Tagged: Mental health-WI
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Videoconferencing is the Telehealth model I will select. Video conferencing allows the provider to assess or provide care to the patient through visual interactions. In mental health, assessment of patients through video allows the provider to clear identify not only the reported behavioral aspect of care but also non-verbal cues that are essential to arrive at clinical decision making. Equipment o use include tablet, laptop, or cell phone. I will be assessing a patient with mental health diagnosis of anxiety disorder. My role as a provider is to assess the patient using standardized anxiety scale, questionnaires, patient’s self-report and assessment of non-verbal presentation of the patient. Clinical decision making, intervention and individualized care plan can be developed through this model of Telehealth.I will evaluate the effectiveness of the communication of the model selected (internet, clarity of voice etc). The legal consideration involves the approval of videoconferencing in the state of practice. Other professional to be involved include the social work and psychotherapist. A verbal consent will be obtained at prior to the assessment. HIPAA to be maintained throughout the assessment process.
Telehealth is a very reliable means of providing care to patients. It is very reliable, effective and accessible. It is very important for providers to maintain professionalism and always and high ethical standards when conducting videoconferencing. Providers must allow themselves extra time to complete patients’ assessment since internet or device malfunction may occur. Providers must communicate clearly and always consider the population under consideration.
As a PMHNP student, I foresee videoconferencing as a model I will most likely use in my future practice. Currently in clinical, I observe videoconferencing on a daily basis. I feel this is the most appropriate form of telemedicine when dealing with psychiatric conditions. The type of equipment I would utilize myself for this model would be a computer with ethernet hard drive to ensure good connection, while also using a HIPPA approved communication form such as zoom. I would ensure my patient first had access to the proper technology needed for a videoconference such as a smart phone or laptop. Ideally, only stabilized psychiatric patients should be seen via tele-health medicine in my professional opinion, as safety is main priority in this population. Legal considerations would be ensuring maintaining HIPPA guidelines and patient privacy. This may be more difficult in telemedicine as ensuring a secure and private internet connection may pose problems. I would establish baseline protocols focusing of patient privacy and safety, but no telecommunication would be completed until a patient consent form is signed in office agreeing to telecommunication and to follow protocol as outlined. It is important providers communicate throughly and appropriately over a tele-health visit and ensure patient understanding prior to ending the visit.
I am a new family nurse practitioner and am in school for a psychiatric mental health nurse practitioner program. I am very interested in telehealth and had the opportunity to see telehealth in my clinical setting. I live in the state of Montana, where there are severe shortages of providers. Specialties have even more shortages.
Telehealth Model: Combination of telehealth services including store & forward, videoconferencing, and mHealth. The organization that I am contracted with already has the capabilities for these options plus this is so meaningful for patients that don’t have access to a car or that live in rural Montana.
Type of equipment: Combination of videoconferencing, mHealth, and Store & Forward technology including the organizations vendor (that I am not sure of currently), laptops and platforms that meet scientific rigor and what my organization requires with contracts and meeting HIPAA compliant.
Type of population/healthcare: Family practice needs of patients including preventative care and chronic medical needs plus mental health services with my next degree.
Role in the program: With the resources of my organization, I see myself in the role of provider.
Evaluation: My organization sends surveys to patients every so many patients to get patient satisfaction scores. This is a huge deal within the organization. I plan to ask at the end of telehealth visits: What went well and what can I improve?
Legal considerations: Having an appropriate vendor and set-up is so important. I will need to determine my organizations requirements for charting of visits and informed consent. I will closely follow the state of Montana requirements for telehealth services.
Other professions: I would love if specialties would offer telehealth services. This would be meaningful for cardiac visits and PT services that can be difficult for patients to get to with primary care needs.
Protocols: Educational pamphlets with steps for telehealth and how to be prepared, including a sample video would be extremely helpful to patients.
Consent: I would get consent, per written requirements and a verbal consent when possible with the patient, at the beginning of the visit.
As a PMHNP, I would use videoconferencing as well as M Health. Videoconferencing can be done in the comfort of the clients own home. This helps greatly for those with anxiety and social phobias, as well as for those that have little access to transport. As we learned, there is such a high percentage of people that do not seek out mental health help. With being able to teleconference from the comfort of their own home, this could change. I would include M health as well. There are many apps that can help track mental health symptoms as well as explore triggers. There are also many calming apps that can be utilized for different mental health issues. Tools that can be used include laptops, tablets and smartphones.
