Tag: telehealth

Case Management with Email Messaging

Posted on | by SOS Blog | 1 Comment on Case Management with Email Messaging

Many of our customers include Case Management as part of the mix of services provided to clients. Among the seriously mentally ill (SMI) population, Case Management has become an essential service helping individuals gain the most from the services they receive. Helping the client take their medication as prescribed, assessing their current symptom status, intervening to alter treatment rapidly if a crisis is looming are all functions that Case Managers provide. These services are provided both in-person and by telephone.

A new study published in The Journal of General Internal Medicine suggests that email contact with a trained psychiatric nurse can dramatically improve the outcome of medication treatment for depression by internal medicine practices. Reported in Healthcare IT News on March 17, the study was a follow-up to a similar study using telephone contact with patients who had newly been started on antidepressant medication. According to the report, the email messaging was even more effective than a telephone call in improving the benefit of the medication.

The study utilized 208 members of Group Health, a consumer-governed, nonprofit, integrated healthcare organization that coordinates care and coverage for 600,000 individuals in Washington state and Idaho. The Group Health Research Institute (GHRI) was the responsible research organization. GHRI  is a non-proprietary, public-domain research institution within Group Health.

The Group Health plan includes a patient portal that has access into the organization’s electronic health record. According to the abstract of the article, the Intervention consisted of:

 Three online care management contacts with a trained psychiatric nurse. Each contact included a structured assessment (severity of depression, medication adherence, side effects), algorithm-based feedback to the patient and treating physician, and as-needed facilitation of follow-up care. All communication occurred through secure, asynchronous messages within an electronic medical record.

This study was motivated by poor improvement outcomes reported nationally for depressed individuals treated by their primary care providers with antidepressant medication. The goal of the entire research project is to determine if use of an organized plan of treatment including evidence-based follow-up services would result in greater effectiveness of medical therapy.

A significant movement is developing within the U.S. to improve outcomes of our healthcare system by providing services in non-traditional ways. The Connected Healthmovement seeks to improve healthcare services and outcomes by use of technology to remotely monitor and provide services. Partners Healthcare Center for Connected Health has been a pioneer in this effort. Their web site states the goal in this fashion:

Changing Healthcare Delivery

We are engaging patients, providers and the connected health community to deliver quality care outside of traditional medical settings. Telehealth, remote care and disease management initiatives reflect the opportunities for technology-enabled care programs.

What potentials do you see for the use of electronic methodologies like secure email communication with clients within your organization? Are you already engaged in such endeavors? What do you see as the obstacles to such care? What are the potential benefits to your clients? How do we get from here to there?

Please share your experiences, concerns and other comments below.

Remote Conversations: How do you do it?

Posted on | by SOS Blog | 7 Comments on Remote Conversations: How do you do it?

I’ve mentioned here pretty often than I am not a technology sophisticate. I use technology every day in my work life, but I am a slow-adopter. For some of you, this article may be so old-hat that you will ask “Kathy, where have you been?” But I know there are others out there like me, so here goes anyway.

My mother-in-law had back surgery in Miami early this month. Since my 89-year-old mother lives with us, it has been impossible for me to go down to see her since the surgery. This past weekend, we arranged to skype a conversation so she could talk to me and my mom and we could “see” how she is doing. That word I just used…”skype” did not exist as a verb until August 2003 when a group of Estonia-based developers released the first version of what became Skype.

So what in the world is a skype? It is a company that created a technology that allows one computer to make voice and video calls to another computer free of charge. It also allows one to make phone calls from your computer to land lines and cell phones for a very low charge. Of course, it is the free-of-charge calls to other computers, especially video calls, that makes it so exciting. The process of doing this has become “to skype” or “we skyped.”

The technology allows high quality computer connections without going through a telephone service. As long as you have a high-speed internet connection, there are no voice/video delays. As long as your web cams are decent quality, picture and voice quality are excellent…and Skype has built-in tools to help you improve quality if you are having any difficulty.

But here’s the rub…Skype has become so popular that our Sunday morning attempt to connect was unsuccessful. The servers were all busy! So what’s a computer video newbie to do? Well, use Google Chat instead, of course.

