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Telepsychiatry in the cloud

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   By Tom Toperczer, Nefsis, August 2011

Reaching rural communities in underserved markets.

Tom
Toperczer,
Nefsis

In 2001, the Georgia Department of Behavioral Health and Developmental Disabilities made a commitment to privatizing the movement to ensure that children and young adults between the ages of 4 and 22 requiring mental health services could be served in their home communities. This was a relatively easy problem to address for children living in the inner cities, but it was far more complicated for rural populations, where children are at the highest risk of being removed from their communities and placed in a stabilization or residential program somewhere else in the state.

CarePartners of Georgia, a community-based behavioral healthcare provider, provides services to public-sector children in a rural five-county service area. Each of these remote communities, designated as a health professional shortage area (HPSA), is within 90 miles of Macon, Savannah or Augusta. Because of the difficulty of recruiting psychologists and healthcare professionals to work in these areas, CarePartners of Georgia staff would drive children and their families to one of the three cities — up to 90 miles each way — for their scheduled psychiatric appointments, typically every six to eight weeks. Paying staff to drive up to five hours each day for one appointment, along with very high gas and vehicle maintenance costs, created multiple barriers to improving patient care.

About two years ago, CarePartners of Georgia explored telepsychiatry as a way to increase efficiency, reduce travel costs and improve the process of providing care, but the organization found that to set up a hardware-based video conferencing system, it would need to purchase at least two endpoints at $12,000 each. It would also need to pay for an expensive dedicated T1 line to connect them plus licensing fees.

"The technology at the time was cost prohibitive for our small organization," says David Crooke, CEO of CarePartners of Georgia.

About nine months ago, however, Crooke came across Secure Telehealth, a Pittsburgh-based company that provides a complete, Web-based, secure platform for telepsychiatry over the Internet. Secure Telehealth partners with Nefsis, a cloud-based video conferencing service.

"Telepsychiatry is an effective way to provide access to psychiatric care for individuals living in underserved areas," says Jim Mountain, president of Secure Telehealth. "It has become one of the most successful of all the telemedicine applications because its practitioners don't need to touch their patients to treat them. We have found Web-based video conferencing to be an effective service-delivery method."

The term "cloud computing" refers to on-demand services provided over the Internet, using hardware and software located at the vendor's location rather than at the customer's location. It would, for example, completely eliminate the need for CarePartners of Georgia to purchase the $12,000 endpoints and dedicated T1 line. In addition, the on-demand service makes it easier for customers because they don't have to maintain the servers and other sophisticated equipment. They just have to install a small application on their PCs. In addition, cloud computing offers substantial business and technical benefits, including increased performance and scalability, and the simplicity and reduced maintenance associated with buying complex applications as online services.

David Crooke, CEO, and
Kathy Durden, COO, of
CarePartners of Georgia.

CarePartners of Georgia first met with Secure Telehealth in October 2010 and went live during the first week of December 2010.

"Having a video conferencing system in place improved our ability to successfully recruit a child psychologist to work with our rural populations," says Crooke. "The kids seem to like the technology and are comfortable with it."

With only a standard PC, off-the-shelf Webcam and Internet connection, CarePartners of Georgia psychologists and physicians can now conduct assessments, therapy and medical checks securely from any location, including their professional offices or homes. The Nefsis cloud automatically secures the video conference with encryption, ensuring that CarePartners of Georgia complies with HIPAA requirements.

"Our budget to get the project started was $800 out of pocket since we already had one PC available to use. We purchased an additional PC, two Logitech 9000 Webcams and two Phoenix Duet microphones from Amazon. We did decide to invest in an additional Internet connection, at $60 per month, because the existing DSL service was unreliable at one of the remote locations," says Crooke. 

Once the equipment was in place, the organization just needed to download a small software application to each PC. As a result, there were no set up fees, and even the staff training was done using video conferencing.

