Ohio Department of Alcohol and Drug Addiction Services

Telehealth WebinarAugust 25, 2010

CSAT TA & Telehealth Blue Ribbon Panel Met monthly from February through

May 2010 Explore the benefits and limitations of

telehealth Define services – explore how telehealth

can be utilized across Ohio How to get paid Establish rules for AoD services Webinar recommendation

Telehealth

Telehealth, e-therapy, online counseling, telemedicine, telemental health, videotherapy, interactive videoconferencing, distance counseling, Internet-supported therapeutic interventions, e-health

TelehealthDefinition ODADAS rule – interactive

videoconferencing - use of secure, real-time audiovisual communications of such quality as to permit accurate and meaningful interaction between at least two persons

This expressly excludes telephone calls, facsimile machines, and text messages without visualization of the other person, i.e., electronic mail.

Telehealth Services considerations

Assessment Individual Counseling Group Counseling Case Mangement

TelehealthPotential Benefits Make it possible for clients to access services at any

time, any day of the week Take services to clients in remote and under-served

regions Reach out to clients who are physically unable to leave

their homes Provide confidentiality for clients in small communities Increase honesty and candor – experience shows clients

may be more forthcoming on the Internet than in person

Reach clients who are unwilling for a variety of reasons to seek face-to-face services

Give clients access to highly specialized practitioners, since geographical proximity is not an issue

TelehealthPotential Benefits Make services available to clients who are highly

mobile, since they can access services from any internet portal anywhere in the world

Reduces the time needed for the client and practitioner to develop rapport

Make help available to the client at the time of greatest need

Give the practitioner access to a larger pool of potential clients

Make it feasible for practitioners to develop more specialized practices

Allow practitioners more flexibility in their work schedules

TelehealthLimitations The potential for miscommunication may be greater online due to lack

of non-verbal and paralinguistic cues Lack of access to client’s non-verbal behavior may make it difficult to

correctly assess and diagnose disorders Online services may turn out to be ineffective – little research exists

on the efficacy of online services Differential effectiveness – online services may be completely

inappropriate for people experiencing psychotic symptoms whereas they may be very particularly appropriate for children with attention deficit disorder

Is difficult to insure the confidentiality of online communications The ability to intervene in emergency situations (e.g., suicidal client)

may be severely limited Clients may misrepresent themselves, undermining the integrity of the

services provided Fewer safeguards for clients increases the burden on them to be

intelligent consumers Online services are available only to clients who have access to the

internet and the skills to use it

Telehealth

Telehealth

Telehealth

Establish rules for AoD services

How does the state regulate Confidentiality Framework –group/individual/assessment Allow for flexibility

Confidentiality

All treatment services provided by interactive videoconferencing shall begin with a verification of the client through a name, password pin number

Confidentiality All data, including audio, video, text and

presentation materials shall be transferred using a minimum of 128 bit-encryption.

All treatment services rendered by interactive videoconferencing using the public internet must use at a minimum the Advanced Encryption Standard (AES) algorithim or be rendered through use of a Virtual Private Network (VPN) to ensure the transmission is secure.

Resources

SAMSHA http://download.ncadi.samhsa.gov/prevline/pdfs/sma09-4450/sma09-4450.pdf

NARBHA http://narbha.org/for-providers/telemedicine/

ODADAS TelehealthNext Steps

State participation in CSAT regional meeting

FAQs Filing of telehealth rule