Market Forces Are Driving Telehealth Advancements

(Part 3 of 3)

In the final installment of this video, Psych Congress steering committee member Edward Kaftarian, MD, CEO of Orbit Health Telepsychiatry, Encino, California, describes the advances in medical records as a shareable resource and how market forces are driving telehealth. He also discusses what clinicians can learn about their patients that they may not have gathered on-site in an office. This interview, conducted by Meagan Thistle, associate digital editor, Psych Congress Network, took place at this year’s Psych Congress in San Antonio, Texas.

In the previous part 1, Dr Kaftarian discusses the impact telepsychiatry has had on access to mental healthcare, including removing barriers.

In part 2, he explores why telehealth is “here to stay” and why he hopes government officials will continue to have an open policy about telehealth.

Read the transcript:

Meagan Thistle: Where are we and how far along are we with medical records being a shareable resource among providers and using those to help the patients?

Dr Edward Kaftarian: Meagan, I think that we still have ways to go with that. Fortunately, we're finally beyond paper records. I've not seen paper records for a while now. We're now almost

fully electronic, which is great. The problem is that everybody has their own ingenious electronic health record that solves every problem, supposedly, but they don't talk to each other. That's a huge problem.

If we're going to have integrated care and continuity of care, we can't have a patient coming to a different provider and then that provider not having access to the previous records. That continuity is so important for healthcare outcomes because people can present a certain way in the moment, but to have that history, that longitudinal view of the patient is so important.

Also, with electronic health records, there's still a lot to be desired. For example, the goal has been to include as much as possible in the notes. The notes have become impossible to read because there are so many disclaimers and so many topics that are being covered.

They're even including disclaimers about telepsychiatry, and did you get consent for telepsychiatry, which in some states is required, so I understand why it's in the note. The actual content that providers like me are looking for in the note is buried under hoards of information.

The future is going to be looking for a way for medical records to transfer the right information and communicate the information that makes it easier for me as a provider to provide care. There are multiple areas where electronic health records have been incredibly helpful. I'm very optimistic in general about the direction that this is going to go.

I would say, it's not that more is better. Adding all these bells and whistles to electronic health record, that is helpful in some ways, but think about how if you add more bells and whistles, there's more noise and all you can hear is bells and whistles.

People have to come up with the health records that will actually serve the original purpose, which is to communicate the important things about the patient between doctors and providers, not just to be a tool to cover yourselves legally.

Thistle: If you could also talk a little bit about how the market is pushing things, maybe boxing things in? Just elaborate a bit there for us.

Dr Kaftarian: The market with telepsychiatry is definitely in transition right now and in a good way. There's been a lot of investment into digital health and technology. That goes to the idea that telepsychiatry and telehealth are here to stay because all of these companies have invested huge amounts of money into these technologies.

I don't think they're going to want to walk away from them. They're going to want to find ways to implement them. That's good news for telehealth. There are all kinds of market forces. For example, reimbursement. If you are reimbursing on-site care more than telehealth, then that's going to drive people from telehealth.

There's no good reason why on-site care should be reimbursed higher, or conversely, if telehealth should be reimbursed lower because you're getting the same care, essentially. Then other market forces, people's reluctance to go back to how it was before. That's a market force. People are going to demand healthcare on their terms. That's actually going to allow telehealth to further thrive.

You see lots of companies getting into telehealth. Ultimately, telehealth may be commoditized so that would drive down the costs, which can be a good thing for most patients. Overall, the market forces, typically it tends to be about money. In many cases, telehealth is cheaper. It's a cheaper alternative.

Let me tell you a few reasons why telehealth is cheaper. One is because you don't have to run office space, this whole infrastructure. You can have entire clinics that are done online. Would you rather do it online, or would you rather have to find space? There's air conditioning and heating expenses. There's all the other utilities.

There's also liability because if you have people coming into the same space with each other, they could get hurt in some cases. There are insurance costs to having and maintaining space. There's also the cost of the provider traveling to the clinic.

Then the efficiencies that are involved. For example, if a provider is not able to go to the clinic, then with telehealth, that's not a problem because you can have another provider conducting things remotely. At a split second, you can have somebody come in and provide care.

There are a lot of efficiencies to be gained by doing things remotely. I would say that all of that definitely is driving telehealth more into the mainstream, and again, I don't think that you can get that genie back in the bottle.

Thistle: So you were starting to make a case, too, so that the reimbursement for telehealth is higher for on-site, and you made it clear very much that it is definitely better for the provider as well, not just the patient. What can we learn from a patient that we're meeting with online that you might not be able to learn if you are on-site?

Dr Kaftarian: That's a great question. The perfect question to display some of the advantages of telepsychiatry. One is that telepsychiatry can sometimes be more ecologically valid. If the audience doesn't know what that term means, that's basically the information that you're getting, is it relevant to that patient?

If a patient comes into an office and their blood pressure is high, maybe that's white coat hypertension, as they say. Maybe the patient is stressed and nervous. They don't know what they want to talk about. They've just driven an hour to see the doctor, and they fought traffic. They've been sitting in a waiting room. All of that has an effect on how the patient might present to the doctor.

If you have a patient, that's in their home environment, then they're less likely to be intimidated or stressed out. You can see their background to see, are they hoarding things? Is it messy? Is it overly neat? Are there people coming in and out, which obviously is bad for confidentiality purposes, but you can see what their environment is like? Is it rundown?

That's been very helpful to me to understand the patient. That's ecological validity, whereas if you're on site, there are all sorts of confounding factors that may change the way the patient presents.

Meagan: Great. That's all we have time for today. Thank you so much for sitting down with us. We really appreciate it.

Dr. Kaftarian: Thank you, Meagan. It was a privilege. Thank you very much for having me.

Edward Kaftarian, MD is a nationally recognized psychiatrist and leader in the field of telepsychiatry and healthcare technology. Trained at the Johns Hopkins Hospital, he is board-certified in Psychiatry, Forensic Psychiatry and Addiction Medicine. Dr Kaftarian has served in a variety of executive roles within the California prison system, including chief psychiatrist, senior psychiatrist, medical director, and director of pharmacy. He is the founder of California’s Statewide Prison Telepsychiatry Program, which is the largest correctional telepsychiatry program in the world. Dr Kaftarian is currently the Chairman and CEO of Orbit Health Telepsychiatry, a company that provides telepsychiatry services to jails and prisons.