Benefits of telepsychiatry for the community

With two separate clinics set up for video conferencing, the rural communities in Georgia began to see immediate, positive results. Families needed to travel just 30 minutes or less to a local clinic and could be seen at any time, even during a crisis. Video conferencing also eliminated the need for children to wait up to six months to get an initial assessment. Once in treatment, follow-up appointments could be scheduled weekly, which helped to enhance program retention rates. Scheduling appointments also became far easier. Most important, telepsychiatry enhanced the community's crisis-response capacity. Previously, during a behavioral health crisis, children would have to go to their local emergency room and wait three to four hours to be seen by a physician. Now, in emergencies, a child psychiatrist can be called upon through video conferencing — 24 hours a day, 365 days a year — and assess if the child needs to seek hospitalization. 

Prior to the solution, the costs associated with the daily travel ate up a huge portion of the organization's budget, and those costs were not reimbursable by Medicaid. As a result of implementing the video conferencing service, CarePartners of Georgia is able to run far more efficiently.

"With Secure Telehealth, our overhead to provide psychiatric services has drastically dropped, and we have been able to increase our revenue by providing additional services to the community," says Kathy Durden, COO of CarePartners of Georgia. "We have become a much more efficient organization with telepsychiatry and are looking to expand our mental health services to other rural communities in Georgia. Since Secure Telehealth/Nefsis is an online managed service, it is automatically maintained and easier to expand as we grow without the financial risk of making a hardware investment."

In the first six months of implementing cloud-based video conferencing, CarePartners of Georgia realized a 350 percent return on its minimal investment in the technology. Adds Durden, "Telepsychiatry can expand any organization's capacity to serve its members. For rural behavioral health providers, our clinical bottom line is measured by enhancing access to services, improving service continuity and increasing service retention. I think the ROI and our 95 percent member satisfaction rate for the service indicates that so far, telepsychiatry is exceeding all expectations in those three areas and is greatly helping our organization in terms of clinical effectiveness and efficacy."


For more information on Nefsis solutions

For more information on Secure Telehealth solutions

In 2001, the Georgia Department of Behavioral Health and Developmental Disabilities made a commitment to privatizing the movement to ensure that children and young adults between the ages of 4 and 22 requiring mental health services could be served in their home communities. This was a relatively easy problem to address for children living in the inner cities, but it was far more complicated for rural populations, where children are at the highest risk of being removed from their communities and placed in a stabilization or residential program somewhere else in the state.

CarePartners of Georgia, a community-based behavioral healthcare provider, provides services to public-sector children in a rural five-county service area. Each of these remote communities, designated as a health professional shortage area (HPSA), is within 90 miles of Macon, Savannah or Augusta. Because of the difficulty of recruiting psychologists and healthcare professionals to work in these areas, CarePartners of Georgia staff would drive children and their families to one of the three cities — up to 90 miles each way — for their scheduled psychiatric appointments, typically every six to eight weeks. Paying staff to drive up to five hours each day for one appointment, along with very high gas and vehicle maintenance costs, created multiple barriers to improving patient care.

About two years ago, CarePartners of Georgia explored telepsychiatry as a way to increase efficiency, reduce travel costs and improve the process of providing care, but the organization found that to set up a hardware-based video conferencing system, it would need to purchase at least two endpoints at $12,000 each. It would also need to pay for an expensive dedicated T1 line to connect them plus licensing fees.

"The technology at the time was cost prohibitive for our small organization," says David Crooke, CEO of CarePartners of Georgia.

About nine months ago, however, Crooke came across Secure Telehealth, a Pittsburgh-based company that provides a complete, Web-based, secure platform for telepsychiatry over the Internet. Secure Telehealth partners with Nefsis, a cloud-based video conferencing service.

"Telepsychiatry is an effective way to provide access to psychiatric care for individuals living in underserved areas," says Jim Mountain, president of Secure Telehealth. "It has become one of the most successful of all the telemedicine applications because its practitioners don't need to touch their patients to treat them. We have found Web-based video conferencing to be an effective service-delivery method."

