Telepsychiatry: Treating Patients In and Out of Your Home State

Telepsychiatry is a hot topic in the psychiatric community. Through the use of telemedicine, patients can receive mental health services directly from a psychiatrist, even when they live far from the psychiatrist or when a community has limited or no mental health resources. The use of telepsychiatry can also help bridge the gap in health care services provided regardless of the clinical setting.

Although telepsychiatry services are much needed, there are key risk and licensing issues to consider. A psychiatrist providing telepsychiatry services is required to be licensed in the state where the patient is located. This licensing requirement also applies when a patient is traveling out of state or out of the country during the time of the telepsychiatry visit.

Telepsychiatry visits can be conducted via telephone or videoconferencing. With regard to videoconferencing, the psychiatrist must use a videoconferencing service or software that is HIPAA compliant and obtain a business associate agreement with the videoconferencing service provider. (A business associate agreement is a written arrangement that specifies each party’s responsibilities with regard to protected health information.)

The psychiatrist should explain the telepsychiatry process to the patient, including risks, benefits, and alternatives, and obtain proper informed consent. To comply with HIPAA privacy rules, the patient and the psychiatrist should be physically located where others cannot hear the session, just as though the patient was physically located in the psychiatrist’s office.

Here are some other risk management tips to keep in mind:

• If you are not licensed in states where you plan to provide telepsychiatry services, consult the Interstate Medical License Compact website (https://imlcc.org) and the Federation of State Medical Boards website (https://fsmb.org) for details on how to obtain a medical license prior to engaging in telepsychiatry.

• Follow all federal and state laws, including laws related to telemedicine, prescribing, civil commitment, and HIPAA privacy and security for each state where you are licensed and plan to practice telepsychiatry.

• Obtain proper informed consent including a discussion of risks, benefits, and alternatives to telepsychiatry.

• Create an emergency plan in case the patient requires access to local or immediate mental health services that may not be conducive to therapy or consultation through telepsychiatry services.

• Create a plan for instances when the connection or telecommunication devices are not working properly and the telepsychiatry visit cannot go forward.

• Ensure you and the patient are properly trained on the telecommunication device(s) used to conduct a telepsychiatry visit (for example, use of the internet, computer, videoconferencing software, and so on) and are comfortable with the techology.

• Maintain good medical record documentation, consistent with the standards of practice for in-person sessions.

• Create a procedure for sending and receiving documents between you and the patient (for example, informed consent documents) through a HIPAA-compliant process (for example, an encrypted/password protected patient portal).

• Consult an attorney for any legal issues and a risk consultant for questions related to risk management. ■

This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings Ltd., a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World.