MDNews - Central New York

fa mily members or from healthcare providers who are in close proximity to the patient. If the quality of video technology — including audio and lighting — used by both provider and patient is good, the clinician is still able to detect nuances, such as body language and infl ections in tone, in a patient's behavior, Klapow says. Moreover, the technology to deliver telehealth is improving, proponents say. Dr. Wong a lso points to resea rch showing good outcomes among patients who receive telemental health services. According to a 2013 review in Telemedicine Journal and E-Health, multiple studies have found telemental health is as e ective as in-person sessions across multiple age groups, in varied settings and for a range of conditions. It can even be better than in-person care in some instances. While telemental health helps bridge the distance between patients and providers, it also may encourage otherwise reluctant patients to seek care. Some patients may feel more comfortable meeting with a psychiatrist via video conference than in an office because of the stigma surrounding mental health issues. Additionally, if patients have infl exible work schedules or if circumstances such as inclement weather arise, meeting online can save transportation- and work-related time and money, Tyner says. Similarly, because providers are in short supply, telemental health may save resources that providers would otherwise expend on travel to meet patients at distant locales. "With telemedicine, they're able to [see patients] from one central location and spend more time treating the patient, as opposed to driving to the patient," Tyner says. REGULATORY HURDLES Bigger challenges, according to advocates, lie in legal roadblocks that hamper tele- mental health's full potential to increase access to care. "There are all kinds of artifi cial bar- riers involved," says Gary Capistrant, Chief Policy Officer of the American Telemedicine Association. "Licensure is an important one." Strict license regulations and practice rules make it diŸ cult for a provider to treat patients in multiple states. However, those barriers are diminishing. As of mid-2015, nine states had adopted the Federation of State Medical Boards' Interstate Medical Licensure Compact, designed to stream- line interstate provision of care. Reimbursement issues are also becom- ing more manageable. "When I started, there were 11 states that had legislation requiring private insurers to reimburse for telemedicine," Tyner says. "Now there are 29." ■ information while the session is underway, Tyner adds. INCREASING ACCESS With a nationwide shortage of roughly 25,000 psychiatrists, one of the primary reasons for telemental health's rapid g row th is that it holds promise for substantially increasing access to care, particularly in rural and remote areas. The National Alliance on Mental Illness reports that approximately 25 percent of American adults su er from a diagnosable mental disorder. However, about 60 percent of those adults do not receive treatment. Many of those who go untreated live in areas where providers are often unavailable. " M a y b e a r o u n d 50 percent of counties in our country don't have access to a mental health provider," says Donovan Wong, MD, Medical Director of Behavioral Health at Doctor on Demand, a San Francisco-based company that strives to increase access to health care through telemedicine. Industry observers see telementa l health as an important component of addressing that disparity. However, like other nontraditional means of care delivery, telemental health has faced skepticism. Some practitioners and researchers have raised digital privacy issues. Others hold that direct human contact is essential to mental health work and healing. And some question clinicians' ability to build rapport with patients from a distance. OVERCOMING OBSTACLES There can be sensory, technological or other barriers to delivering telemental health services e ectively, industry experts acknowledge, but they say those issues can be resolved relatively easily. Not being able to smell a patient to detect possible alcohol abuse or lack of personal hygiene, for instance, can impede treatment, Dr. Wong notes. However, he adds, such information often can be obtained from " I think skeptics would say you miss out on ... that sort of intangible feeling of being in the room with someone, or that you're less able to pick up on body language. Those are fair questions to raise, but going back to the research, those things haven't proven to be problematic." ¥ DONOVAN WONG, MD, MEDICAL DIRECTOR OF BEHAVIORAL HEALTH AT DOCTOR ON DEMAND Growth Industry The United States' telehealth market is expected to grow to $1.9 billion by 2018, up from $240 million in 2013, according to market research fi rm IHS. M D N E W S . C O M /// M D N E W S C EN T R A L N E W YO R K ■ 2 016 2 5

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