Surviving the Storm: Telepsychiatry and Disaster Relief
By Harold German
ATSP Online
3/21/06
Brian Levin's constant brushes with nature are unlike most, and his coping method is uncannily brilliant. Mr. Levin is the coordinator of Telepsychiatry Services at CFG Health Systems , a behavioral healthcare service provider focused on the delivery of quality mental health services based in Marlton, NJ. He and his staff manage by using telemedicine, which allows medical practitioners to disseminate medical information from one site to another using video conferencing for the health and education of patients, regardless of location.
His latest encounter with Mother Nature came in the form of the northeastern blizzard of January 23rd, 2005. The treacherous blizzard was blamed for no less than twenty deaths, and incapacitated all airports and mass transit terminals in the North East Mr. Levin's telepsychiatry is a growing methodology generated directly from the tremendous impact and success that telemedicine has had with medical institutions.
"The most recent snow blizzard caused a local State of Emergency, and our patients' critical treatment would have been delayed if it wasn't for telepsychiatry. We use telepsychiatry seven days a week, 365 days a year, and regardless of external conditions we are able to provide our patients with the vital care that they need," said Mr. Levin. "Prior to CFG bringing telepsychiatry to our screening center in Cumberland county, there was no after-hours, face-to-face psychiatric coverage, which is mandatory for a psychiatric commitment. It's a rural and underserved county, and if roads were blocked due to a storm, any patient needing care after hours would be held over until the next morning when the next psychiatrist would come on duty. This meant that patients and their family members had to wait a possible twelve to fourteen hours for medical attention. Fortunately for us, those days are over."
CFG's revolutionary telepsychiatry system has been operational since 1999 and Mr. Levin been an integral part of its success. "When I came here in July of 2000, CFG had one video conferencing unit in our Marlton, NJ office and another at the Psychiatric Screening program of the Cumberland County Guidance Center at Bridgeton Hospital. Both were from Tandberg's 800 series," said Mr. Levin. The primary driving force for CFG's utilization of this technology was the need to provide quality psychiatric care in a timely manner to under-served areas that would otherwise go without face-to-face psychiatric evaluations, regardless of environmental conditions.
"My position was created to help develop the telepsychiatry technology at CFG. My first order of business was to install the telecommunication lines in each of our psychiatrists' homes; those who would be part of the overnight coverage. There were a total of five at the time and we used ISDN for the connections. It was quite clear to us at the time that there would be no increase in funding for our program so we needed to be creative in planning the system."
As a starting point, James R. Varrell M.D. and Les Paschall, the Medical Director/President and Chief Executive of CFG respectively, traveled to see how telepsychiatry was being used in the far western side of Virginia. The Appal-link Project, a program run by the Cumberland Mountain Community Services of Virginia, whose mantra is, "Mental health services without boundaries," taught the team a great deal about how to efficiently utilize a video conferencing system within a hospital network environment, and brought the concept back to our system. The Virginian hospitals were using the technology for complete case management for their patients. However, CFG quickly realized the emergency treatment benefits.
"Until that time, if our Psychiatric Screening Center needed a psychiatrist to evaluate a patient in the middle of the night, the psychiatrist would need to travel from the Marlton area, where most of our psychiatrists lived, and drive over an hour to Cumberland County. Since we are in the Northeast, there were many times when the weather made driving difficult, dangerous or even impossible for our physicians. There was also the issue of physicians losing between 3-4 hours of time on emergency mid-night visits, only to return a few hours later to begin the next work day."
CFG's strategy was to make using the equipment easy for the physicians. "We bought two Polycom ViewStation SP384 units, to be used as travel units, which could be passed between three of the psychiatrists covering overnight responsibilities. We also secured state of the art carrying cases to protect the equipment and I provided the technical support to troubleshoot any "hook-up" issues. After a couple of years, we realized that the passing off the units every couple of days was no longer efficient, especially since the cost of these units was beginning to drop."
"To put this in perspective, our original two Tandberg Vision 800 series units with Triple NT-1 Terminators, 25” monitors and one-year maintenance agreements were purchased in June 1999 at a cost of $19,258. Today we would pay a small fraction of that for the same set up. Because of these price drops, we now own thirteen units and some of the hospital systems even have their own equipment."
CFG has been so successful with video conferencing that it now utilizes telepsychiatry at Temple University Children's Medical Center in Philadelphia, PA, in three hospital screening centers in New Jersey and two county jails. "We have four additional projects that will be live by July 1, 2005 (three in New Jersey and one in Pennsylvania). The simple fact is that the technology has been around for decades but it is only recently that the equipment and telecommunication lines have become affordable. It has allowed us to create unique services for our customers; services such as "Virtual Doc," a plan that provides a psychiatrist, over video, from 7:00 p.m. to 7:00 a.m. to respond to emergent psychiatric evaluations. Other services, such as our work with the Temple University Children's Medical Center, enables them to scheduled psychiatric consultations for children on their medical floors in addition to emergent evaluations in their Pediatric Emergency Department 24 hours per day."
"Traditionally, video conferencing was used to host business meetings or to enable distance-education programs," explains Ira M. Weinstein, senior analyst of Wainhouse Research, an independent market research and consulting firm focusing on rich media conferencing and collaboration.. "In recent years, however, a host of applications have emerged that leverage the immediate, face-to-face aspect of video conferencing to bridge geographical gaps and 'virtually transport' subject matter experts to locations around the world. As organizations continue their quest to drive down costs and improve efficiency, we expect the demand for video-empowered applications, like telemedicine, telejustice, and telepsychiatry, to continue to rise."
CFG has been successfully relying on telepsychiatry for several years and has received industry awards for their pioneering approach to long distance health care. Over the years, the technology, and CFG's approach to it, has evolved. "The cost is probably the most dramatic difference. The technology is also much more dependable and the picture and sound are markedly better. Ultimately, we've learned that patients are best served by getting real-time care when they need it, regardless of time, place or weather conditions."
About the Author
For many years, Harold German has been recognized as a knowledgeable source for information on corporate branding methodologies. Mr. German is a renowned author and contributor, with appearances in noted international publications such as The Economist. Mr. German is a director at IVCi (http://www.ivci.com) and covers IP networks and the future of conferencing technologies.
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