Telepsychiatry and Remote Consultation

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Telepsychiatry and Remote Consultation


Guidance about Telepsychiatry for the COVID-19 pandemic
Dr. Terry Rabinowitz MD, DDS, FACLP, provides up-to-date guidance about telepsychiatry and specific hints and tips.
Telepsychiatry in the Covid pandemic 032520.pdf

Telehealth Attending Provider Manual from University of Washington Medicine
Amanda Focht, MD, Denise Chang, MD, Cara Towle, RN, MSN, Jay Wellington, MSW, LICSW, Laurel Pelligrino, MD, Jen Erikson, DO, Ryan Kimmel, MD, and Tom Soeprono, MD, provide a superb and detailed 36-page manual for telepsychiatry. This is a special resource provided by the University of Washington Medicine to assist facilities in rapid implementation of telehealth services in the present emergency.
University of Washington Telehealth Attending Provider Manual 032020.pdf

NYU Langone Health TELE Consultation Manual and Report
Dr. Rachel A. Caravella, MD, Allison B. Deutch, MD, Paraskevi Nouslas, PsyD, and David Ginsberg, MD, of the NYU Langone Health system report on using remote technology to perform consultations. The system uses tablets that are built into patient tray tables, as well as tablets that were purchased locally to aid in the crisis. Submitted March 26, 2020, updated April 3, 2020.
NYU Langone Health TELE Consultation protocol 032620.pdf

How to Use IPads for Patient Communication
Drs. Victoria Nettles, MD, and Blair Walker, MD, provide a guide to setting up iPads for use in patient communication. Submitted April 9, 2020.
U of T Austen Tele iPad Setup 040920.pdf

Yale New Haven Hospital Training on Televisits using Epic and Haiku / Canto
This PowerPoint shows the steps in using these Epic-based apps for remote visits. Submitted April 10, 2020.
Yale New Haven Telehealth Notes for Epic Canto & Haiku 041020.pptx

Report on Conversion to Telepsychiatry at the VA System from Palo Alto, CA
Dr. Divy Ravindranath, MD, MS, FACLP, reports on converting to telepsychiatry in a system of VA facilities in the Bay Area. Submitted March 24, 2020.
COVID and conversion to telepsychiatry in VA inpatient hospital Military and Veterans SIG Skype Meeting 032420.PDF

University of Pittsburgh Medical Center Manual for Video Consultations
Dr. Priya Gopalan MD, FACLP, provides a detailed manual for video CL The manual is authored by Sharon Altman MD; Morgan Faeder MD PhD; Daniel Fishman; Priya Gopalan MD; Shelly Kucherer MD; Michaelene Landy APRN; Darcy Moschenross MD PhD Alexis Pape MA; Gina Perez MD; Sharvari Shivanekar MD; Meredith Spada, MD, Med, of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15206-4206 United States. Submitted March 26, 2020.
University of Pittsburgh Medical Center COVID19 CL COVID MANUAL 032620.pdf

Telepsychiatry Tips
Additionally, Laurel Pellegrino, MD, and Thomas Soeprono, MD, of the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, offer tips for telepsychiatry services. Submitted March 29, 2020.
U of W Tele Tips during COVID 032920.pdf

APA Provides Guide to Billing for Curbside Consults
The APA’s page on Coding ( now includes a guide to consultation without examination of the patient (“curbside consults”) that Medicare began reimbursing in 2020. Also see the explanation of the new online/digital codes 99421-3.


How to Integrate Video Teleconferencing into Inpatient Rounds from Johns Hopkins
This video gives hints for protecting the medical team by telerounding. The use of a headstrap-mounted cell phone is particularly novel (around minute 12).

Hints for Effective Use of Zoom
“Zoom hackers” have been invading teleconferences. Consider making your default settings to (1) Enable  screen sharing only for the host, who can then allow other participants to share their screen by “managing participants in a meeting” – host can put meeting participants on hold or remove them from the meeting and (2) Allow only host to use the annotation tools to add information to shared screens. Hints on managing participants are available here.

More hints on using Zoom:
Hints for effective use of Zoom 033120.pdf

American Association of Child and Adolescent Psychiatry Telepsychiatry Toolkit
The AACAP provides an extensive collection of resources for telepsychiatry. Please particularly see their page on “Coding for Telemedicine Services” regarding the use of the .95 modifier.

American College of Physicians Advice on Telemedicine
Two excellent pages of resources are below.

American Psychiatric Association Resources for Telepsychiatry

Telehealth in a Post-Pandemic Future: Regulatory and Privacy Issues
Carmel Shachar, JD, MPH, Jaclyn Engel, and Glyn Elwyn, MD, PhD, MSc, of Harvard Law School, Cambridge, MA, and Geisel School of Medicine at Dartmouth, Lebanon, NH, argue in this piece in JAMA that new regulatory standards should be continued after the Covid-19 crisis ends.

Centers for Medicare and Medicaid Services Allows Billing for Audio-only Telehealth
CMS announced on April 30 that it would permit billing for telephone remote services (without video), retroactively effective to March 1, under Medicare. See the APA webpage for details:

MyWall device

Dr. Rachel Anne Caravella, MD, NYU Langone Medical Center, sends this photo of a MyWall device attached to a patient tray table. Televisits can be done directly through this device.

Over One Quarter of US Adults Using Telepsychiatry
A new survey of over 2,000 US adults by Alkermes and Harris Poll found that 27% were using telepsychiatry services, with 74% of these hoping to continue such telehealth after the Covid-19 crisis.