Telepsychotherapy: What's Up!?

by Donna Koger, 6.28.16

For any clinician providing telepsychotherapy / telepsychiatry, there are many issues that should be considered. The following are recommendations by the Society for the Advancement of Psychotherapy for remote practice, whether in your home state or over state lines.

Informed Consent

When practicing telepsychotherapy, informed consent should include issues such as:

• Privacy – the most private medium is a landline telephone call. Consider that the Internet is not regulated and not protected by privacy laws. Confidentiality – the medium utilized may offer more or less privacy.
• Fees
• Reimbursement
• Security and reliability of video & phone - not all applications used on the internet are encrypted, which means the session is not confidential communication. Skype is a good example of non-encrypted communication. Cell phones do not have the security of a landline.

SAP warns, “Providing psychotherapy on unencrypted sites is ill advised” - and the common consensus is that Skype is considered a non-secure and therefore “illegal” option for telehealth:

     • Skype for telemedicine: is it compliant?
     • 4 Skype security risks for telehealth
     • Skype Illegal for Telehealth

The following factors should be taken into consideration for any video + phone services used for telehealth:
     • Communication limitations
     • Record keeping
     • Termination
     • Availability for emergencies
     • Cancellation policy 

Malpractice Insurance

Psychologists should be sure their malpractice insurance covers telehealth practices.

Licensure

As explained in our article on practicing remotely in-state or across state lines, practitioners must check their respective locations for regulations regarding telepsychotherapy.

Billing

Essentially, psychologists need to check with the insurance carrier for each client to be sure there is a proper provision for reimbursement for telepsychotherapy.

Client Types

SAP further recommends “this type of work is only advised with clients not considered to be high risk. Clients at risk, however, can become at risk. If psychotherapy will be provided at a distance, it is important that the treating psychologist establish clinical support in the patient’s geographic location in case of emergency so that standards of care can be met.”

Technical Issues

How many of us have suffered the pangs of technology? These problems are no different when conducting telepsychotherapy. As a matter of fact, the problems associated with using technology can exacerbate an existing problem with a patient. Practitioners should consider a contingency plan available for potential failure of the medium used. A stand-by phone call can be used as a back-up to online communications.

Training in Telepsychotherapy Skills

As with anything, there are skills necessary to using technological means of communication. These include not only the technical skills, but the more subtle interpersonal aspects of providing psychotherapy remotely.

PIMSY Offers Integrated Telehealth

PIMSY mental health EHR has partnered with Secure Video to offer integrated telehealth services. Conduct a telepsychotherapy or telepsychiatry session right from your PIMSY calendar, with automatic meeting invitations to your clients for seamless scheduling.

PIMSY is both robust EMR - and efficient Practice Management Software – rolled into one flexible, comprehensive, and affordable program. See how PIMSY can address your practice needs.

Resources Include

http://societyforpsychotherapy.org/report-task-force-telepsychotherapy/

Donna Koger is currently the HIPAA Compliance Officer and materials developer for software training and support at Smoky Mountain Information Systems, home of PIMSY EHR. Ms. Koger is also a regular contributor to the PIMSY EHR Blog.