The term "cloud computing" refers to on-demand services provided over the Internet, using hardware and software located at the vendor's location rather than at the customer's location. It would, for example, completely eliminate the need for CarePartners of Georgia to purchase the $12,000 endpoints and dedicated T1 line. In addition, the on-demand service makes it easier for customers because they don't have to maintain the servers and other sophisticated equipment. They just have to install a small application on their PCs. In addition, cloud computing offers substantial business and technical benefits, including increased performance and scalability, and the simplicity and reduced maintenance associated with buying complex applications as online services.

David Crooke, CEO, and
Kathy Durden, COO, of
CarePartners of Georgia.

CarePartners of Georgia first met with Secure Telehealth in October 2010 and went live during the first week of December 2010.

"Having a video conferencing system in place improved our ability to successfully recruit a child psychologist to work with our rural populations," says Crooke. "The kids seem to like the technology and are comfortable with it."

With only a standard PC, off-the-shelf Webcam and Internet connection, CarePartners of Georgia psychologists and physicians can now conduct assessments, therapy and medical checks securely from any location, including their professional offices or homes. The Nefsis cloud automatically secures the video conference with encryption, ensuring that CarePartners of Georgia complies with HIPAA requirements.

"Our budget to get the project started was $800 out of pocket since we already had one PC available to use. We purchased an additional PC, two Logitech 9000 Webcams and two Phoenix Duet microphones from Amazon. We did decide to invest in an additional Internet connection, at $60 per month, because the existing DSL service was unreliable at one of the remote locations," says Crooke. 

Once the equipment was in place, the organization just needed to download a small software application to each PC. As a result, there were no set up fees, and even the staff training was done using video conferencing.

Benefits of telepsychiatry for the community

With two separate clinics set up for video conferencing, the rural communities in Georgia began to see immediate, positive results. Families needed to travel just 30 minutes or less to a local clinic and could be seen at any time, even during a crisis. Video conferencing also eliminated the need for children to wait up to six months to get an initial assessment. Once in treatment, follow-up appointments could be scheduled weekly, which helped to enhance program retention rates. Scheduling appointments also became far easier. Most important, telepsychiatry enhanced the community's crisis-response capacity. Previously, during a behavioral health crisis, children would have to go to their local emergency room and wait three to four hours to be seen by a physician. Now, in emergencies, a child psychiatrist can be called upon through video conferencing — 24 hours a day, 365 days a year — and assess if the child needs to seek hospitalization. 

Prior to the solution, the costs associated with the daily travel ate up a huge portion of the organization's budget, and those costs were not reimbursable by Medicaid. As a result of implementing the video conferencing service, CarePartners of Georgia is able to run far more efficiently.

"With Secure Telehealth, our overhead to provide psychiatric services has drastically dropped, and we have been able to increase our revenue by providing additional services to the community," says Kathy Durden, COO of CarePartners of Georgia. "We have become a much more efficient organization with telepsychiatry and are looking to expand our mental health services to other rural communities in Georgia. Since Secure Telehealth/Nefsis is an online managed service, it is automatically maintained and easier to expand as we grow without the financial risk of making a hardware investment."

In the first six months of implementing cloud-based video conferencing, CarePartners of Georgia realized a 350 percent return on its minimal investment in the technology. Adds Durden, "Telepsychiatry can expand any organization's capacity to serve its members. For rural behavioral health providers, our clinical bottom line is measured by enhancing access to services, improving service continuity and increasing service retention. I think the ROI and our 95 percent member satisfaction rate for the service indicates that so far, telepsychiatry is exceeding all expectations in those three areas and is greatly helping our organization in terms of clinical effectiveness and efficacy."


For more information on Nefsis solutions

For more information on Secure Telehealth solutions


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