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Service Brings Psychiatrist to the Patient, via Computer Screen

Originally published on The Daily Item

By: Joe Sylvester

LEWISBURG — Evangelical Community Hospital patients who needed a psychiatric consultation in the past sometimes had to wait two or three days to talk to a psychiatrist.

Since February, the wait has been an average of 90 minutes but no longer than 4 hours, thanks to technology provided by a New Jersey company.

InSight, based in Marlton, N.J., provides telepsychiatry services via computer screen. Once contacted, the company can have a board-certified psychiatrist on screen within an hour or so. A hospital staff member wheels the screen, attached to a cart, to the patient, and the patient can talk to the psychiatrist in private. An on-screen camera allows the doctor to see the patient, said Hannah Richards, a registered nurse in Evangelical’s emergency department.

When a patient with a psychiatric issue comes to the emergency room or is admitted to one of the floors, the hospital contacts InSight, which has a time limit of 4 hours to have a psychiatrist call back. The screen is brought to the patient for the consultation after the doctor comes on it, Richards said.

“We can do it both in the ER and upstairs on any patient floor,” said Christal Dixon, director of nursing specialty services at Evangelical.

She said the hospital has three screens for the service, which the hospital began implementing in January and started using in February. Now the services are used six or seven times a month, Dixon said.

While she wouldn’t reveal the cost, she said the flat fee is significantly less than the cost of the local services the hospital previously used. The hospital also pays a fee for each consultation.

“We used a service before, but it would take two to three days,” Dixon said.

She said the local service also wasn’t available for late-night or weekend consultations.

She and Richards said the hospital could always contact CMSU if a patient was a danger to himself, herself or others or needed immediate placement in a facility.

She and Evangelical spokeswoman Deanna Hollenbach said one problem is the shortage of psychiatrists in the Valley. Hollenbach said Evangelical, Geisinger Health System and other groups sponsored a community needs assessment in the region, and it found psychiatric services were lacking.

Dixon said InSight is certified and its psychiatrists credentialed to work in Pennsylvania. Its psychiatrists can see the patients’ medical records electronically before consulting with them and prescribing medications, if needed. Evangelical doctors can bounce suggestions off the psychiatrists in a followup call.

“This company has been doing this for over 18 years,” she said.

Richards said the telepsychiatrist also can do consultations with the patient and family members.

“I think it’s really beneficial,” Richards said. “It was difficult to treat a patient holistically. We have the medical part down but not the psychiatric.”

Richards said patients have made positive comments about the service.

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.

Use of Telepsychiatry Improves Provider Links at Pennsylvania Hospital

chester county hospital

Mental Health Weekly
By: Gary Enos

As administrators of a general hospital with no specialized psychiatric unit, leaders at Chester County Hospital in eastern Pennsylvania had become accustomed to a waiting game for psychiatric consultation when a patient with clear mental health needs presented in their emergency department. As is the case at a growing number of general hospitals around the country, telepsychiatry is providing these leaders with an alternative to what can become a crisis in emergency operations — as well as for patients in need.

In partnership with national telepsychiatry company InSight Telepsychiatry, LLC, Chester County Hospital is now using video technology to enable it to receive expert consultation on cases, usually within an hour of making initial contact.

This reduces wait times for services and creates more effective referral to specialty mental health treatment services in the community, while in other cases it simply might offer a more rapid and expert confirmation that a patient with mental health needs can be safely discharged.

“In the emergency department, the availability of specialty services is always difficult,” Betty Brennan, Chester County Hospital’s director of emergency services, told MHW.

“We were finding that the availability of psychiatrists was increasingly more difficult, because of their professional load in their offices. The immediacy that we needed just wasn’t there.”

The hospital’s phone calls to other facilities to see how they were handling the issue of delays in mental health patient transfer or discharge led the organization to InSight in 2011.

Brennan said the high quality of communication between patient and remote provider via video gives her confidence that the sessions between patient and psychiatrist virtually duplicate the more common face-to-face experience. “You almost forget in today’s world that you’re talking on videoconference,” Brennan said of the telepsychiatry experience.

The hospital launched its work with telepsychiatry for evening and overnight hours but has since expanded the program in order to maintain round-the-clock coverage.

The Encounter

In a typical scenario, a patient might present with suicidal ideation and be seen immediately by an emergency physician on the hospital staff. Once an initial level-of-care evaluation takes place in the ER setting, the hospital will contact In- Sight’s Access Center and transmit a patient history.

Brennan said InSight provides a number of psychiatrists for the telepsychiatry services, and the hospital has been able to develop a rapport with these individuals over the course of the project. (The psychiatrists are required to be credentialed at the hospital facility with which they are working.)

Often the hospital staff physician will speak with the psychiatrist before the specialist conducts the patient interview. For the video interviews, the hospital uses several secure rooms that are located a fair distance from any hospital exits. A hospital employee, such as a nurse or a member of the security team, is required to be present while the patient is being assessed via video.

The interviews are highly detailed and usually last anywhere from 20 to 45 minutes, Brennan said.

The high-definition videoconferencing equipment helps to establish a process that very closely approximates what occurs in a face-to-face interview, she said.

“We’ve never had a patient refuse,” Brennan said, as the message to them becomes one of facilitating necessary services in the quickest manner possible. “The physicians are very skilled, and the patients like that it’s private.”

A written consult from the psychiatrist is faxed to the hospital upon completion of the specialist’s interview and evaluation. “We’re not waiting for a psychiatrist to come in when his office hours are over,” Brennan said.