SOS has recently switched all of our email to a Google corporate account. This gives us access to a number of other tools…Google Chat is one that we have used in-house for instant messaging. While I only learned about this through our Google account (I told you I am technology-impaired), this tool is also available to anyone who wants to use it…just check out the link above. I had not input the settings correctly before this weekend, so we combined old-fashioned cell phone technology with Google Chat computer video. There was a lack of synchronization between our cell phone service and the video, but now that I have my webcam microphone set up as the sound source it will be synced on future calls.

Yahoo! Messenger has provided similar service and functionality for years, and for Microsoft fans, Windows Live Messenger also allows these same capabilities. Ichat is a similar service used by Apple aficionados.

I must tell you that I do not have much interest in using this technology for work, but for personal contacts with family members who live far away, these are wonderful tools. My assessment of this may change over time. For many of you, the time may be now. Video conferencing is a wonderful way for scholars and far-flung colleagues to work together. It is also a fantastic way to provide behavioral health services to remote and home bound clients.

Several months ago, a Florida psychology listserv to which I belong was the setting for considerable discussion about remote provision of services. While some of the practitioners were hesitant to consider providing psychotherapy via computer video, some have already begun doing so. Community behavioral health organizations are actively considering such services for rural clients and others who require case management but are not readily available for visits. Over time, providing low-income, seriously mentally ill individuals with an inexpensive computer, internet service and webcam could save thousands of dollars in case manager travel and time costs, not to speak of hospitalization costs when deterioration not noticed on a telephone call but readily apparent on a video conference, is beginning.

The biggest push for these services may come from Medicare, Medicaid and other payers. A December 2008 article from the American Telemedicine Association details Medicare’s authorization for payment for remote services. These are provider and location-of-recipient dependent, so check out the details before you decide to start billing Medicare for such services. Since psychotherapy is a covered service for the purposes of telehealth, I expect more practitioners will begin to provide these services. I hope more abundant research on comparative efficacy will follow.

Has your organization begun providing any services remotely using video conferencing? What methods do you use? What benefits and limitations do you experience? If you are not already providing services in this fashion, what might it take to move you to do so?

Please share your comments by clicking on the title of this article and entering your comments in the box at the bottom of the page. Thanks for participating in the discussion!

Remote Health Services: Will behavioral health be a player?

Posted on | by SOS Blog | 2 Comments on Remote Health Services: Will behavioral health be a player?

A couple of weeks ago, I read with interest a discussion on a Psychology listserv about telephone and other remote consultations. Florida psychologists tend to be pretty conservative about telehealth and Internet psychotherapy; after all, it is difficult to apply the same standards to remote interventions as to face-to-face contacts when psychotherapy is the product.

The same week, I received an email from the Center for Connected Health, a division of Partners HealthCare in Boston. Partners was founded by Brigham and Women’s and Massachusetts General Hospitals in 1995; its purpose is to perform “pioneering research in a wide range of connected health-related areas. Their progress report for 2008 includes articles on a number of their initiatives.

Just what is connected health? It is any healthcare endeavor that involves electronic connection between patients who are the receivers of care and the providers of that care. It can involve remote monitoring of medical variables (e.g. blood pressure, blood sugar) utilizing instrumentation that does the test/measurement and reports it to the provider; it can involve sending reminder text messages and determining the impact of those messages on patient behavior. If you start to think about the possibilities, it can involve an incredible range of services provided to consumers of those services from a distance and utilizing electronic media of some sort as the means of connecting.

A wonderful example in the report demonstrates how patient behavior and healthy lifestyle can be studied using an Internet tool like Second Life. Participants in the study are taught the Relaxation Response in a classroom setting in Second Life (see page 5 of the report mentioned above). The study will measure the effectiveness of teaching this stress reduction technique in virtual reality. Other articles in the report study patient compliance with medical protocols when monitored remotely, another area where the expertise of behavioral health researchers should be invaluable.

As a former media psychologist…host of a TV show that focused on psychological issues, answering phone calls and providing public education…I find the research being done by the Center very exciting. If we are going to find ways to reach people where they live and to reduce the costs of care by increasing compliance and changing patient behavior to live healthier lifestyles, we must begin to study and be prepared to utilize these electronic methodologies.

What do you think about telehealth and mental health services? Should behavioral health providers be learning to provide services remotely? Is it time for all of us to support research and training and developing best practices for provision of services electronically? Could you imagine yourself participating as a recipient of remote healthcare services?

Please tell us what you think. Just click on the title of this article and enter your comment in the box at the bottom of the article.