This week, we speak with acting State Health Director Dr. Robin Cummings about the new, statewide telepsychiatry program starting in January, and how East Carolina University will be involved with the program.
Last week, we heard an in-depth conversation about the future of telemedicine in eastern North Carolina and how new technology could be used to provide access to specialized healthcare for people living in rural and underserved areas of the state, such as Bertie, Beaufort, Duplin, and Edgecombe.
This week, we continue our coverage of telemedicine with a feature about how it’s being used to make up for a shortage of psychiatrist in North Carolina. According to Deputy Secretary for Health Services and acting State Health Director Dr. Robin Cummings, 58 of the North Carolina’s 100 counties have too few physicians addressing mental health issues.
“It’s severe. We have counties where there is no psychiatrist at all. And so patients are simply not being appropriately addressed.”
Dr. Cummings estimates that the need for psychiatrist will only increase as the population of the state continues to grow and people age. To make up for the deficit, a concept called Telepsychiatry is being implemented at local hospitals and healthcare providers in eastern North Carolina and across the state. The telepsychiatry program begins operating in January 2014. The $4 million project was announced by Gov. Pat McCrory and Health and Human Services Secretary Aldona Wos, MD in August at East Carolina University in Greenville. Acting State Health Director Dr. Robin Cummings.
“The need for more and more care will increase. So we just have to be smart and use technology to tie the limited number of providers to the growing need and number of patients.”
Telepsychiatry involves a two-way interactive audio/video link that matches a patient with a consultant, similar to Facetime or Skype. The psychiatrist can conduct a consultation from anywhere in the world, but Dr. Cummings says the consultations in North Carolina will be conducted through ECU’s E-Behavioral Health Telepsychiatry Center.
“The patient will be put in a room by a nurse or by an associate at the emergency room. The nurse will take the vital signs and transmit them to the consulting psychiatrist. The system will be activated. There will be a psychiatrist on the other end and they will be connected. The patient will then be interviewed by the psychiatrist.”
The patient will see the psychiatrist on a high-definition monitor screen and the psychiatrist will be able to see the patient. But the doctor will be able to control the patient camera to monitor body language during the consultation.
“This equipment that we use is able to zoom in and the psychiatrist can watch the patient, obviously their hand movement, they can watch their eyes and see if their pupils are dilating or constricting, they can see sweating on the skin. So very, very sensitive video equipment. And so a full confrontation is conducted.”
Dr. Cummings expects the process will be straight forward and cost effective. Once an initial investment is made, maintaining the telepsychiatry equipment is very low. And as the procedure becomes more available, Dr. Cummings believes it will drive down costs even more, making the process very affordable for patients.
“In terms of cost, if the patient has insurance, insurance will pay for this just like they would for a regular patient doctor interaction, so there’s no additional cost there. Medicaid reimburses, Medicare reimburses.”
Since telepsychiatry can be implemented at small, rural hospitals, patients won’t have to drive long distances to see a doctor.
The concept of telepsychiatry isn’t new, but it is becoming accepted. And thanks to technological advancements, it’s becoming more accurate too. While some people see the concept of telemedicine as beneficial, others believe it can never replace an “in-person” visit with the doctor. Dr. Cummings disagrees.
“Patient reacts to it, to the technology very well obviously folks have televisions, they have computers, so everyone’s very familiar, very comfortable with the concept of a screen. Talking to the psychiatrist thru the screen takes about a minute or two of accommodation, getting accustomed to the situation. And really from there, it really becomes an interactive situation.”
In a world of online chatting and smartphones, it’s not surprising that adolescents actually respond better to telepsychiatry sessions.
“Children really, just absolutely take this technology and don't hesitate at all to interact, children this day in time just deal with technology, they grow up with it. They don’t, it doesn’t faze them at all.”
North Carolina’s new interest in telepsychiatry is based on the successful telepsychiatry project started by Albemarle Hospital Foundation in 2011.
“It came to the attention of the Dept. of Health and Human Services. We gathered a work group together and began looking at how we could expand what they had done with their project over two years and see how we could expand it statewide. So the project is already up and running, 14 hospitals going. We have about 30 maybe 32 hospitals on a waiting list right now to get going.”
In North Carolina, there are over 108 hospitals with an emergency room and less than 50 percent of those have 24/7 access to a psychiatrist. Dr. Cummings says rural hospitals that currently do not provide psychiatric care will be among the first be added to the state’s telepsychiatry program as it rolls out in January. Jared Brumbaugh, Public Radio East.
