Starting Your TeleMental Health Program

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Starting Your TeleMental Health Program

• Abdel Fahmy, MD, CPHIMS
• President, ISAM
• President, Soft Landing Ltd
• Regional Medical Director and Medical director
  for Substance Abuse, Access Community Health

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Health Information Technology

• Technology for comprehensive management of
  medical information and its secure exchange
  between health care consumers and providers.
• Improve health care quality
• Prevent medical errors
• Reduce health care costs
• Increase administrative efficiencies
• Decrease paperwork and
• Expand access to affordable care

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HITECH Title XIII

• American Recovery and Reinvestment Act of 2009 is
  all about HIPAA!!!
• Expands BA agreements
• Civil and Criminal penalties!
• Penalties funds HHS civil rights enforcement
• Willful neglect by 2/12/2011
• DOJ to pursue penalties or OCR will

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HIT Funds

• 19.2 Billion 12 Billion savings

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The docs get some money

• Up to 65K per physician over 5 years starting
  10/10
• Penalties to hospitals by 2015
• Meaningful use of EHR
• Certified
• Interoperability
• E-Prescribing
• CDSS
• CPOE

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EHR in Behavioral Health
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EHR in the Treatment community

• Few scattered vendors that dont have to follow
  standards.
• CCHIT standards due by 07/2010
• CDSS to support placement criteria
• Interoperability with medical counter-part
• Higher standards of HIPPA compliance
• Integrated eHealth technology

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TeleHealth -eHealth

• Use of telecomunication to deliver healthcare
• Quality regardless of distance
• Comparable efficacy to FTF
• Higher rate of patient engagement
• Various application including telesurgery
• DoD, VA and HRSA are most advanced
• Prevalence in rural States
• TeleMental Health is No. 1 Application

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TeleMental Health

• Some studies claim superiority
• First AV was in Nebraska Psychiatric Institute in
  50s
• 1968 Mass General Hospital started emergency
  psych consults
• Flourished in the 90s
• Today we have a significant advantage with
  encrypted streaming and mobility

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Reimbursement

• Medicare Rural to Urban, Hub and Spoke, same as
  face to face plus Hub Admin fees
• PPO Aetna, Cigna, BCBS
• HMO variable
• IDPA State by State
• California, Hawaii, Texas and Louisiana have
  passed bills prohibiting private health insurers
  from discriminating between traditional medical
  and telemedicine service reimbursement.

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Medicare

• Hub sites include
• County mental health clinic or publicly funded
  mental health facility
• Federally Qualified Health Center (FQHC)
• Hospital -- either inpatient, outpatient or a
  critical access hospital (CAH)
• Office of a physician or other practitioner
  (this includes medical clinics)
• Renal dialysis facility
• Rural Health Clinic (RHC)
• Skilled nursing facility
• Tribal Health Center (THC)

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Great Lakes States-Medicaid

• Illinois Yes
• Indiana Yes
• Michigan Yes
• Ohio SB94 services provided by Telemedicine
  shall not be excluded

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Developing the Program

• Mission and vision of organization
• Champion
• Needs assessment
• Feasibility studies
• Project planning and management
• Policy and procedures
• Workflow

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Simple Equipment
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Equipment

• Desktop computer, microphones, speakers,
  monitors, cameras, CODEC and other accessories
  ITU standards
• Policies and procedures regarding equipment
  quality control and validity testing.
• Physical security
• Good working condition and replace equipment as
  necessary
• Disaster planning and backup

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Equipment Cont.

• 100s to 40,000
• High speed connections

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Privacy

• A written privacy policy to be reviewed and
  signed by all involved
• Provisions to prevent monitoring of patient by
  unauthorized parties
• The patient has to be informed at the beginning
  of session as to who is present at the providers
  location during the video conferencing and
  notified immediately if anyone else enters the
  room during the video conferencing session

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Privacy and Confidentiality

• HIPAA compliance
• Access logs and
• Audit trails
• e-Discovery

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Informed Consent

• What is TeleMental Health
• Compared to Face To Face (FTF)
• Potential risks
• Agreement is voluntarily
• Refusal will not withhold treatment
• May terminate session at any time

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Training

• Mental health professionals have to be trained
• how to properly use the technology
• Organization policy
• HIPAA and security
• Indications
• When to cancel and order a FTF
• Quality control and peer review

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Medical Records

• Documentation same as FTF
• In addition should state
• Location of provider
• Location of patient
• Malfunctions interfering with quality
• All personnel present during session

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Food for Thought

• Social networking in web 3.0
• Texting for Health- No HIPAA products
• Avatars and Virtual counseling - Harvard
• Online group Therapy Our specialty

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MySpace
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MySpace

• Started in 2003 by Internet marketing outfit
  eUniverse
• Has become a social media site for musicians,
  artists, actors and comedians
• 73 million users in the U.S. and 117 million
  globally (June 2008)
• No. 1 social network in the U.S. according to
  Nielsen

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Facebook
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Facebook

• More than 200 million active users
• More than 100 million users log on to Facebook at
  least once each day
• Average user has 120 friends on the site
• More than 3.5 billion minutes are spent on
  Facebook each day (worldwide)
• More than 850 million photos uploaded to the site
  each month
• More than 8 million videos uploaded each month

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LinkedIn
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• Thats all Folks
• Questions?

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• Abdel Fahmy, MD, CPHIMS
• Soft Landing Ltd
• Oakbrook Terrace Medical Centre
• 1s224 Summit Ave. Suit 310
• Oakbrook Terrace, IL 60181
• 630-261-9220
• Dr.Fahmy_at_SoftLandingRecovery.com
• WWW.SoftLandingRecovery.com