Traversing the 114 Mile Gap at the Speed of Light A D A M B I U C - - PowerPoint PPT Presentation
Traversing the 114 Mile Gap at the Speed of Light A D A M B I U C K I A N S , M D E R I N G L E N N , L S W Who We Are Adam Biuckians, MD Community Services Group, Medical Director Board Certified Child and Adolescent Psychiatrist
A D A M B I U C K I A N S , M D E R I N G L E N N , L S W
Community Services Group, Medical Director
TrueNorth Wellness Services, Fulton County Outpatient
Figure 1: Timeline of communication tools, 2014 update. Ref: Khourdajie, A. (2008), Marketing for the Wireless World. Individual Term Paper, MARK1051, University of Greenwich, UK.https://commons.wikimedia.org/w/index.php?curid=31202496
Face to Face Telephone Snail Mail Facsimile
Email Instant/Text Messages Patient Portal Virtual Visits (telepsychiatry) Apps (ie MyStrength)
Debut of audio and video transmissions in psychiatric setting Starting with teaching medical students at Medical College of
(American Psychiatric Association (APA))
Funded the first microwave relay to facilitate a direct
Occurred between Dartmouth Department of Psychiatry and a
(Solow, C.; Weiss, RJ.; Bergen, BJ., 1971)
Use of closed circuit television for psychiatrists to see patients at a
nearby airport
Reportedly the term “telepsychiatry” came from this project Also introduced the use of remote control cameras to pan, zoom, and
tilt
(APA)
Slow growth, but gradually increasing acceptance and overcoming of
various obstacles/barriers
Ongoing, and often dramatic, improvements in technology help to
facilitate growing acceptance
(APA)
More rapid growth Larger institutional programs utilizing more frequently VA Health Maintenance Organizations Academic Centers Smaller clinics and hospitals begin utilizing as well Individual practitioners direct to patients’ homes with the explosion
web-based videoconferencing
Telepsychiatry companies begin offering services to clinics/hospitals
unable to sufficiently staff for their communities’ needs
(APA)
Uses video cameras and microphones Able to connect psychiatrists to patients in otherwise remote
Direct services provided include diagnostic assessment,
Indirect services provided include consultation and
Total Population: 14,747 (US Census Bureau – American Community
Survey 2010-2014)
15.7 % of population eligible for Medical Assistance (PA
Department of Health, Bureau of Health Statistics & Research 2014)
56/67 ranking among PA counties for Health Factors (County
Health Rankings 2015, Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute)
Measured considering Health Behaviors, Clinical Care, Social and
Economic Factors, and Physical Environment
Largest Employer: JLG Industries, Inc. (Center for Workforce
Information & Analysis 4th Quarter 2014 Initial Data)
Figure 2: 400S Telescopic Boom Lift, JLG.com
Prior to TrueNorth Wellness opening in Fulton County, there
Two major PCPs in area. Overwhelmed by having to provide mental health care on top
Chambersburg, PA – Approximately 25 miles, 35-40 minutes Hagerstown, MD – Approximately 30 miles, 45 minutes Harrisburg, PA – Approximately 75 miles, 1 hour 20 minutes
Susan Blue, Mary McGrath, James Martin, Gary Minnier
Every other Tuesday 110 Services in Year 1
Every other Thursday 155 Services in Year 1
Directly interacting with the consumers and providing
Consultation provided to another provider, regarding a
InSight InnovaTel
Secure Telehealth
Majority made by area Primary Care Physicians Referrals made to Centralized Intake Department Same process for seeing on site physician 6 years old and up, scheduled 5 years old and younger, clinical supervisor consulted Looking for other supports and services being tried prior to
psychiatry
Weight (each visit) Blood Pressure (each visit) Medical History (first visit) Assess (each visit) Safety, medication compliance, side effects, etc.
Nurse can follow up on lab work requests, additional
Nurse and/or front office assist in completion of releases for
This challenge really is based more on timing than providing
Once every other week is not always enough time
First half hour of each day is scheduled for physician, nurse,
Conference calls scheduled for “off weeks” Nurse is able to email for any emergent concerns On site meetings, alternating locations, 2 times per year
Having physicians working with multiple agencies makes
We found that we had to be flexible on each side Offer other days to replace days off Utilize on site physicians when necessary
Not living in the community in which you work can make
It is often a challenge to locate needed resources, especially
Created a resource list for physicians to have on hand
Often very little information when a client is referred Telehealth physicians are not linked to local providers
We have learned to utilize our nurse as a detective We are working to determine better ways to access
We have taken telehealth providers to local agencies in order
Technology is not always reliable What happens when there is a disconnect?
“Tech guys” for each agency worked on developing the system
We do have “back up plans”
Turn it off and turn it back on Call the “tech guys” Urgent matters addressed via telephone in interim Offer a different location CSG and TrueNorth Wellness both have the ability to use telepsych
equipment from other locations
Our adult provider one time even drove to Fulton County!
Refills, prior authorizations, side effects, etc.
Nurse coordination is key Nurse is able to refill some medication, complete prior
Coming soon: electronic prescribing of controlled substances
Occurs with both consumers and physicians Still not particularly common, which can create some natural
resistance
Is not comfortable for all providers Provider must learn how to utilize multiple EHR systems Provider must be able to adjust to multiple agency processes and
cultures
We are able to continue to provide face-to-face for adults We can refer child if necessary Educate clients regarding telehealth services from initial contact Not always able to replace providers, but able to communicate
Insurances covering telehealth services has traditionally been
Able to take Medical Assistance, Medicare, and limited other
Not always able to utilize Medical Assistance as a secondary
In more recent months, private payers have begun covering
Have worked with local Medical Assistance entities to consider
Prior to June 4, 2013 0 Psychiatric Services June 4, 2013 – August 9, 2016 Psychiatric Evaluations: 82 Medication Management: 434
January 23, 2014 – May 26, 2016 Psychiatric Evaluations: 118 Medication Management: 359
“Was the doctor animated enough that you were connecting while
talking?/Did the doctor seem connected to you as an individual?”
96% answered yes “Could you understand the doctor?/Were you able to hear clearly?” 96% answered yes “Was care as good as in person?” 3.7 average (4 being excellent) “How would you rate quality of service?” 3.6 average (4 being excellent)
Ability to share resources with client directly, provide psycho-
Example: Apps tracking health and wellness components
Collect and gather information and releases ahead of time
American Academy of Child & Adolescent Psychiatry (2016). Workforce Maps by
http://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce _Maps/Home.aspx
American Psychiatric Association. History of Telepsychiatry [Video file]. Retrieved
from: https://psychiatry.org/psychiatrists/practice/telepsychiatry/history-of- telepsychiatry
Fulton County Chamber of Commerce and Tourism (2016). 2016 Community
Profile & Membership Directory. Centre Hall, PA: Centre Publications.
JLG Industries, Inc. (2016). [Image file.] Retrieved from:
https://www.jlg.com/en/equipment/engine-powered-boom-lifts/telescopic/400- series/400s
Khourdajie, A. (2008, updated 2014). [Image file.] Retrieved from:
https://commons.wikimedia.org/w/index.php?curid=31202496
Solow, C.; Weiss, RJ, Bergen, BJ (1971). 24-Hour Psychiatric Consultations via TV.
American Journal of Psychiatry, 127, 1684–1687.
University of Wisconsin Population Health Institute (2015). County Health
Rankings 2015. Retrieved from: http://www.countyhealthrankings.org/sites/default/files/state/downloads/CHR20 15_PA_0.pdf