Topic 4: Telepsychiatry


Relevance to the Underserved Issue

Telepsychiatry is currently one of the most effective ways to increase access to psychiatric care for individuals living in underserved areas.


Summary of Key Information


Telepsychiatry, or telemedicine, is a specifically defined form of video conferencing that can provide psychiatric services to patients living in remote locations or otherwise underserved areas. It can connect patients, psychiatrists, physicians, and other healthcare professionals through the use of television cameras and microphones. Telemedicine currently provides an array of services, including but not limited to diagnosis and assessment; medication management; and individual and group therapy. It also provides an opportunity for consultative services between psychiatrists, primary care physicians and other healthcare providers. Telepsychiatry is also being used to provide patients with second opinions in areas where only one psychiatrist is available.

Telepsychiatry has been shown to improve collaborative services between professionals. Studies indicate that healthcare professionals feel telepsychiatry has given them an opportunity to work more effectively as a team. Patients surveyed say they felt that the communication between their physicians had improved their outcomes. There are a few barriers to providing telepsychiatry services. Reimbursement is still difficult to receive, especially through third-party payers, and licensure can be difficult to obtain.

Overall, telepsychiatry provides increased access to services and has helped enhance the provision of services to families with children and other patients who are homebound. Patients participating in telepsychiatry say they are satisfied with the care they are receiving and that they feel telepsychiatry is a reliable form of practice.


Model Programs and Collaborative Project


  • The Rural Health Care Program of the Universal Service Fund:

    The Rural Health Care Program provides discounts to eligible rural healthcare providers, for telecommunication services and monthly internet service fees. The program's goal is to keep telecommunications affordable in rural areas. More information can be found below at:     http://www.universalservice.org/rhc/
    Contact Information
    2000 L Street, N.W.
    Suite 200
    Washington, D.C. 20036
    Phone: (202) 776-0200
    Fax: (202) 776-0080

  • University of Colorado Health Sciences Center (UCHSC), American Indian and Alaska Native Program (AIANP):

    UCHSC provides the following two programs for American Indian and Alaskan Native populations:
    1. The Center for Native American Telehealth and Tele-education (CNATT) provides technological resources, education, clinical programs, research, web-based services, and technological assistance to American Indian and Alaska Native communities. More information can be found at:     http://www.uchsc.edu/ai/
    2. Telemental Health Treatment for American Indian Veterans with Posttraumatic Stress Disorder (PTSD) provides treatment services for PTSD consisting of medication management and individual and group psychotherapy clinics. More information can be found at: http://aianp.uchsc.edu/cnatt/clinical_care.htm
    Contact Information
    Jay H. Shore, MD MPH
    Assistant Professor, American Indian and Alaska Native Programs
    University of Colorado Health Sciences Center
    Nighthorse Campbell Native Health Building
    P.O. Box 6508
    Aurora, CO 80045-0508
    Phone: 303-724-1465
    Fax: 303-724-1474


  • Medical College of Georgia Telemedicine Center
    This program provides training in telepsychiatry for students, online distance education for mental health professionals, and psychological consultations. More information can be found at:     http://www.mcg.edu/telehealth/
    Contact Information
    1120 15th Street, EA-100
    Augusta, GA 30912
    Phone: 706-721-6616
    Fax: 706-721-7270
    e-mail:     maxs@mcg.edu or ekhasanshina@mcg.edu

  • Southern Illinois School of Medicine, Department of Psychiatry:
    The Southern Illinois School of Medicine is in the process of implementing a telepsychiatry program to provide psychiatric services in rural areas. More information about this program can be found at:     http://www.siumed.edu/psych/
    Contact Information
    Mary I. Dobbins, M.D., Lead Psychiatrist
    Deborah Seale, Program Director
    SIU School of Medicine, Department of Psychiatry
    P.O. Box 19642
    Springfield, IL 62794-9642
    Clinic Phone: (217) 545-8229
    Business Phone: (217)-545-3935
    Fax: (217) 545-2275
    e-mail:     rkanwischer@siumed.edu

  • Emory University Healthcare Services:
    The Fuqua Center for Late-Life Depression at the Emory University School of Medicine has launched the American Indian and Alaska Native Telepsychiatry Program. This program uses videoconferencing technology to connect older adults living in rural communities to providers practicing at Emory. The telemedicine program was developed through a partnership between Georgia Department of Insurance, the Georgia Rural Health Care Initiative, and Well point/Blue Cross/Blue Shield of Georgia. More information can be found at:     http://www.emoryhealthcare.org/departments/fuqua/index.html
    Contact Information
    The Fuqua Center for Late-Life Depression;
    1841 Clifton Road NE, 4th Floor;
    Atlanta, GA 30329
    Phone: (404) 728-6302 (M-F 8am - 5pm EST);
    New patient appointments: (404) 728-6362
    Toll Free: 1-877-498-0096
    Fax: (404) 728-6269
    Email:     fuquacenter@emory.edu

  • Military Psychiatry, Walter Reed Army Medical Center -
    Video teleconferencing (VTC) for forensic military cases, broad range, general, family and children, and in prison systems used from Walter Reed to other military facilities, i.e., Fort Belvoir and Fort Drum. More information can be found at:     http://www.wramc.army.mil/Patients/healthcare/psychiatry/mentalhealthservice/Pages/default.aspx.