Often it is the case that the psychiatrist’s consultation offers a rapid confirmation of a course of action that was already apparent to the hospital staff, from a referral to a specialty behavioral health facility in the community to a discharge without extensive follow-up.

Brennan added that having this service available not only helps establish more effective linkages with mental health providers outside the hospital for followup care, but also speaks to a more humane way of addressing patient needs.

“There is an increased focus now on the rights of the mental health patient, and on getting them to the right facility,” she said.

Additional Applications

Brennan believes the telepsychiatry option can work equally well for adult and adolescent patients. The secretary of the Delaware Department of Health recently said that telepsychiatry could assist in reaching underserved young people in a state that this year has seen a significant number of teen suicides related to unaddressed mental health needs.

Brennan said the telepsychiatry experience at Chester County Hospital has proven so effective that the hospital has begun to extend telehealth into other operations. It is now using similar technology for evaluations of stroke patients, she said.

Other hospitals across the country that are working with InSight technology have reported similar improvements in wait times and overall emergency operations as a result of telepsychiatry’s availability.

“On occasion, patients are taken to the hospital under the Baker Act for a behavioral issue when they’re actually under the influence of drugs or alcohol,” said Eddie Carie, behavioral health case manager at South Florida Baptist Hospital in Tampa.

“These patients used to wait days for a psychiatrist’s evaluation. Now, we’re able to have a psychiatrist evaluate the patient and make a decision within hours.”

InSight Telepsychiatry Supports Creativity and Innovation During Psychiatry Innovation Lab Event

Oct. 19, 2016 | InSight Telepsychiatry was proud to support three awards during the Psychiatry Innovation Lab at IPS: The Mental Health Services Conference organized by the American Psychiatric Association.

Washington, D.C. — InSight Telepsychiatry awarded three finalists for innovative ideas in the advancement of behavioral health care during the Psychiatry Innovation Lab at IPS: The Mental Health Services Conference organized by the American Psychiatric Association.

Chaired by psychiatrist and author Dr. Nina Vasan, the Psychiatry Innovation Lab is an educational workshop that fosters the advancement of health care delivery. The lab offers the opportunity for professionals in technology, business, medicine, government and nonprofits to connect and collaborate with psychiatrists and mental health professionals.

On Oct. 8, participants pitched ideas for the advancement of behavioral health care delivery by way of entrepreneurship, policy, systems redesign, education, collaboration, technology and more. InSight awarded a total of three of the six awards presented at the event.

A team of neuropsychiatry-minded high school students was awarded Outstanding Progress for their work on AlzHelp, an augmented-reality and intelligent personal assistant app that keeps individuals living with Alzheimer’s disease safe. The app was designed by Akanksha Jain, Michelle Koh and Priscilla Siow.

Presented by mental health care entrepreneur April Koh, Spring.com was awarded the Most Promising Innovation for enabling the prediction of treatment outcomes for depression by way of machine-learning and big data.

The last award supported by InSight went to a group called Beacon led by Shrenik Jain for the Most Disruptive Innovation. Beacon is a mobile application for chat-based group therapy that has participated in a diverse selection of health care technology initiatives. A consistent group of anonymous users come together in judgement-free communities with this group therapy app.

Other winners included: The grand prize winner Joseph Insler for his “overdose recovery bracelet” and the audience choice Swathi Krishna for SPECTRUM, an app for children with autism spectrum disorder.

As the leading national telepsychiatry organization, InSight is proud to support a workshop that cultivates the advancement of behavioral health care through innovative applications of technology. InSight provides psychiatric care through innovative applications of technology by providing telepsychiatry services to hospitals, outpatient clinics and other health care organizations nationwide.

New Telepsychiatry Program Enhances Access to Behavioral Health Care in Northwestern Illinois

The initiative is funded by the Metropolitan Chicago Healthcare Council (MCHC), which received a grant from The Partnership for a Connected Illinois to launch a telepsychiatry program in the area which is critically underserved by behavioral health specialists. More than 70 percent of rural, medically underserved counties in Illinois do not have a psychiatrist, according to a report from the National Center for Rural Health Professions at the University of Illinois at Rockford and Project Export.

“By leveraging technology and medical expertise, this pilot program is providing patients with access to behavioral health care in an area where it would otherwise be hard to come by,” said Dr. Michael Wahl, Medical Director of MCHC. “Telepsychiatry allows us to enhance the quality and efficiency of care for some of our community’s most vulnerable members.”

InSight Telepsychiatry was chosen to provide clinical and technological support for the program. As part of the pilot, InSight telepsychiatrists are available 24 hours a day, 7 days a week to work with emergency department (ED) staff at Midwest Medical Center and FHN to evaluate the behavioral health needs of patients and help to determine the appropriate disposition and treatment. The InSight telepsychiatrists who are serving Illinois facilities are licensed in Illinois and thoroughly oriented to the communities they are working in.

“I’ve seen consumers who have, before telepsychiatry, had to wait days to see an in-person psychiatrist. It is powerful to be able to give these individuals a psychiatric evaluation within about an hour of a request,” said Dr. Jim Varrell, Medical Director at InSight Telepsychiatry. “It means the consumer can get the appropriate treatment more quickly and the ED can improve their patient flow. Technology is just a modern-day medium for accessing specialist care.”

Telepsychiatry allows for unprecedented access to specialists like child and adolescent psychiatrists and substance abuse specialists. These specialist services can be used in other settings beyond the ED including outpatient facilities, residential programs, psychiatric crisis centers, primary care offices and correctional facilities. The pilot program will run through May 31 and the participating hospitals will have the opportunity to continue the service after the pilot is completed.