As a PMHNP, my clientele would be those seeking out mental health services. The goal of telehealth is to reach more people that would normally not have access to a therapist or prescriber. My role would be primarily the prescriber. I would like to involve therapists, social workers and case managers. Working collaboratively with all of these roles enhances the clients experience and gives them the most help. Along with therapy and medication management, the social workers and case managers can help with insurance, housing, food, transport, and filling of medications.
My main things to evaluate would be effectiveness, patient satisfaction, compliance and ease of use. I would consider legal issues such as HIPPA, as well as Medicaid and Medicare guidelines. I know in my state of Michigan, we are permitted to prescribe controlled substances via telehealth with the exception of suboxone. To consent the client, I would obtain a verbal consent. Along with this I would also email a consent to be electronically signed and returned. I would set up protocols that include educational material on telehealth as well as link them to an instructional video.
I am a student in the PMHNP program and see using videoconferencing as part of my future practice. In mental health it is important to acknowledge nonverbal cues and assessments so videoing with the patient to monitor their behavior and non-verbal cues would be necessary. The equipment needed would be a laptop with a web camera, tablet with web camera or a smart phone. Good internet connection and privacy would be required. A program that allows secure videoconferencing between the provide and the patient is needed. Video conferencing allows easier access to care for patients. Less time is needed away from responsibilities for the appointments. The population of patients would be those seeking mental health services. My role in this program would be that as a provider being the PMHNP. The patient should be given an evaluation after the session to provide their thoughts as to what went well and what could be improved. Seeking feedback is needed to improve the effectiveness of the sessions. Legal considerations would be privacy laws and informed consents. Documentation and billing are important considerations. The sessions need to be eligible for reimbursement from the insurance providers. Patients could benefit from telehealth from all professions. Telehealth provides accessible care with minimal time commitments from the patient. The protocols would be education on the service, equipment needed for the videoconferencing session and informed consent for the service. Protocols should also include reimbursement information. A verbal and written consent should be obtained prior to the session. The provider should also obtain verbal consent at the beginning of the session.
As a student studying to become a Psychiatric Mental Health Nurse Practitioner, the video conferencing telehealth model will be a program that I hope to eventually have a part in with working and treating patients with mental illness. With video conferencing and the role of PMHNP, these telehealth sessions would be spent assessing the patient, who may be new or established, and making appropriate decisions regarding diagnosis and medications if needed for their mental health. This would be done by talking with the patient, assessing their mood and behavior, and discussing any recent changes in their life, big or small, concerning stress, appetite, sleep, etc. I would be able to call in medication to their specific pharmacy if needed, as well as discuss positive coping strategies and lifestyle changes that may be beneficial to the mental health issues they may be currently experiencing. I would also hope to collaborate with therapists and social workers to better meet the patient’s specific needs and identifying resources in their area. These telehealth visits would be conducted via smartphone, tablet, or computer. In efforts to keep the process as easy as possible for patients needing to be seen via telehealth, I would obtain consent electronically, if possible, by having a consent form signed and sent back through email or the clinic’s website prior to the telehealth appointment. Consent would be a major legal consideration to keep in mind as well as ensuring proper health privacy is in place. Protocols would be developed to ensure the process of the telehealth visits are correctly executed including proper consultation, patient education on virtual appointments, consents, privacy, and billing. I would be evaluating the technology and how it is affecting the engagement and quality of the care and time spent with the patients.
The telehealth program that I would be involved in would be telepsychiatry due to becoming a PMHNP. The program would address all aspects of the mental/behavioral health spectrum. My role in the program would be to serve as a provider. Telepsychiatry involves providing a range of services including psychiatric evaluations, therapy, patient education and medication management. The program will hopefully have a psychiatrist, psychologists, advanced nurse practitioners, and licensed therapists to provide care to the patient population. The main model of choice would be videoconferencing. Store and forward could be utilized for evaluation of patient labs for medication management. The main type of equipment that would be used is videoconferencing equipment to assist with the interactions between the provider and the patient as well as providing support to primary care providers with mental health care consultation and expertise. When evaluating the program, the NQF quality measurement framework for telehealth will be utilized. The program will be measured on access to care, finical impact to patients and providers, patient and clinical experience, and effectiveness of both the clinical and operations systems. Major legal considerations center around maintaining HIPPA. The program will have a BAA with the vendors, and written consent will be obtained from all patients. Even though written consent my not be a state requirement it is always in the best interest of the facility to obtain consent. Developing protocols for the program will center around the American Psychiatric Association and the American Telemedicine Association practice guidelines. The protocols will assist in the way the sessions occur, and in deciding if the patient is a candidate for telepsychiatry.
