"When I was doing face to face there was always an excuse for the case manager not to be present. With telemedicine they are required to be there. They are always there and we are a team."
- Beth Caspian, MD

 
    Clinical telemedicine policies & procedures

NARBHA telemedicine policies:
NARBHA psychiatrists are all required to be oriented prior to providing telemedicine services.
Clinical Telemedicine Services Policy

Patients must consent (verbal and written) to treatment via telemedicine. General and Informed Consent to Treatment Policy

Informed Consent to Participate in Telemedicine Services Form

Informed Consent to Participate in Telemedicine Services & Videotape Form

Confidentiality is maintained.
Clinical Telemedicine Services Policy

NARBHA telemedicine procedures:
Telemedicine services in the NARBHA system generally include a therapist, case manager or nurse present in the room with the member at one endpoint while the psychiatrist or psychiatric nurse practitioner is at the other endpoint. This approach improves the team treatment model and has become a standard on the NARBHA telemedicine network. This approach is discussed in a book chapter authored by NARBHA's Telemedicine Medical Director, Telemedicine Director, and former Telemedicine Program Manager:

 

 

 “Having all members of the treatment team present has been an ideal that was seldom achieved prior to NARBHA Net. The entire clinical staff in Apache County feels that the delivery of clinical care has been improved by this team treatment model and that it more than compensates for any disadvantages for the psychiatrist.”

(Gibson, Sara F., Morley, Susan and Romeo-Wolff, Catherine P. "A Model Community Telepsychiatry Program in Rural Arizona." E-Therapy. Ed. Robert C. Hsiung. New York, NY: W.W. Norton & Company, Inc. 2002. 69-91.)

In addition, the therapist, case manager or nurse operates the video equipment, helping to make the technology unobtrusive to the patient. Comments from a recent survey of clinical staff at existing NARBHA telemedicine endpoints illustrate the benefits to patients and providers of this team approach to telemedicine-based patient care:

"I find it very useful and generally get good validation from you (psychiatrist) with my client. Often, hearing from you what I have been saying makes a difference. Also, brainstorming what to do with a client is helpful."

"I most appreciate that I get to be fully participating in the telemed sessions, taking notes and discussing events/observations with both the client and the doctor(s)—makes for a full circle, no unlinked treatment team stuff behind closed doors."

Clients may request not to have the therapist, case manager or nurse present; a decision is made baseed upon medical necessity. In a winter 2007 survey of Apache County clients:

  • 92% said that a clinician in the room either had no effect on their comfort level or made them feel more comfortable.
  • 76% agreed or strongly agreed that a clinician in the room helped them feel that they had a team of people contributing to their treatment.

Utmost care is taken to ensure the confidentiality of a clinical telemedicine session. At both ends the door is closed and an “In Session…do not enter” sign is placed on the door. Where needed, white noise machines or other soundproofing have been added. Telemedicine equipment is set to be muted upon entering a videoconference and the camera lens is covered when the equipment is not inuse.

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