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Connecting the docs

April 1, 2007
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Ohio providers turn to videoconferencing to increase consumers' access to psychiatrists

Technology and its applications have become commonplace in all aspects of our society. Telecommuting, videoconferencing, and other resources have changed the way the world communicates. Much of the healthcare industry, including behavioral health providers, also has entered the digital age by offering resources that connect people to needed services.

One of the most common reasons that people do not seek treatment for behavioral health issues is lack of access. The Community Mental Health and Recovery Board of Licking and Knox Counties (CMHRB), Ohio, believes that available technology can help reduce the access barrier.

This past September CMHRB formed a partnership with two behavioral healthcare providers in central Ohio to implement interactive videoconferencing technology: Moundbuilders Guidance Center in Newark and Mt. Vernon, and Southeast, Inc., in Columbus and New Philadelphia. The “Connect the Docs” project is designed to enhance access to and efficiency of psychiatric services while maintaining the integrity and quality of services.

We need this program because it has been difficult for our system of care to recruit the numbers of practitioners to meet consumers' needs. The decision to implement videoconferencing was directly linked to a recent change in standards issued by the Ohio Department of Mental Health (ODMH) that permits service delivery and state reimbursement using this technology for psychiatric and counseling services. Consumers have the choice of whether to use the videoconferencing system, which we began using this past September, and a consumer's initial visit is face-to-face with a practitioner unless an emergency warrants otherwise. Through the Connect the Docs program we hope to increase consumers’ access to psychiatrists.

The equipment was purchased through a grant from the Osteopathic Heritage Foundations, which funded the installation of videoconferencing technology at the main offices of Southeast, Inc., in Franklin County and Moundbuilders in Licking and Knox Counties. This videoconferencing network is tied into ODMH's state hospital and central office's interactive videoconferencing system and the 14-site Southern Ohio Telepsychiatric Network, through Ohio University's College of Osteopathic Medicine's Office of Information Systems and Instructional Technology. The network can connect to regional, national, and international locations, and the network has the capacity to connect to other networks to conduct real-time distance learning.

Connect the Docs uses a dedicated, secure, encrypted T1 line, similar to cable TV, to transmit images from a small camera placed on a TV at each location. The equipment can be moved to different rooms to maximize flexibility. People in each room can see each other on their respective TVs, and the picture on the screen splits to show both locations when someone picks up the remote. The camera can pan the room, move in close (such as when a psychiatrist wants to check a consumer for tremors), and pull back for a wider view.

In addition to consumer services, the technology has been used to provide distance learning to enhance staff competencies; conduct team meetings between state hospital staff, the consumer at the hospital, and staff at the outpatient site; and conduct multisite administrative and quality improvement meetings. Staff travel time has been significantly reduced. Additionally, the technology is used as needed to connect hearing-impaired individuals with clinicians proficient in sign language.

The project is still in the early implementation stages. A number of practical procedural issues need to be addressed, including informed consent, HIPAA compliance, reimbursement, record sharing, consumer and staff acceptance, and project evaluation. The providers currently are testing information flow and billing practices.

ODMH developed a consumer and provider satisfaction survey tool to determine consumer and staff comfort with the new technology and manner of service delivery. Early consumer feedback indicates consumers are just as satisfied with the videoconferencing service as they are with face-to-face contact. There appears to be no difference in satisfaction between youth and adults. One parent wrote, “It was just like a regular appointment.” Others commented that they would rather be seen sooner using the technology than wait for a face-to-face appointment. The response from psychiatrists has been mixed, with the majority preferring face-to-face contact instead of using videoconferencing.

Our use of videoconferencing is still in the early stages of development, and we have faced some unanticipated hurdles. Yet we believe videoconferencing technology has significant potential to improve access to care. The most exciting part of this project has been the consumer response. That positive response will be the impetus to keep the project moving forward. I believe we have only scratched the surface in understanding how this technology can improve consumer care and enhance efficiencies.

Wendy Williams, MS, is Executive Director of the Community Mental Health and Recovery Board of Licking and Knox Counties, Ohio (