Telehealth Model: As a PMHNP student I foresee using video conferencing in my future practice. With telepsychiatry you’re enabling more patients access to mental health care. I would utilize videoconferencing because it allows you to visually assess the patient in real time
Type of Equipment: In future practice I see utilizing several equipment options such as videoconferencing, RPM, and E-Consults; these are great tools to assess patients, collect patient data, and connecting/collaborating with other providers that are involved the patients care.
Type of Population/HealthCare Issue: The patient population in my future practice are those with mental health disorders in urban communities/settings. Many patients I encounter in urban communities state they felt uncomfortable seeking treatment due to the stigma of mental illness so telepsychiatry is a great tool for these patients to seek care in the confinement of a place they feel comfortable.
Role in the program: My role in the program will be provider.
Evaluation: I will evaluate patient satisfaction of their telepsychiatry visits to see what was good about the visit and what improvements could be made.
Legal Considerations: Prior to initiating any telehealth services, it is essential to know each states guidelines where you deliver patient care i.e. consent, parity laws, licensure requirements.
Other professions: Other healthcare professionals I would like involved in future telehealth services are Clinicians-PCPs, Psychiatrists, PMHPS, LCSWs, Counselors, Therapists, and Substance Abuse Counselors
Protocols: The healthcare organization I currently work for and plan on working for in the future does not offer telepsychiatry services so I would act as team lead to push use of telepsychiatry in the future through organization buy-in. I eventually would like to start my own independent practice and will want to utilize telepsychiatry, protocols I would utilize to start up telepsychiatry services are: selecting a good telehealth software system, establishing telehealth consent forms, providing education to my patients on the pro’s to using telehealth services for patient buy-in.
Consent: I would obtain both verbal and written consent for future telehealth services.
My name is Brigitte Lee, and I am a PMHNP student. The type of telehealth model that I would like to be involved in is the videoconferencing and mHEALTH. Both programs will be very helpful in my practice. It will be very convenient to use the video conferencing for my visits with mental health patients. I will also be using mHEALTH for other miscellaneous things such as appointment reminders and patient education. I plan to work outpatient as a PMHNP, and part of my future practice is going to include telehealth and getting very familiar with technology and seeing patients online. The type of population that I will treat is going to be patients ranging from children to geriatrics with mental health problems that need treatment.
I believe the majority of what I will be treating will be depression, anxiety, and PTSD. There will be other diagnoses such as dementia, schizophrenia, bipolar and many others. My role in the program would ideally be to have my own private outpatient practice. The things that I would evaluate about the program would be how well the patients and I are able to connect and stay connected online. The transitions between patients and the effectiveness of having them wait in the waiting room (online). I will be evaluating the entire telehealth video conferencing experience to see if it is ideal for my practice or if seeing patients in person is a better option. I would also evaluate mHEALTH for patient education and helping with appointment reminders.
The legal considerations that I would implement into my practice would be having a Business Associate Agreement (BAA) to ensure ePHI and patient information is protected. The next thing would be making sure that all my patients are signing consent to treat on a tele health platform agreement. I would also check my state to ensure that I am able to provide tele health in my state and what all the laws are surrounding my state. I would like to involve therapists to work alongside me to ensure that my patients are getting the best care possible. I would also hire another PMHNP or share office space with them to have another colleague to consult with.
We would develop protocols around ensuring that our patients are aware that they can access our services through telehealth and ensure they know that this is an option. By developing a video and sending this out to every patient prior to the telehealth visit, they can prepare for the visit and prevent any barriers to making the visit a successful one. I will also ensure that we are getting up to date phone numbers and emergency phone contacts on every single visit, as well as local emergency department contacts for their area in the event the patient is suicidal. I would always ensure that the patient has signed the consent form prior to treating the patient and make sure to state this in the visit encounter. I am very excited to be a part of this improved way of meeting our patients needs.
