Psychiatric services in communities throughout New York State will now be accessible to individuals through the use of the State’s recent approval of Telepsychiatry. The new regulations issued by the New York State Office of Mental Health (OMH) authorize “the use of two way real-time interactive audio and video equipment to provide and support mental health services at a distance…” The defined services do not include a telephone conversation, or email messages or fax between a provider and a patient. As noted in the OMH release, “under these new regulations, a patient in Vestal will now be able to receive mental health services from a psychiatrist in Valhalla, with minimal wait time.”
The regulations require that a provider of services obtain prior written approval of OMH before engaging in Telepsychiatry. Approval is based on a provider’s sufficient demonstration that Telepsychiatry will be used for assessment and treatment purposes consistent with the regulations and that the services are being requested because they are necessary to improve the quality of care of individuals receiving services. Providers must demonstrate that they will use electronic encryption to protect patients’ information, obtain informed consent from patients, and implement procedures for handling patient emergencies. Details on these protections must be part of the application submitted to OMH for approval.
Other practical guidance to providers includes technology standards to ensure that psychiatrists are trained to manipulate the camera via pan, tilt and zoom, in order to better observe a patient’s body language. While Telepsychiatry services performed in accordance with the regulation “shall be considered face-to-face contact when the service is delivered…”, a notation must be made in the record indicating that the service was provided via Telepsychiatry and must specify the start and end time of the session.
Among the benefits cited in the regulations are improved access to care, provision of care locally in a more timely fashion, improved continuity of care, improved treatment compliance, and coordination of care. Telepsychiatry raises concerns about privacy, security, patient safety, and interoperability of health information systems. Performing Provider Systems (PPSs) under DSRIP (Delivery System Reform Improvement Program) and QEs (Qualified Entities) participating in the SHIN-NY (Statewide Health Information Network for New York) are already hard at work addressing these concerns. Health information exchange experts describe these concerns as presenting ‘significant, though not insurmountable’ obstacles. The sooner technology vendors focus on these challenges, the quicker the solutions will come. Unified pressure on vendors from the New York State Department of Health and OMH, as well as from the QEs, PPSs and their respective participants delivering the services will accelerate the problem-solving.
This development signals a significant step forward in the utilization of technology to improve the delivery of healthcare in a cost-effective manner, allowing certain services to be available in a manner which eliminates or reduces transportation costs and time delay for services not immediately available in many areas of the state. The challenge will be for the technology to keep pace with the requirements for privacy and security, particularly when dealing with behavioral health data. The new regulation can be found at 14 NYCRR Part 596.