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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.

In recent years, technologies like the voice-over-Internet protocol service Skype have emerged, and prices for complex software and high-resolution video cameras have dropped dramatically, making it possible for psychiatrists to connect securely -- and relatively cheaply -- with remote patients.

Fishkind also noted that younger, more tech-savvy patients are far more comfortable being treated via Web-based video conferencing.

"Thirteen to 25-year-olds are the most comfortable with it because they commonly use Skype and other technologies to communicate. That's the way they've communicated their whole lives, so they may see as completely adequate," Fishkind said.

Skyping your patients

Voyager Telepsychiatry LLC administers a national Skype network for 80 clinicians and clinics that it claims is used to treat millions of patients.

Besides administering the network, the company runs a scheduling and billing system for the clinicians.

CEO Douglas Ikelheimer said sophisticated 256-bit AES encryption makes Skype as secure as proprietary technology, but without the added software costs.

"It should revolutionize telepsychiatry and eventually the practice of mental health itself," he said in an email to Computerworld.

Ikelheimer said that telepsychiatry has long been limited by cost and more recently by the advent of "HIPAA fear-mongerers," who he said spread fear about security issues often for financial gain.

"This group is largely comprised of people from the videoconferencing industry ... and HIPAA education people that provide training courses, books, and manuals on the subject," he said.

Ikelheimer argued that even though Skype is peer-to-peer technology -- which is less secure than dedicated server networks -- the encryption algorithm means it can only be accessed by the most dedicated cyber-criminals.

"Whereas you can easily buy sophisticated listening and phone tapping equipment to spy on traditional appointments," he wrote. "And when it comes to checking on the latest changes to your Prozac dose, who is going to go to those lengths and for what gain?"

Secure or not, some psychiatrists still feel Skype exudes insecurity.

"I wouldn't feel that it was safe," Chandran said. "I don't know about it in terms of encryption. I'd assume most computers are safe enough."

Others feel laptops don't offer a large enough screen to provide a feeling of intimacy with a physician.

Fishkind the screen size issue depends on the patient. "The younger the patient, the more comfortable they are [with a computer screen]. As patients get older -- 45, 55 or 65 - then the comfort of a computer screen diminishes as opposed to a television screen."

Smartphones become therapists

Northwestern University's Feinberg School of Medicine is currently field-testing a mobile application that is said to enable a smartphone to determine when patients are at risk for depression.


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