Telehealth utilizes telecommunication technologies to communicate real time in video-audio chat to monitor patients, collect and view data, view and store images, and provide patient conveniences in regard to time and place .Telehealth overcomes the limitations of limited access, health care provider shortage, disease management, and aging population to gain access to distant care via live videoconferencing . It is important as an upcoming family nurse practitioner to understand the purpose and importance of telehealth, impact of telehealth in practice, and to apply informatics skill and knowledge in practice. It is also important as family nurse practitioner to understand the importance of telehealth and to stay up to date to provide adequate education to staff and patients as telehealth will help to reach the population who does not have the social support or transportation to receive medical assistance. The equipment I would like to use will be video conferencing because I believe it will help me connect well with my patients, also help me assess my patients better including non-verbal cues. The population / healthcare issue I would address is psychiatric patients and my role will be as a provider. What I evaluate about the program is whether my patient is satisfied with the telehealth and will conduct survey at the end of each telehealth. Some of the legal consideration I would address is HIPAA/Privacy- ensures to protect patients’ personal health information. Other profession I would involves will be social workers. Protocols I will develop will be to first educate patients about telehealth before they are set up for appointment and electronic consent signed before appointment.
As a PMHNP I will use videoconferencing using a tablet or laptop. I will be treating pregnant patients who have mental health concerns. My role is as the provider. Evaluation of the program would involve surveying the patients to assess how the experience worked for them. I will also track patient compliance with keeping appointments, as well as any technical issues that may hinder the process. I will check with my stat to determine what documentation is necessary for billing and coding as well as consent requirements. I would involve clinical social worker, language interpreters as needed, and the patient’s primary prenatal care provider. Protocols in place would include emergency plans. I would consent the patient based on my state’s requirement.
I am currently working as a family nurse practitioner, and also I am a PMHNP student. In my future practice as a mental health nurse practitioner, I would like to use videoconferencing. This model works great with social phobias and many other psychiatric conditions. Patients can obtain faster access to their providers. This is the best way to protect patients and staff from COVID-19 during this pandemic time. I want to collaborate with primary care providers, families, caretakers, therapists, social workers, and case managers to enhance the clients’ experience and help them. Telehealth can be used in any population looking for help. For pediatric and mentally challenged patients needs accompanying family or caretakers just like an in-person visit.
One of the significant concerns for video conferencing is assuring that unauthorized people cannot gain access to the video call or the data generated in the course of the call. It is essential to follow the HIPPA complaint, CMS guidelines for Medicaid and Medicare patients, state guidelines for prescriptions for controlled substances. Post telehealth survey to validate the effectiveness of the tele-visit is essential for improving the program. Informed consents, documentation, and proper coding are crucial considerations. The sessions need to be eligible for reimbursement from the insurance providers. Mental health patients could help from video conferencing with social workers, counselors, and case managers. Verbal and written consent is essential before the session. The provider should also ask for verbal consent at the beginning of the session.
As a student in the PMHNP program:
• I would be interested in participating in the videoconferencing model in my future practice.
• The equipment needed is a computer/laptop with a web camera, smartphone, or tablet with a web camera and strong internet connection.
• The population I would address would be patients with mental health/psychiatric illness.
• My role in the telehealth program would be to deliver care via telehealth as the PMHNP.
• What you would evaluate about the program- Sprout Measurement Framework Domains (Health Outcomes, Value of Healthcare Delivery, Patient/Provider Experience, and Program characteristics, performance, and implementation.
• Legal considerations that need to be addressed is the originating site of the visit will need to be addressed. In Virginia, Governor Northam signed HB5046/SB5080 that eliminated the originating site restrictions for CMS payment. This legislation expired on 7/1/21. This means telehealth visits need to consider where the patient is when performing the telehealth visit when requesting reimbursement from DMAS.
• I would also like to include primary care providers, social workers, case managers, and therapists in telehealth services.
• Protocols would need to be developed for procedures for a patient with technical difficulties, privacy protocols, consent protocols, and protocols for the types of visits that are appropriate for video conferencing.
• Verbal and/or written consent will be required before each visit.
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