Unchartered waters for telepsychology

Telepsychology has been around for a number of years, but privacy and confidentiality issues are still a hurdle to overcome. How can psychologists add value to their practices with telehealth? Is innovation being suffocated by existing services? And will an unregulated industry dissuade practitioners from adopting telehealth?

These were some of the topics fleshed out by clinical psychologist Bill Campos when he sat down for a yarn with Pulse+IT.

Pulse+IT: What technological changes have taken place recently in telepsychology?

BILL CAMPOS: The focus of the technology – the essence of connecting people – is still the same. What has changed a lot is the storage – where that information is stored and how it can be kept private. So the main issues lately about technology are confidentiality and privacy, especially when you are delivering clinical services online.

Pulse+IT: Where is the sector heading in terms of integrating telepsychology provision with other healthcare sectors?

BC: The next step is to have the ability to have a “warm transfer” of services so that GPs are in dialogue with a patient and they need to refer the patient to a psychiatrist or someone else. They go online and see who the next available specialist is, and they’ll click on it so the patient can talk to the specialist while sitting down with the GP.

That’s the kind of thing we are moving towards, but I don’t know if we’ve achieved it just yet because, like I said, privacy and confidentiality is a big stumbling block, and we don’t always have the ability to make that service fluid. There are still some gaps – freezing, downtime, servers not working properly, internet connections that aren’t reliable.

Pulse+IT: Is this something that will take off when the NBN is rolled out?

BC: Exactly. Hopefully when the data rates are much higher and when the NBN is a more robust structure to deliver services, then we’ll have a capacity to do that. Then we’ll need to encompass quite a lot of frameworks around how to develop software that will make such an interaction private and confidential.

Where things are going with telehealth for psychological services is more of a large, structured approach from organisations than increased use by individual practitioners.

Organisations are developing their own software or web portals so that people can go into their environment to access the service, then hop out without any trace on their own computers.

There is also what we call virtual counselling. There have been discussions about development of a virtual counselling arena – some kind of virtual world which people can go into and discuss issues, like Second Life, with trained counsellors.

It actually happened a few years ago in Second Life, where people would access counselling and pay for it with virtual currency.

Pulse+IT: And how did they check the bona fides of the counsellors?

BC: I don’t know – it’s completely unregulated.

Pulse+IT: Are you aware of any software developers who are designing integrated software specifically for psychological counselling?

BC: No. There’s not a big market for that just yet. Part of it is because of the ever-changing scale of the software and hardware – and [on the consumer demand side] people’s ability to complicitly engage with the one service. They will often shop for services more often [when it comes to counselling].

Telehealth is not a good way of making money because you are competing with helplines that are providing services free; you have providers with wrap-around services. So as a clinician, providing telehealth services is not a big incentive other than having some sort of continuity of care with the patient. In that case, telehealth comes in quite handy.

Pulse+IT: Skype is a very popular telehealth tool. If a psychologist is using Skype on a consultation, what are the security problems there?

BC: It all depends on if things go wrong. Suppose I am talking to Mum at home and she doesn’t log out. Little Johnny comes along and finds out what has been happening. There’s also hacking.

Pulse+IT: Do you think that technological constraints, the fears of privacy and confidentiality and the paucity of innovation is putting a brake on adoption by practitioners?

BC: Yes and no. There are some psychologists out there who are still delivering services online, but I think what people are trying to do is stay away from online and use the telephone – and there are quite a lot of clinicians using telephone consultations.

The difficulty is that once we have everyone connected to broadband and more telehealth services, we have to identify the appropriate clinician for the patients’ needs. There is an array of services available, but the best services will be the ones that match the patients’ needs to the appropriate clinician. So if you’re talking mental health as it relates to perinatal depression or indigenous communities or children, you’re going to need the right clinician for those populations.

As the area develops, you’re going to find there’ll be a greater focus on matching the clinician to the patient and vice versa.

Pulse+IT: That sounds like a very difficult task.

BC: It comes down to evolution. People will become more comfortable using telehealth services, and there are organisations investing a lot in telehealth for general practices. The difficulty comes in the availability of the specialist.

People are going to need to start investing their faith in these services, and developing transition points to implement the service, because some of the research is showing that there are benefits to having telehealth – but ultimately that service is a stepping stone to a face-to-face intervention. So there is what they call a “transitionary phase” when telehealth turns into a face-to-face consultation when that needs to be the case.

Pulse+IT: I’m glad you mentioned research. What directions are suggested by research into telehealth for psychological counselling?

BC: There is some evidence that says telehealth is good because of the accessibility of the services, so that someone in distress can find a point of help for their treatment quite quickly. The evidence is saying that telehealth is a much more agile way for providing help to someone in a minimal timeframe.

The research is also telling us that there is scope for continuity of care in telehealth. You can go to four of five appointments with a psychologist, and some of those sessions can continue in a telehealth environment. Research is telling us that it’s the continuity of care that is important, whether it’s face-to-face or telehealth.

The third thing is referral. After someone has gone through treatment – whether it be drug and alcohol counselling, marital problems, or whatever – the next step is whether the person needs any further health assessments after that. Telehealth can be a point of reference as to what the next step might be, because of accessibility and the sheer number of people online these days.

Pulse+IT: What does government need to do to create a better environment for promoting telehealth in psychological counselling?

BC: The most important thing is to regulate it. There’s very little regulation, and what we’re finding is that there are some blurred boundaries through jurisdictions. For example, you can do it worldwide, but are people overseas registered within Australia? So there are big issues regarding regulation and quality control.

The government is starting to realise that this is something it needs to focus on, but at the moment anyone can deliver a service. I can call myself a counsellor with no experience whatsoever, put up a website offering tele-counselling and start delivering services.

So there has to be accreditation and some overarching guidelines on how to deliver telehealth services, for two reasons. The first is quality of service, and the second is the legal repercussions in terms of privacy, responsibilities of the clinician, and duty of care.

There is a very large legal area that has been uncharted.

Posted in Allied Health


0 # Victoria Wade 2013-04-12 17:35
We have been operating a telepsychology service for four years, to two rural sites in South Australia. It is real time video, through the ATAPS program, which was run through a Division of General Practice and has now been transferred over to the Medicare Local.

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