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Breaking Down Remote Provider Silos

Written by Shelley Sellinger, M.D. Originally posted on Becker’s Hospital Review

There is little debate that telemedicine has carved out a powerful niche in health care. Rapid growth of remote care models in recent years underscores the opportunity for both providers and patients alike. Yet, as health care organizations continue to adopt telemedicine models, many find that one all-important strategy is often overlooked: remote provider engagement.

It’s not a surprising revelation. While many providers find the telemedicine career path attractive because of the flexible scheduling options or ability to work remotely, they are often unprepared for the disconnected nature of the work and can be left feeling like they’re in a vacuum. That’s why it’s essential for organizations to consider how they can create unified, interconnected teams across geographies to support remote provider needs, and in turn, optimal care delivery.

Consider, for instance, the experience of my organization, InSight Telepsychiatry, which provides on-demand, scheduled and direct-to-consumer telepsychiatry services. With our providers spread remotely across the nation and even the world, InSight took note of the potential engagement struggles we as remote staff could experience.

To address this challenge head-on, InSight developed a comprehensive remote provider engagement strategy designed and led by a team of remote providers. Through the establishment of a provider engagement committee, we are now able to bring our offsite teams together in much the same way we connect with patients—virtually—to ensure providers feel connected and receive the support they need.

Considerations for Remote Provider Engagement
Like any provider community, telepsychiatry providers need access to clinical growth opportunities, peer collaboration and an understanding of priorities to feel part of the comprehensive provider team. The provider engagement committee serves as a critical resource for delivering clinical feedback, providing professional development opportunities, establishing a shared vision with managers and giving providers a voice in the organization.

As any worthwhile initiative, remote provider engagement programs require organizational resources from both a time and direct cost perspective. Consider administrative time that must be allocated for clinical supervision and staff development activities that may require monetary investment. Ultimately, a successful remote workforce model requires traditional management practices to be adapted to ensure remote providers feel engaged and part of a team. Designing a thorough program where a remote team has both professional development and social needs met is a crucial piece.

Advancing Engagement Strategies
As a remote provider who helped design and lead charge of our engagement committee at InSight, it’s important to remember that thoughtful program design is key. Through a number of strategic initiatives, we’ve been able to build an effective and sustainable program that addresses remote provider challenges head on while also meeting our unique needs as a company. Videoconferencing technology is used administratively to connect remote providers and team members, creating opportunities to collaborate, share feedback or ask questions when facing a challenging or new situation. Other key initiatives as part of our engagement program include the following.

Mentoring programs
Especially for new telepsychiatry providers, mentoring programs provide an effective way to onboard providers to organizational clinical processes and best practices for success. During the onboarding process, it’s important to have the opportunity to connect with someone who is not an administrator, as that can be intimidating at times. Connecting with another provider allows a peer relationship to form and can increase the comfort level of the new provider. Mentors connect with mentees by video or phone and are available for collaboration through other means as needed.

Clinical check-ins
Regularly scheduled clinical check-ins allow medical directors and telepsychiatry providers to discuss their work, ask questions or voice concerns. Telepsychiatry providers review performance and go through patient charts in detail at these meetings as well as connect with remote providers on a more personal level. Health care organizations can further extend clinical check-in strategies to include group sessions, allowing collaboration with multiple telepsychiatry providers to discuss best practices, difficult cases, common issues and any other topics that may arise. Group collaboration can also serve as a platform to support clinical peer review where providers and their colleagues review patient charts in compliance with industry standards.

Provider engagement newsletters
Monthly or bi-monthly newsletters are a great way to keep remote providers updated on organizational happenings, new initiatives or changes to care delivery processes and procedures. In addition, these forums can provide a platform for educating on new evidence and research.

Provider town halls 
The town hall model is typically used for high-level discussions regarding organizational updates and announcements to keep remote providers engaged with what’s happening on a macro level. The opportunity for providers and the administrative team to come together is imperative, and the town hall model allows providers to interact with one another and address questions or concerns to the administrative team.

These sessions might be held quarterly, bi-annually or once a year depending on resources and needs, allowing clinical leadership and operations managers to discuss current focus areas for telepsychiatry, changes in strategy or long-term plans. Additionally, this type of forum makes it possible for providers to interact with one another as a group. This allows a chance for providers to meet those who may be located in the same state or work with a similar facility which could then lead to a new peer relationship.

Continuing medical education
Critical to professional development, remote providers need access to continuing medical education opportunities to maintain their licensure. Our organization offers the opportunity to advance learning and earn credits through remote programs similar to providers working in a group setting.

Provider Engagement for Sustainable Telemedicine Models
Growth across the telemedicine field shows no sign of slowing. As the influence of these forward-looking models increases, the need for remote provider engagement strategies cannot be overlooked.

Remote provider organizations can follow suit and take a similar approach by applying this model and tailoring to their specific needs to keep provider teams from becoming disconnected and disengaged. Ultimately, it comes down to ensuring remote providers have the resources they need to succeed and giving them a voice in the organization.

About the author
Shelley Sellinger MD, ABPN is a board-certified psychiatrist from New York specializing in adult services, including anxiety and depression, substance use and addiction, trauma and abuse, and psychopharmacology. Dr. Sellinger has devoted her career to expanding access to behavioral health care. She joined InSight Telepsychiatry to continue that mission and assist patients nationwide.

