Below is are the typical program requirements for facilities utilizing our telepsychiatry services. Telepsychiatry program requirements will vary from clinic to clinic.

Policy: Telepsychiatry Program (TPP)

Purpose:
To establish guidelines and protocol to manage Telepsychiatry Program at Mental Health Facilities (Patient Site) contracted with e-Psychiatry

Statement of Need:
Patients in rural areas and/or nursing facilities often face more obstacles to obtaining mental health services. Barriers of access to mental health services often result from geographic, economic and cultural factors. In sparsely populated areas travel expenses increase the costs of both providing and obtaining care which serves as another barrier to care. Implementation and use of telepsychiatry services is one way to overcome such barriers.

Procedures:

I. Administrative Protocol

A. A partnership agreement between e-Psychiatry and Patient Site will be signed prior to providing telepsychiatry services
1. An information packet will be sent to the Patient Site containing the following:
a) Partnership agreement
b) Information sheet
- Exam room requirement
- Technical requirements
- Appointment protocol
c) Patient paperwork
- Signed consent form
- Signed release of information
- History and Physical
- Recent or relevant psychiatric evaluation
- Most recent progress notes
- Record of current medications
- Payment source information
- Signed HIPPA document
- Signed Patients’ Rights form
d) Telepsychiatry room requirements
e) Technical requirements

B. Patient Site will contact Care Coordinator to schedule appointment

C. Care Coordinator will assure all requirements are met prior to the appointment
1. Patient assessment to determine if appropriate for telepsychiatry i.e. no hearing, visual or cognitive deficits that limit their ability to communicate via this technology
2. Ensure appropriate staff is available to meet patient and provider needs before, during and after appointment
3. Assure appropriate paperwork and records are forwarded to office prior to appointment via secure fax, email, or via online registration
4. Develop patient chart on e-Psychiatry Portal if utilizing e-Psychiatry's EMR.
5. Call Patient Site to confirm appointment one day prior to appointment
6. Perform test between Patient Site and office the day of appointment to assure functionality of equipment

D. Care Coordinator will assure transmission of prescriptions, lab orders, progress notes, etc. from the office to Patient Site following the appointment to ensure reciprocal communication between the physician and patient site

E. Billing Specialist will bill for services provided according to the payment source listed

II. Clinical Procedures

A. The standard of care delivered via telepsychiatry will be equivalent to any other type of care that can be delivered to the patient

B. All persons in the room at the office and the Patient Site will be identified to all participants prior to starting the session

C. Crisis/Emergencies
1. A patient who is suicidal, homicidal or suffering from dementia or acute psychosis requires additional personnel in the room or a family member in order to address potential safety concerns
2. If additional personnel and/or family members are not available, the provider will make a determination whether immediate intervention is necessary for patient safety
3. Medical (e.g. cardiac arrest) or behavioral emergencies (behavioral dyscontrol) which occur during a clinical encounter will be managed per Patient Site policies and procedures

D. After Hours Emergencies
1. Dial 911
2. All patients will be given an after hours number to call that will be managed by the Patient Site and will relay any messages to the Psychiatrist/Psychiatric NP

E. Progress notes for the session will include:
1. Location of the Psychiatrist/Psychiatric NP while providing telepsych appointments
2. Location of the patient
3. Type of equipment used and any malfunction that may have affected clinical care
4. Those persons present during the session and the role of those present

F. Prescriptions will be prescribed and mailed, faxed or phoned to the pharmacy or Patient Site. In such case schedule III – V medications will be phoned to the pharmacy. For schedule II medications (eg. Ritalin or Adderall) paper prescriptions must be generated (by law) and mailed to Patient Site.

III. Technical Specifications/Room Requirements

A. Technical Requirements
1. Computer - minimum 3G Ram and core-2 duo
2. A minimum transmission speed of 5mb upload and download
3. Webcam (Logitech Webcam Pro9000 or Microsoft LifeCam Cinema Webcam recommended)
4. VSee an online web communications service or other VTC technology for secure, HIPAA compliant videoconferencing
5. External speakers
6. Audio at 7kHz full duplex with echo cancellation with mute function and volume adjustment

B. Exam Room Requirements
1. During the session the room shall be considered a patient exam room
a) Room should have a door that can be closed to provide patient and physician privacy throughout the appointment
2. Noise distraction kept to a minimum
3. The ability to view written or drawn material
4. Lighting as close to day light as possible
5. Room clean and free of distractions such as books, papers, etc.
6. A staff member present to assist patient and/or physician during the appointment