Cerner. It’s important to remember that even if features are built in they may not be convenient, and patients may prefer using a common conference product rather than a built in one that is only used for that electronic health record.

5. Staff Onboarding - adding telehealth is a huge change in administrative tasks among staff, and the digital tools will be brand new, so before a single patient is seen it’s vital that any staff involved are aware of the processes involved, with staff training being key. Using telemedicine is a much larger change than it can seem, and it effects everyone from the biller to the scheduler. The entire staff will likely need access to the health record, so it’s important they’re trained in the usage of it; many of them will also become impromptu tech support staff for patients with issues, so it’s important they participate in test appointments. Only whole office buy in will make this work.

Review if Your Program is Successful

Once you’ve gone live, it’s important to get constant feedback from patients, staff, and take stock of your own experience. These programs are only successful if everyone finds that they provide care to patients in a way that works for all parties involved. There is no objective benchmark that tells whether a program is successful or not; it’s a subjective measure based on how the parties involved see the programs goals, which will vary depending on your situation.