Telepsychiatry: Risk Management Best Practices

There is no question that the use of telehealth increased exponentially during the COVID-19 pandemic. In fact, the pandemic hastened implementation of telehealth for many health care professionals. As a result, swift legislation and executive orders facilitated a seamless delivery of health care to ease patient access to mental health services. Two years later, telehealth continues to be an essential tool to afford patients the necessary access to their mental health professional.

The end of the pandemic appears to be on the horizon, and it will be important to stay abreast of the federal and state regulations to ensure you maintain compliance. It is best to check the websites for the Federation of State Medical Boards and the Interstate Medical Licensure Compact for up-to-date information on the licensure as well as reimbursement impacts in your state or a state in which you may wish to provide telehealth services. Keep in mind the following when utilizing telehealth:

• Standard of Care

  The standard of care should be the same as in traditional face-to-face office visits. The same standards and expectations for the patient and health care professional exist as if the patient is present in your office. It is important to set clear expectations at the onset of using telehealth, such as normal business hours and a consistent private location for visits.

• Licensure

  You must be licensed in the state where the patient is physically located at the time of the visit. Be aware of the regulations in the state where the patient is located, as state laws may vary on issues such as mandatory reporting for minors, commitment process, duty to warn, prescribing, and collaboration with other providers.

• Informed Consent

  Prior to initiating telehealth sessions, you must obtain informed consent from the patient. Be aware that some states may require both written and verbal consent. The basic elements of consent should cover the risks and benefits of telehealth visits. Include confidentiality language as well as privacy and security information when addressing the technology used. Lastly, at the onset of each session confirm and document the patient’s consent to the telehealth visit.

• Documentation

  The documentation for a telehealth encounter should be similar to that for a face-to-face encounter. As such, at the start of the visit, the provider should obtain the patient’s consent to continue with the telehealth visit. In addition, it is important to document the patient’s location, the health care professional’s location, the type of technology platform used, and the presence of other participants in the session and their role.

• Safety and Security

  Safety is paramount when providing telehealth services. For that reason, prior to initiating telehealth services, consider the patient’s appropriateness for telehealth services and develop an emergency plan in the event your patient experiences a crisis.

• Technology Platforms

  Use a HIPAA-compliant platform and obtain a Business Associate Agreement from the vendor to ensure appropriate technology security measures, such as encryption, are in place to safeguard protected health information exchanged or stored on the platform. Use of social media platforms such as FaceTime, Skype, and Messenger are not HIPAA compliant and pose privacy risks and have the potential for fines and penalties.

• International Telepsychiatry

  It is important to understand the regulations in the country where the patient is located at the time of the encounter. Considerations include but are not limited to licensure, privacy laws, emergency planning, and prescribing implications. Also, contact your malpractice insurance carrier to confirm coverage is extended to international practice. ■

Risk Management services are provided as an exclusive benefit to insureds of the APA-endorsed American Professional Agency Inc. liability insurance program.

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. © 2022 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.

Cara H. Staus is a risk management consultant in the Risk Management Group of AWAC Services Company, a member company of Allied World. Risk Management services are provided as an exclusive benefit to insureds of the APA-endorsed American Professional Agency Inc. liability insurance program.