The growth of telehealth and important issues surrounding it are addressed in two articles in the December issue of the American Psychological Association's (APA) of Professional Psychology: Research and Practice.

David W. Nickelson, Psy.D., J.D., of the American Psychological Association, discusses strategic opportunities for professional psychologists in the telehealth arena while laying out some of the challenges psychologists face in utilizing this increasingly popular form of service delivery. Dr. Nickelson defines telehealth as "the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, and information across distance." Behavioral telehealth is the application of the same technology to provide behavioral health services.

B. Hudnall Stamm, Ph.D., of the Veterans Affairs National Center for Posttraumatic Stress Disorder and Dartmouth Medical School, notes that nearly any technology can be used in providing telehealth services, including the phone and fax machine. The two technologies, which form the cornerstone of telehealth programs, are store-and-forward and video teleconferencing (VTC). E-mail is the simplest and most common form of store-and-forward, and store-and-forward technology allows information to be "stored" at both the sender and receiver ends, thus the parties need not be present simultaneously.

However, Dr. Stamm notes that psychotherapy via e-mail is controversial, and store-and-forward interactions between patient and provider "are more likely suited for adjunctive or crisis interventions than for a primary means of contact." VTC, the other form of store-and-forward, sends real time audio and video data, providing technology mediated face-to-face contact. Dr. Nickelson asserts that while professional psychology has traditionally shied away from technological innovations, some form of telehealth will likely play a significant part in the future of health care delivery. Dr. Stamm maintains that while psychologists do not have to become technology specialists do be competent providers of telehealth services, practitioners will need more technology proficiency, especially with computers, than has been the norm.

However, there are some obstacles that must be overcome before psychologists can reap the benefits offered by telehealth, including questions concerning reimbursement, licensure, and standards. While it has often been difficult for practitioners to be compensated for telehealth services, after January 1, 1999, the Health Care Financing Agency (HCFA) will reimburse for telehealth services undertaken by any Medicare eligible provider rendered to Medicare patients residing in one of the 745 Health Provider Shortage Areas. This offers telehealth providers with their first reliable provider payment revenue stream and should spur additional growth of rural telehealth. At least ten states are currently paying for some telehealth services, and Dr. Nickelson predicts more states will follow suit.

Licensure requirements are also an obstacle to telehealth growth, since it has yet to be determined whether providers "enter" State B from State A and "practice" a regulated profession in State B via a telecommunications links. Psychologists who practice across state lines are strongly encouraged to read their malpractice insurance contracts and speak with their carrier to determine the limits of their current policy. Regarding the issue of standards, Dr. Nickelson argues that professional psychology will likely be called on to by the federal government to develop guidance for its clinical telehealth providers, and if the profession does not, it risks having the government or even another provider group intervene.

Dr. Stamm offers some points to consider before establishing a telehealth project. The primary consideration is whether telehealth services will improve the standards of care. A decision to begin a telehealth program involves accompanying decisions about which clinical services are necessary to the program. Practitioners must also determine the types of disorders and consultations that will be encountered, as well as their own comfort level and that of the patient with telehealth. Finally, the prospective telehealth provider should also consider whether anyone should be with the "patient" at his or her end of the link (such as another mental health provider). Dr. Stamm concludes, "telehealth will work best when there is a real need that cannot be met through traditional face-to-face means and when the provider has a real interest in using telehealth to meet that need."

Dr. Nickelson asserts that psychologists should undertake efforts to ensure that psychology is included in relevant federal and state telehealth legislation. This includes protecting patients from harmful applications of telehealth, developing and operating behavioral telehealth systems by applying for federal and state grants, and creating joint ventures or strategic partnerships with health systems, academic medical centers, technology vendors, and telecommunications providers. Dr. Nickelson also asserts that psychology should work to educate consumers about how to determine which services are appropriate for telehealth and which are not, thus giving consumers the power to make decisions about the services they seek and who they seek them from.

Articles

Clinical Applications of Telehealth in Mental Health Care by B. Hudnall Stamm, Ph.D., Veterans Affairs National Center for Posttraumatic Stress Disorder and Dartmouth Medical School in Professional Psychology: Research and Practice, Vol. 29, No. 6.

Telehealth and the Evolving Health Care System: StrategicOpportunities for Professional Psychology by David W. Nickelson, Ph.D., American Psychological Association, in Professional Psychology: Research and Practice, Vol. 29, No. 6. Full Text available from http://www.apa.org/journals/pro.html

The American Psychological Association (APA), in Washington, DC is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 155,000 researchers, educators, clinicians, consultants and students. Through its divisions in 50 subfields of psychology and affiliations with 59 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.