How has your practice been affected by the recent COVID-19 pandemic? Are you prepared to transition to telepsychiatry during this time? We recently sat down with psychiatric nurse practitioner, Michele Novella in our most recent NEI Podcast episode, “Treating Mental Health Using Telepsychiatry with Michele Novella” to discuss this timely and important information for your practice. Here is part of the transcript:
NEI: Could you give us the “run-down” in terms of, what are the best apps available currently for telepsychiatry? I know that, some might be overloaded right now because of internet usage and things like that. But what are the most currently used ones, and price-wise could you also share with us some information on how to find these?
NOVELLA: I have been able to vet out some, but not all. Zoom*, because it did have HIPAA compliance, all we had to do was online sign a business associate agreement for our healthcare customers. I want to say the first month was $19.99. And then after that it was $200/month and that was for a practice of between 2-10 people. And actually, the first day that every student in my town started to do distance learning, and most people were working from home, there was a huge load put on our local bandwidth and everyone was home during the day so this was a difficult situation in terms of the connections. I asked a few providers who they were using that day, and did they have any problems? And they were one of the companies that didn’t have any problems to the few people I spoke to. You don’t have to become an IT (information technologist) specialist, by any means. All of these companies pay very well to have IT specialists troubleshoot and be liaisons to their providers, because they know we work in the healthcare field and our expertise is seeing patients. Doxy.me was a stand-alone HIPAA compliance platform. A lot of the HER (Electronic Health Record) all-in-one programs offer the feature of telemedicine. Again, like I said we use Kareo EHR. There’s also doctorondemand.com. But you really have to look online for the telepsychiatry specific ones, because we do need excellent connectivity.
*Please note, that at the time of this interview, the reports about privacy concerns surrounding the use of Zoom for telemedicine had not occurred. Since then, a report by HIPAA Journal on April 3, 2020 reported that the end-to-end encryption that Zoom claims to implement does not apply to video meetings. Instead, the meetings use transport encryption, which means that communication between the meeting participants is encrypted, but that Zoom has access to the unencrypted video and audio. While the Health and Human Services (HHS) Office for Civil Rights will not impose sanctions or penalties for the good faith provision of telehealth services, and applications that may not satisfy all HIPAA requirements can be used during the COVID-19 public health emergency, healthcare providers should exercise caution. Zoom has publicly committed to fixing security and privacy issues and to assess the platform for any further vulnerabilities. Many other platforms are available that do offer true end-to-end encryption, are free of charge, and are HIPAA-compliant, such as TigerConnect. Until the issues have been resolved, it is strongly advised by the HIPAA Journal that other teleconferencing platforms be used during the COVID-19 crisis.
NEI: What are some of the technological challenges to treating patients who might not be as tech savvy, and what do you recommend to overcome these challenges? Especially when it comes to COVID-19, we’re seeing a lot more of the older population being impacted by this, and not to put any major assumptions out there, but this tends to be a population that struggles a bit more with technology. How do you address that?
NOVELLA: Sometimes necessity breeds innovation, and first of all I know that my office manager contacts the patient and tells them that I’m going to be seeing them over telepsychiatry. She asks them “What kind of a device do you have at home? Do you think you’ll be doing the visit with your Iphone?”, Do you have a tablet, or do you have a desktop?” Because, depending on which of those three is the way she will deliver the email. So if they have a desktop, she’ll say “We’re going to send you an email about an hour or so before the visit. That email has a link, which is basically highlighted letters with a line under it. You’re going to click on that link, and it’s going to ask you is this “Mrs. Jones?”. It might ask you to verify if your insurance is still the same, and sometimes for patients who haven’t met their deductible, it may ask do you have a form of payment so that we can charge your copay because the copays and deductibles still do apply. And patients are really good about this, when it comes to telepsychiatry. If they do this on a tablet or smartphone, you will get a text and will tell you to download Kareo medicine. Download that app and when you go on the app you’ll make a username and password. We don’t ask if you’re a robot. We don’t do any of that. We just want you to make a username and password. And then you just press a button when you’ve done that, and then you’ll literally see a circle on the screen, which means that you’re in the virtual waiting room. Once they do it, there’s actually a sense of mastery, and so that’s been exciting to see for the older adults because I will praise them. It’s tricky, and as we do with all things in psychiatry, being a cheerleader for your patient always works well.
For more on this topic, click on the link below for the full episode for part I: Treating Mental Health Using Telepsychiatry, Part I
And for part 2: Treating Mental Health Using Telepsychiatry, Part II
“Zoom Security Problems Raise Concern About Suitability for Medical Use, HIPAA Journal April 3, 2020 https://www.hipaajournal.com/zoom-security-problems/
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