    Forensic Telepsychiatry Program, Walter Reed Army Medical Center
    Major Brett J. Schneider, MD
    Phone: 202-782-8047
    Brett.Schneider@us.army.mil
    General information: Sona P. Patel     sona.patel@na.amedd.army.mil

Relevant Web Resources

  • APA Resource Document, Telepsychiatry via Videoconferencing
    Developed in 1998 by the now retired Committee on Telemedical Services, the APA resource document on telepsychiatry via video conferencing provides information on a range of relevant topics, including the clinical applications of telemedicine within psychiatry, privacy and confidentiality and record keeping/documentation. The resource document can be found at:     http://www.psych.org/edu/other_res/lib_archives/archives/199821.pdf

  • Telemedicine Licensure Report
    This report provides information on state medical and nursing licensure laws concerning telemedicine and the need for interstate licensure as a result of telemedicine. The report can be found at the HHS Office of Rural Health website at:     ftp://ftp.hrsa.gov/telehealth/licensure.pdf

  • Telemedicine Guideline
    The Board of Trustees of the American Telemedicine Association has established a set of guidelines for practicing telemedicine. The guidelines focus on specific criteria for healthcare providers, patients and the use of technology when providing telemedicine services. The complete guidelines can be found at:     http://www.atmeda.org/news/guidelines.html

  • HIPAA Guidelines
    HIPAA guidelines are applicable to every aspect of healthcare that involves electronic transmission, and this includes telemedicine. The main purpose of the HIPAA guidelines is to protect patient's privacy and regulate healthcare operations. In the practice of telemedicine HIPAA requires physicians to get consent prior to any use or disclosure of confidential health information for treatment, payment, or any other operation. Specific details about HIPAA guidelines for telepsychiatry can be found at:     http://telemed.org/legal/privacy/

  • Reimbursement:
    Reimbursement for telepsychiatry services is becoming more prevalent. Several surveys on telepsychiatry reimbursement have been completed and are included in The Private Payer Reimbursement Information Directory. This directory includes information on some of the programs receiving reimbursement for telemedicine services as well as on private payers who are currently providing reimbursement for telemedicine services. It also includes information on states that have passed legislation mandating private-payer reimbursement for telemedicine services. The Private Payer Reimbursement Information Directory can be found at:     ftp://ftp.hrsa.gov/telehealth/licen.pdf

  • Medicare
    Medicare has specific criteria for payment of telemedicine services. Medicare provides payment for telemedicine services for face-to-face services via video conferencing; and non-face-to-face services delivered through telecommunication technology, e.g. x-rays, tissue samples. Coverage for telemedicine in home healthcare settings is very limited and is explained in detail in the document listed below. More information on Medicare coverage for telemedicine practice can be found at:     http://www.americantelemed.org/news/Medicare_Payment_Of_%20Services_Provided_Via%20_Telecommunications.pdf

  • Telemedicine Legislative, Legal, and Policy Issues
    There are constantly new legislative, legal, and policy issues regarding telemedicine. Information on legislation and policy on the federal and state level is provided on the Telemedicine Information Exchange website and is updated frequently. More information can be found at:     http://tie.telemed.org/legal/federal/

  • Private Insurance
    The Telemedicine Reimbursement Report prepared by the Center for Telemedicine Law gives a listing of states currently providing reimbursement via private insurance for the practice of telepsychiatry. Some states that are already providing funding include: Hawaii, Colorado, California, Texas, Louisiana, Oklahoma and Kentucky. A copy of the report can be found at:     http://www.amdtelemedicine.com/private_payer/index.cfm
  • Funding Programs
    Other funding sources include grants, charities, community health providers, foundations, and the Office for the Advancement of Telehealth at the United States Department of Health and Rehabilitative Services (HRSA). More specific information is available through the United States Department Telehealth Grantee Directory at     http://www.hrsa.gov/telehealth/granteedirectory/overview.htm or the Telemedicine Information Exchange at http://tie.telemed.org/funding/links.asp

  • Developing a Telemedicine Program
    According to the Technical Assistance Manual prepared by the National Rural Health Association there are seven steps needed to build a successful telemedicine program:
    1. A needs evaluation
    2. Developing a care services plan
    3. Developing a business plan
    4. Planning for technology that will be used
    5. Training personnel
    6. Testing care that will be provided
    7. Evaluating outcomes.
    Specific information on these steps and other detailed information on starting a telemedicine program can be found in the Teleheatlh Technical Assistance Manual at: http://www.nrharural.org/pubs/pdf/Telehealth.pdf

  • State Programs:
    Telemedicine programs are now being developed in Alaska, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma,Oregon, Pennsylvania, South Dakota, Tennessee, Texas,Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and Ontario, Canada.

  • The Center for Telemedicine Law
    http://www.ctel.org/

  • American Telemedicine Association
    http://www.atmeda.org/

  • Association of Telehealth Service Providers
    http://www.atsp.org/

  • American Association for Technology in Psychiatry
    http://www.techpsych.org/

  • Office for the Advancement of Telehealth, Health Service Resources Administration HHS
    http://www.hrsa.gov/telehealth/

  • Telemedicine Technical Assistance Documents: A Guide to Getting Started
    http://telehealth.muhealth.org/general%20information/getting.started.telemedicine.pdf

  • Eastern Montana Telemedicine Network
    http://www.emtn.org/mental_health.html

  • California Rural Health Policy Council
    http://www.ruralhealth.ca.gov/telehealth.htm

  • Ontario Psychiatric Outreach Programs
    http://www.psychiatry.med.uwo.ca/ecp/body.html

  • University of Kansas Center for Telemedicine
    http://www2.kumc.edu/telemedicine/

From: 
Email:  
To: 
Email:  
Subject: 
Message: