Premier Psychiatric Group (Premier Psych), the practice we founded in 1998, is committed to finding new and innovative ways to bring important treatments and patient care to our patients – many of whom are located in rural areas where on-site visits may involve hours of commuting time. We have found that telehealth with high-definition, HIPPA secure video conferencing allows increased patient access to our clinical providers, thus improving patients’ quality of life.
Premier Psych is a medically-driven practice based in Lincoln, NE with over 50 employees, including physicians, nurse practitioners, physician assistants, therapists and psychologists. Our growth has us now seeing approximately 250 patients per day either face-to-face, or remotely at mental health facilities, nursing homes, primary care offices and satellite clinics. Much of our work involves psychiatric evaluations and pharmacological management. We also are the country’s largest provider of Brainsway deep transcranial magnetic stimulation (FDA-approved for treatment-resistant major depressive disorder).
By Walter J. Duffy, M.D.
Premier Psychiatric Group (Premier Psych), the practice we founded in 1998, is committed to finding new and innovative ways to bring important treatments and patient care to our patients – many of whom are located in rural areas where on-site visits may involve hours of commuting time. We have found that telehealth with high-definition, HIPPA secure video conferencing allows increased patient access to our clinical providers, thus improving patients’ quality of life.
Premier Psych is a medically-driven practice based in Lincoln, NE with over 50 employees, including physicians, nurse practitioners, physician assistants, therapists and psychologists. Our growth has us now seeing approximately 250 patients per day either face-to-face, or remotely at mental health facilities, nursing homes, primary care offices and satellite clinics. Much of our work involves psychiatric evaluations and pharmacological management. We also are the country’s largest provider of Brainsway deep transcranial magnetic stimulation (FDA-approved for treatment-resistant major depressive disorder).
When we founded Premier Psych, many patients were driving more than two to three hours to visit our main office in the state’s capital. We knew alternative delivery methods of treatment were needed to serve patients across the state and broaden our reach outside of Nebraska. Almost ten years ago Nebraska instituted a statewide telehealth network that encouraged caregivers to use video collaboration technology to provide medical services to patients who were unable to travel or who lived in particularly rural areas. We began using the state’s telehealth network in 2006 to connect with patients and provide services.
By 2012 however, our telehealth needs were skyrocketing, and the statewide telehealth network no longer could support the volume of requests for our services. After looking at the gamut of videoconferencing equipment companies or leasing bandwidth from another company’s telehealth infrastructure we decided to invest in our own video conferencing technology, as well as our own IT staff and overall technology infrastructure. After reviewing a variety of video conferencing companies we chose ClearSea from LifeSize, based in Austin, TX to partner with us in growing our planned, scalable telehealth model with plans to become one of the top telehealth delivery, partner and distributor organizations across the country.
We use video conferencing for treatment in primary care clinics and residential treatment settings. We also use the technology to coordinate care among our locations and in joint cooperative ventures out of state. With video conferencing, we are able to conduct healthcare provider meetings between our offices in Lincoln and Omaha. Unified virtual conferencing lets us connect up to 40 different sites, for both training and for secure patient treatment. It has also allowed us to have virtual face-to-face meetings with potential partners within and outside the United States while saving on travel, phone calls, etc. The recent high-definition enhancement of our system has been a “wow” factor to us, our partners and our patients. Clarity is one thing but being able to have a new sense of depth from the entire visual lends itself to increased depth of engagement between the clinician and patient or between anyone over videoconferencing. In addition, it also lends itself to increased accuracy in assessing emotions, body movements, skin lesions, wounds, etc. I would say “once you have high def you will never go back.”
One benefit of using video conferencing in behavioral healthcare is that it extends the reach of the behavioral health provider. Psychiatrists, child psychiatrists and mid-level providers are typically concentrated in urban areas. Treating patients outside of urban areas typically involves setting up a secondary clinic, which can be prohibitively expensive. Without this type of service many patients delay an initial or follow-up visit with the downstream effect being increased hospitalizations, increased presenteeism/absenteeism from work, worsening of physical health conditions, etc. This results in overall increased healthcare costs, decreased worker productivity, and decreased physical and mental health.
Video conferencing improves access to care, and increases the appropriate utilization of care. (In some cases, patients who do not have immediate and convenient access to care simply choose not to seek care at all.) Video conferencing allows specialists to be much more readily involved with difficult-to-treat conditions such as schizophrenia or bipolar disorder. Patients with severe conditions requiring immediate treatment can be seen the same day with minimal disruption to their schedule or the provider’s schedule. Better still, video conferencing enables our treatment professionals to see patients not only in Omaha and other locations in Nebraska, but in South Dakota, Iowa, etc. as well.
One particular success story in using video technology comes from Bob Lundholm, a nurse practitioner and clinical manager in Premier Psych’s Omaha, Nebraska location.
In our practice Bob primarily treats children and adults. One child patient, who lives five hours away from the Omaha office, was able to use video conferencing in a satellite clinic to increase the number of visits for treatment of his severe behavioral and developmental issues. This increased number of treatment sessions has had a direct effect on his well-being. When first seen in our practice, this child was able to attend school for only one hour per week. With the increased frequency of treatments, the child’s behavior improved so dramatically that he is now in school for four hours each day.
The video option which resulted in increased visits helped Bob more readily understand the child’s moods and frequency of outbursts, while also being able to more quickly and efficiently choose, monitor and adjust levels of medication. Bob is able to do everything he would normally do if during an appointment he and the patient were in the same room, including visual observation, assessment and medication management.
If your practice is still considering whether to use video conferencing and telehealth, I would offer a few pieces of advice to get started successfully:
- Secure communication and a HIPAA-compliant secure health record sharing are absolutely vital. Look for open standards-based solutions. They typically offer that level of security —which is not typically true of proprietary systems.
- Look for a high definition solution that is easy to use and scalable. Avoid fixed license programs. You need to be able to quickly add or remove users as your practice requires. You also will get the best results with a system that can be readily downloaded onto any device – desktop, laptop, tablet or other mobile device.
- Make sure that the staff on the other side of the video conference are properly coordinated. Patients must be brought in for treatment just as they would in face-to-face appointments, meaning only when the health care professional is ready to see them. This discipline is essential for the best possible results in video conferencing treatment.
- Learn to start using it. It’s common to put the technology in place and still rely on traditional in-person visits. Video allows you to see more patients, and to see patients more efficiently, closer to where they live. It allows you opportunities to grow your practice, putting you in touch with a greater number of potential patients and partners.
Video conferencing technology and telehealth in general has allowed Premier Psychiatric Group to dramatically increase our breadth of service. We have twice the number of patient interactions that we had with the Nebraska statewide network. We are now seeing patients in remote areas of South Dakota and Iowa, which we would not have been able to do without acquiring our own system. Video conferencing also has enabled us to initiate conversations with a number of collaborating partners.
Most importantly, video conferencing is simply an excellent way to care for patients. Patients are typically comfortable with being seen via video. If the patient is comfortable, the provider is one step closer to success.
ABOUT THE AUTHOR
Walt Duffy, M.D., is a Board-certified child and adult psychiatrist and the owner, founder and CEO of Premier Psychiatric Group and of Premier Psychiatric Research Institute, based in Lincoln, NE.
