Rural Telemental Health Work Group Meeting Summary
Thursday, October 1, 2009 9:30 a.m.-12:30 p.m.
Metro Counties Government Center
Members Present: Ron Brand, Gary Davis, Jode Freyholtz (chair), Dwight Heil, Mary Olson, Kate Zacher Pate, Sue Sailer, Cindy Uselman
MDH Staff Present: Kristine Gjerde, Jill Myers, Tamie Rogers, Mark Schoenbaum, Kristen Tharaldson
ORHPC staff provided the members with background information leading to the formation of the work group. (See Handouts)
RURAL MINNESOTA TELEMENTAL HEALTH WORKGROUP PROJECT PLAN
The work group reviewed the project purpose, focus areas, approach, work plan and membership. The following changes were suggested:
- Include the following in the discussion: care system design and practice model, clinical process, arrangement and flow, and patient care experience
- Invite SISU to participate as a key informant on the project because of their expertise in broadband and health communications issues.
PRESENTATION: MINNESOTA ASSOCIATION OF COMMUNITY MENTAL HEALTH PROGRAMS
Executive director Ron Brand presented on the use of telemental health within community mental health programs. Key presentation and discussion points included:
- The provision of telemental health improves direct client care and efficiency of services.
- There is little progress in understanding regulatory issues and information exchange.
- Credentialing is a lengthy and difficult process for hospitals/remote doctors and clinics/remote doctors.
- Minnesota Department of Human Services' mental health link to school projects reaches clinics in schools and is integrated with special education. Telehealth is used for access to specialists and evaluation. When working with schools, can reach a complete cross-section of the community.
- Sen. Franken proposed the hospital use of telehealth amendment. This only affects joint commission accredited facilities.
- VA telehealth model defines consultations versus direct care versus shared care (e.g., primary care and mental health).
- In general, mental health services are less vertically integrated (e.g., network oriented) and more horizontal in connections to other providers.
- The DIAMOND PROJECT provides better identification of mental health issues. This is essential, but with more patients being identified, providers need support with the challenge of treating and managing more patients. When using telehealth in a primary care setting, consultations are more routine. Its easier to form relationships and strengthen mental health screening and care capabilities of primary care doctors.
- The Duluth Telehealth Network is another model for telemental health care delivery. The main use is to support primary care providers in a consultation capacity. A secondary use is to provide mental health care for patients as needed, especially for complicated cases out of the range of expertise of primary care providers. In these cases, they serve as the default mental health service.
- Another key use of telemental health services is to provide support to physicians to prevent burnout. Recruitment can improve when remote providers can connect to other providers and decrease professional isolation. This is especially important in cases of patient suicide when a practitioner needs colleagues to work through the emotional burden of the situation.
Other points of discussion:
- Telehealth is a catalyst for change in community mental health organizations
- Origination site fee is important
- Telehealth site coordinators are important
- Open architecture minimizes firewalls or VPN “islands”
- There are intersection between current state health reform efforts (health care homes and baskets of care) and telemental health
- Need to connect health reform efforts to telemedicine applications
- Easier for primary care to handle complex conditions and coordinate care
- Basket of care for depression; compete on price but no specialists; using telemental health is a way to overcome barriers
- New technologies are cheaper and more efficient than ever before
- The “art” of telemental health is in the details
- Using auto-presets for ease of flow
- Understanding proper alignment of the camera
- Making the patient feel comfortable
- Biggest need in order for telemental health to be successful is to work through payment and regulatory barriers. One idea would be to have an Administrative Uniformity Committee-like forum to work with payers on these barriers.
Work group members were encouraged to envision the environment and provision of telemental health services in the future, and to share what they see. The purpose of the exercise was to articulate what the group thinks this environment should ideally look like. Discussion points regarding telemental health services in the future included:
- Everyone should have access (visual) to another person
- Plenty of specialists are willing to participate (and they will be reimbursed)
- There is not a lengthy credentialing process
- Mental health outcomes are improved
- It doesn’t matter where the provider is physically located
- EMR is part of telemental health
- Urgent telemental health is available in a variety of community locations
- There are bridges with state operated systems (especially when the ER is the first point of care)
- Telehealth supports ER/Urgent are diversion
- Funding and reimbursement are more than adequate
- There are increased access points (schools, nonprofits, etc.) – this will promote early intervention
- Telemental health includes health coaching for wellness goals, especially for people with chronic health conditions
- Regulators, insurance companies, educational institutions have a common understanding of common telemental health goals
- Consumers have choices
- There is greater acceptance and less fear of the technology
- Telehealth is built into the curricula for students
- Telehealth is used for transitioning clients from one setting to another.
- Mental Health and Primary Care in Rural Minnesota (Executive Summary) – In 2005, an RHAC work group developed a report on the intersections between mental health and primary care. Recommendations were made in the areas of workforce, health systems and state/federal policies.
- Mental Health Health Professional Shortage Area (HPSA) designations – This is determined by the ratio of population to psychiatrists.
- Mental Health Indicators: Children (PDF:20KB/3pgs) and Adults (PDF: 37KB/3pgs) – Compilation of mental health indicator data for Minnesota.
- Mental Health: Overlooked and Disregarded in Rural America (PDF: 143KB/5pgs) – Highlights key concerns around access to mental health care and prevention in rural areas.
- Mental Health/Behavioral Health Professionals in Minnesota: Scope of Practice Summary (PDF: 55KB/9pgs) – List of professions, licensing boards and scope of practice for mental health practitioners in Minnesota.
- Telemental Health Work Group Project Plan (PDF: 337KB/3pgs)
- Presentation: “New Connections for Community Mental Health,” (PDF: 458KB/32pgs) Ron Brand, Minnesota Association of Community Mental Health Programs.
The next Rural Telemental Health Work Group meeting will be December 8, 2009 at MDH’s Orville Freeman Building, room B107. Teleconferencing will be available from a variety of sites throughout the state.