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Web-based counseling -- Telepsychiatry -- is taking off

Lucas Mearian | Feb. 10, 2012
Telemedicine has been around since the 1990s, but psychiatrists say it's increasingly used to treat remote patients as technology and security improves, and prices drop.

Dr. Avrim Fishkind, a psychiatrist in Houston, rarely sees any of his patients in person, and that's the way they like it.

Fishkind is part of a fast growing movement in the mental healthcare field where therapists counsel patients via inexpensive, Web-based video conferencing technology.

"We've had just over 60,000 patient encounters. To my knowledge, only six have refused to be seen via teleconferencing," he said. "When it comes to mental health issues and the difficult things you need to talk about in a crisis, a lot of patients feel it's less threatening and easier to be open and communicate via telemedicine."

Fishkind said telepsychiatry is limited only by insurance reimbursements. As more insurance companies start to reimburse for telepsychiatry treatments at the same rate as they do for in-person visits, the emerging medical field will grow exponentially.

In many instances, telepsychiatry is a necessity, not just a convenience for doctors and patients. Patients are often located in regions with no private psychiatric practices or where hospitals don't employ staff psychiatrists.

Telepsychiatry is also often used to treat prison inmates and nursing home patients.

"We're tailor made for telemedicine because we don't check people's livers. We just talk. Besides radiology, you can't imagine a medical discipline better adapted to telemedicine," Fishkind said. "It's so easy to implement, replicate and expand. That's why it's exploding so quickly."

Telepsychiatry is also a perfect platform for expanding the use of electronic medical records to document patient information through physician notes.

Fishkind noted that as he counsels patients via video conferences, he simulataeously types notes on his laptop, which are added to the patient's electronic records.

Dr. Dilip Chandran, a psychiatrist who works for Youth Health Services Inc. in Elkin, West Virginia, has been treating patients in remote locations via telemedicine for the past five months.

Chandran spends three days a week in Morgantown, where his home and this employer University of West Virginia is located, and two days in Elkin. Chandran is works for Youth Health Services under a contract the agency has with the university.

"[Patients] feel great about seeing me on television and they actually become more animated when they see me that way, especially kids with anxiety issues. They do very well with telemedicine," said Chandran, who treats adolescents, including teenagers.

Chandran uses a webcam from Logitech and secure video conferencing software from Secure TeleHealth to communicate with patients, who sit in a fully equipped satellite office near their homes. The whole setup costs less than $1,000 for each side.

While Chandran uses a television for the video conference, a laptop or desktop screen would work just a well.


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