•  Telepsychiatry & Integration with Other Technologies
•  Ranna Parekh, M.D., M.P.H.

A high quality telepsychiatry practice includes an adherence to routine quality care, adapting foundations of clinical practice to videoconferencing, and developing other skillsets related to technology. In a regular or a telepsychiatry practice, clinicians have the opportunity to integrate a wide range of associated technologies as educational platforms or even as adjunctive to therapy. These can include using health information websites, connecting with others through chat rooms or social media, using behavioral and mental health mobile apps, e-mail, or other technologies.

General considerations when integrating other technologies into a telepsychiatry practice:

• Set aside some time to gauge patients’ use of other technologies. Ask them about what they use, how often they use it, and so on. Think of a uniform way to screen for this information with all patients.
• Why are patients using their preferred technologies?
• How does their use of technology in general influence their life or affect their understanding their presenting problem?
• How does it affect the therapeutic relationship, in both positive and negative ways, if any? For example, does the technology make it easier to get to know an adolescent patient, or does it reveal a side of them that has not been so evident?
• Is it safe? For example, does a patient know to talk in-person instead of on-line about suicidal ideation.

  Key considerations about website health information, texting (SMS) and e-mail.

• Health information on the Internet for persons, patients, and caregivers is rarely regulated. When possible, seek out information from organizations/ institutions/businesses that have some oversight/expertise (e.g., the National Institutes of Health; specific disorder agencies like the Depression and Bipolar Support Alliance).
• Remember to verify the identification of the person on the other end of the receiving technology (i.e., if using secure e-mail or messaging applications)
• Be cautious about privacy/confidentiality issues, as well as about use of new digital communication from one user to another user using standard protocols (i.e., e-mail, SMS text messaging, multiple messaging service (MMS) messaging, and instant messaging.) The issues appear to be similar for proprietary networks (e.g., Twitter direct messages, Facebook Messenger), which are not secure like many electronic health record (EHR) messaging solutions.
• Requests for other contact between visits (e.g., texts, e-mails) with asynchronous modalities is good for some things (e.g., answering yes/no questions, trading a piece of information), but not other things (i.e., emergencies, complex decisions).
• Use e-mail, text, instant messaging only for patients who maintain in-person follow-up.

Social media and professionalism:

• Be mindful of privacy, professional image, confidentiality, and expectations for use in general; follow institutional policies, where applicable.
• Consider pros/cons of gathering information about patients via search engines and social media. Understand implications for intentionality and use.
• For physician-produced blogs, microblogs, and comments: “pause before posting” and “step back” to consider what is conveyed to the public about the physician and the profession.
• Follow recommendations about professionalism and social media (e.g., The American College of Physicians, Canadian Medical Association, and British Medical Association).
• Separate personal and professional life to the extent that it can be done.

References

1. Hilty DM, Chan S, Torous J, Mahautmr J, Mucic DM (2015) New frontiers in healthcare and technology: Internet- and web-based mental options emerge to complement in-person and telepsychiatric care options. J Health Med Informatics 6(4):1-14.
2. Chan S, Torous J, Hinton L, Yellowlees P (2014) Mobile Tele-Mental Health: Increasing Applications and a Move to Hybrid Models of Care. Healthcare 2(2):220–33.
3. DeJong SM, Benjamin S, Anzia JA, John N, Boland RJ, et al. (2012) Professionalism and the internet in psychiatry: What to teach and how to teach it. Academic Psychiatry 36(5):356-362.
4. Farnan JM, Snyder Sulmasy L, Worster BK, Chaudhry HG, Rhyne JA, et al. (2013) Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med 158(8):620-627.