A Better Approach to Crisis Behavioral Health

Original article published on Becker’s Health IT & CIO Review

Mark Alter, M.D., InSight Associate Medical Director of On-Demand Services

By: Mark Alter, M.D.

Today’s hospital emergency departments (EDs) are facing a perfect storm of behavioral health challenges. A combination of professional shortages and rapid growth in need for behavioral health services is creating significant supply and demand issues across U.S. communities. The overwhelming reality is that 42.5 million Americans struggle with mental health conditions, and professional shortages exist in all 50 U.S. states.

For many communities, the hospital ED has become one of the primary entry points for behavioral health access. Yet, few EDs are equipped with the expertise to handle the scope and complexities of this evolving challenge, leading to lengthy wait times and overcrowding, especially for patients in needs of psychiatric care.

To improve the outlook, hospitals are increasingly turning to the promise of on-demand telepsychiatry—an approach to care providing psychiatric evaluation or consult as needed via videoconferencing. These forward-looking care delivery models not only improve response times and access to services, but they also positively impact patient satisfaction and the bottom line.

The ED Behavioral Health Challenge: A Deeper Look
Current estimates suggest that one in eight ED visits involves a mental health condition, yet patients in need of evaluation often wait much longer than those in need of general medical care. One report found that 23 percent of psychiatric patients had emergency visits that were longer than six hours and 7 percent waited longer than 12 hours—that’s compared to 10 percent and 2.3 percent of other medical patients respectively. In addition, almost 21 percent of patients in need of an inpatient psychiatric bed wait between two and five days.

In terms of adequate staffing for psychiatric issues, today’s hospitals face the same supply and demand issues as consumers in need of services, especially in rural communities, where the existence of even one qualified psychiatrist is often lacking. EDs typically have limited or non-existent in-house hospital expertise available to them, and patients must wait until an appropriate professional is available. These present-day realities lead to crowded ED waiting areas, protracted waits, and the common practice of “boarding” individuals in need of psychiatric evaluation.

The Growing Influence of ED Telepsychiatry Models
Overall, hospital executives are prioritizing telemedicine models to prepare for value-based care. The “2017 U.S. Telemedicine Industry Benchmark Survey” revealed that 51 percent of executives rank deployment and adoption of telemedicine high strategically.

On-demand telepsychiatry models are certainly gaining traction as hospital EDs look to more effectively deliver behavioral health care and address the growing need for services. Provided via video-conference, telepsychiatry providers offer on-call professionals that can be accessed based on need. This framework enables telepsychiatrists to deliver care remotely to numerous organizations at once, increasing efficiency and workflows for all stakeholders.

Credentialed telepsychiatrists first collaborate with ED physicians, nurses and social workers, and review a patient’s medical record. An evaluation is then conducted with a patient in a private area through a computer, tablet or other mobile device. Ultimately, the goal of these one-time encounters is to ensure timely recommendations and triage of patients to the most appropriate level of care. On-demand providers provide valuable consultation services to ED staff and can also prescribe medications directly.

Benefits of on-demand telepsychiatry in the ED include:

Early stabilization and better outcomes
Timely psychiatric treatment initiated in the ED promotes earlier stabilization of conditions and improves patient safety—for both those facing a psychiatric crisis and other patients in the ED. It also ensures patients are triaged to the appropriate level of care or community service.

For instance, it is not uncommon for police officers in some states to bring individuals behaving erratically directly to the ED for psychiatric evaluation. Many of these patients do not require inpatient psychiatric hospitalizations, which can be often be avoided by having timely access to psychiatric professionals who can determine the appropriate level of care.

Many telepsychiatrists also report that patients in crisis situations, particularly those who are agitated or paranoid, can feel less intimidated by video conferencing as opposed to in-person evaluation.

Increased patient throughput
When evaluations are conducted in a timely manner, ED providers can help get patients to appropriate levels of care, opening needed beds to other patients and improving wait room crowding.

Greater patient satisfaction
A combination of timely evaluation and the right expertise ensures a better overall experience for any patients in crisis, including those with behavioral health concerns. When patients are forced to wait for hours or days to see a behavioral health professional, frustration is understandable.

Lower costs
Timely access to care lends to greater efficiencies in the ED and positive bottom-line impacts. In addition, telepsychiatry reduces the need for full-time emergency psychiatrists and ongoing recruitment costs and challenges.

Many hospitals—especially those in rural areas—simply lack the financial resources needed to hire specialized behavioral health professionals to provide services the ED. Additionally, hospitals benefit from the on-demand model by paying for usage as opposed to a full-time equivalent. EDs also reduce liabilities with timely access to on-demand telepsychiatry services, minimizing the potential for litigation that might otherwise occur if conditions escalate and difficult situations arise.

Reduced provider burnout
This approach to care also takes the burden off in-person psychiatric providers who are on call or responsible for covering night-shifts. Telepsychiatrists can work these shifts remotely from another location, even in different time zones, offering added flexibility and an enhanced work/life balance—critical components in addressing provider burnout.

Providing a telepsychiatry resource can also reduce stress on ED directors and other ED providers who do not have the specialty training in psychiatry, but are often faced with treating psychiatric patients.

Future Crisis Behavioral Health Models
While the current outlook on behavioral health professional shortages is grim, the good news is that telepsychiatry holds great promise for filling needed gaps, especially in critical environments such as EDs. Hospitals can realize notable gains by leveraging on-demand telepsychiatry services to improve outcomes, patient and provider satisfaction and the bottom line.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.