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of the time a nd goa ls to reduce stress 93 percent of the time. NewYork-Presby terian Hospita l a lso saw success with the NYP-Weill Cornell ED Telehea lth Ex press Ca re Ser vice. Within t wo months of launching the service, the average leng th of emergency room v isit s for pat ient s w it h m i nor compla ints dropped from four hours to 30 minutes, according to a late-2016 a r ticle in Healthcare IT News. T e l e h e a l t h s h o w s p r o m i s e f o r ma nagement of chronic conditions as wel l. A systemic rev iew published in Telemedicine and e-Health found that pat ient s w it h ch ron ic hea r t fa i lu re fa red bet t er i n a t elehea lt h set t i n g t ha n under more conventiona l ca re. Patients who completed v ir t ua l v is- it s had fewer episodes of worsen i ng hea lth and had genera l improvement in clinica l, functiona l a nd qua lity-of-life status. Telemedicine reduced the rate of hospita l readmissions, leng th of stay a nd emergency depa r tment visits. SPECIALIZED CARE FOR UNDERSERVED POPUL ATIONS Pr i ma r y ca re physicia ns pick i ng up the phone to consult w ith specia lists i s not h i n g revolut ion a r y. However, Richard Lawrence Merkel Jr., MD, PhD, A ssociate Professor of Psychiatr y a nd Director of Outreach at the University of Virginia, notes that telehea lth providers a re now using a col laborative model of ca re in which the remote specia list is a vir tua l member of the loca l tea m. More tha n just a one-time consu lt , a collaborative model a llows the specia l- ist to prov ide ongoing education a nd suppor t for prima r y ca re providers. D r. Merkel a nd t he Un iver sit y of Virg inia have been providing telepsy- chiatr y ser v ices in r ura l Virg inia for approximately a decade. He notes that in addition to providing suppor t for of ten over whelmed prima r y ca re physicia ns and nurse practitioners, telepsychiatr y has multiple benef its for patients. " Telepsychiatr y is relatively easy to do and just as, if not more, effective than face to face when it comes to treating ps ycholog ica l a nd subs t a nce a bu se problems," Dr. Merkel says. "Morbidity a nd mor t a lit y rates come dow n sig- n i f ica nt ly. In t hese r u ra l a rea s, t he stigma of seeking treatment for menta l hea lth is ver y high. W hen you go to see a counselor, people know quick ly you have gone there. W hen a patient goes to a prima r y ca re or nurse practitioner off ice, no one knows why — it could be diabetes or a hundred other things. It 's easier for patients to feel more comfort- able getting ca re." ■ Training the Next Generation FOR SPECIA LT Y CLINIC S looking to bring mental health care to rural or other underserved areas, fi nding clinicians trained in providing those services via telemedicine can be a challenge. At the Texas A&M Telehealth Counseling Clinic, doctoral students in psychol- ogy provide counseling remotely to patients in the rural areas of the Brazos Valley region. "All of health care, not just telehealth, is expected to use technology, but training programs are signifi cantly lagging in training students," says Carly E. McCord, PhD, licensed psychologist with the Center for Community Health Development at the Texas A&M School of Public Health and Director of Clinical Services at the Telehealth Counseling Clinic. "I strongly believe that the future generation of health professionals should have the knowledge and skills required to use telehealth." In addition to providing training for future psychologists, the Telehealth Counseling Clinic generates signifi - cant savings, McCord says. That's because patients in rural areas with otherwise little access to mental health services do not need to rely on emergency care during a mental health crisis. 1 5 M D N E W S .C O M /// M D N E W S C E N T R A L N E W Y O R K ■ 2 017