Tele-psychiatry is a process offering clinical consultation through electronic means which includes Video-Consultation (VC), telephonic consultation and consultation through e-mail and text messages.
In this process patient will be consulted with remotely with the help of technological aids such as Skype, Google hangout etc along with others forms of electronic media, wherein the patient will not be in the room with the clinician.
Over the last decade there has been increasing awareness of the challenges that the patients face in attending face-to-face assessments. These have included clinical, financial and geographical challenges. This unfortunately leads to lack of consistent follow up and clinical care, particularly in patients with mental health issues. Further mental health care in community involves significant outreach care, which in the absence of consistent face-to-face follow up becomes challenging.
In the above background there has been increased focus on offering Tele-Psychiatry particularly VC all over the world, to facilitate better follow up and out reach care. In the light of current Pandemic of Covid-19, the guidelines in our country and state have become more favorable to offer online consultation. Hence, Samvith Neuropsychiatric Centre (SNC) is currently offering Video Consultation, under its Tele-Psychiatry programme. Guidelines provided by the Indian Government, Karnataka Medical Council and National Institute of Mental health and Neurosciences (NIMHANS) forms a broad guide for our organization to practice Tele-psychiatry.
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a) Patient Selection:
At this stage, VC consultation is being offered to new patients and facilitate follow up care for patients who are already a part of the clinic.
The suitability of a patient to engage in VC care will be made by the treating team (Might include psychologists or psychiatrists working in isolation or both working as a team in some cases), after considering the following variables.
Though, the above factors are a good guide to patient selection, they are just a guide. The decision to enroll the patient for VC consultation entirely rests with the treating team and the same can be changed over time based on the clinical state of the patient. This is supported by research.
While VC consultation is a very good substitute for face-to-face consultation in certain situations; it should not be used for purpose of medical/psychiatric emergencies.
b) Informed Consent:
A standard informed consent will be used across the board for all the patients.
Once the patient is though to be suitable to VC, the front office staff will contact the patient and the family to advise them of the same.
Informed consent will be shared with the patient VIA e-mail or other relevant form of electronic media.
Patient has to duly fill all the relevant parts of the form and returns the same to the front office after duly signing the same.
If there are unable to sign the consent form electronically or otherwise, an e-mail reply to the company e-mail stating that they have read the consent and are happy to abide by the same.
The signed consent copy with or without patient declaration is to be stored in the patient file physically and electronically after getting it signed by the treating team.
Consequently, the front office staff will explain the nature, duration and the fees involved in the consultation (See Below).
c) Appointment, Duration of Consultation, Fees and Refund:
After the consent form is received, appointment will be fixed on date that is convenient for you.
Consultation will be standard duration between 30-60 min or can vary as per the clinical need.
The fees will be in line with the current SNC policy.
The fee has to be paid in advance
Initial assessment with any of the clinicians in the clinic will be for 60 min.
Follow up sessions can run between 30-60 min, but this applies only to sessions with psychiatrists.
Therapy appointments with either the psychologist or the psychiatrist will normally be for duration of 45-60 min. However this may vary based on your situation in rare occasions.
In the event of a VC being discontinued because of technical issues before the first 20 minutes, every attempt will be made to reschedule the appointment. Otherwise the fee for the whole session will apply.
Alternatively, the treating team/psychiatrist to make appropriate decisions about the future appointments based on the clinical need, if, the VC is discontinued.
Fee will not be refunded.
d) Referral to VC:
The patient, family member or the treating team can request VC referral.
e) Procedural information:
Our staff will contact you to check if, you have the essential application (Skype etc) on your system such as laptop or a telephone.
They will send an invite to you from a company skype account in preparation for the appointment.
Our front office will conduct a trial run, a day or two before your scheduled appointment/s as a preparation for smooth VC.
On the scheduled day and time of the appointment SMC admin staff will share the details of the skype account in the name of the company that the clinician will be using.
The doctor/ clinician will contact the patient using the dedicated skype account.
In preparation for the consultation patient is requested to secure a quiet place with minimal disturbances or interruptions during the clinical consultation. This reinforces the spirit of privacy and helps with smooth running of the session.
The doctor will introduce himself with his professional qualifications, registration number and also verifies the patient details such as age, DOB and contact details.
The doctor and the patient will engage in clinical interaction with or without the family member being present.
Though an initial assessment would have been made about the appropriateness of VC in your case, the clinician can conduct a brief initial assessment regarding the same at the beginning of the consultation. This ensures the feasibility of the session.
The doctor will make clinical notes as appropriate.
If the consultation proceeds without any difficulties, at the end of the consultation a follow up date is decided and appropriate clinical advice is given to the patient.
In the event of worsening distress or escalating clinical risk the clinician may decide to terminate the VC and inform the family to seek further care from a nearest health facility.
In the event of worsening distress in the absence of any risk issues clinician may make a decision to stop the VC and request a clinic appointment.
In the event of VC disconnection secondary to technical glitch, an attempt will be made to reconnect with you. If this cannot happen, the clinician may speak to you over the phone briefly to bring closure to the session and the appointment may be rescheduled.
In the event of emerging risk of harm to self or others during the process of consultation the clinician will inform the family and its their responsibility to take to the patient to the nearest mental health hospital.
Patient can withdraw consent to the VC process during a consultation, during when the consultation might have to be stopped.
a) Information about e-Prescription and risks/ benefits & e-Prescription slip:
If needed, a scanned copy of prescription is provided and is e-mailed/ sent to the phone number as in the consent form. In case of any intolerance pertaining to prescription and side effects of medications, patient may stop the medications and consult local doctor immediately. There is also an option to contact the treating doctor in the clinic. The team will get back to the patient at their convenient time. However, if the situation is an emergency the team will not be able to support and hence the patient will have to seek support with your local health service.
b) Clinical Documentation and Storage:
Clinician is to make clinical documentation soon after the consultation or as soon as it is practicable.
If the patient cannot or was not seen in the clinic in view of various clinical circumstances, the clinician is to send clinical notes electronically to the SNC via company e-mail. The front office staff will file it in patients clinical file and store it electronically as well.
The clinician is to document the clinical notes on the company progress notes and write a prescription on the company letterhead.
If its not possible to document on the company letter head, in a situation where the consultation is happening from a remote location than the clinic, the documentation can be done on a white paper with date and patient details and sent to the clinic staff electronically. It’s to be stored after validating the same with the clinic seal.
c) Confidentiality and Right to Withdraw Consent:
Clinical information elicited during the session will be kept confidential. The same may be breached in the event of clinical risk as mentioned in the VC consent form.
If clinically needed the treating team may inform family about relevant aspects of patient care in keeping with the procedure of VC.
The treating team shall not record (audio or video recording) the clinical consultation without prior consent from the patient.
Patient is forbidden from recording (audio or video recording) clinical consultation.
As technology is being used for consultation, the security of patient data will be as per the security of the service provider used. SNC will not have any responsibility for any data leakage or breach in this process.
Both clinician and the patient will not post or publish clinical information in any form of electronic media or discuss it outside the purview of clinical care, without prior consent.
It’s worth noting that that information sharing can done with the limitations for patient confidentiality.
d) Type of Tele-Consultations:
They can be VC, consultations through e-mail, telephones and text messages.
In view of complexities involved in mental health care, SNC at this stage is only going to offer VC.
The Tele-consultation can also be classified by, the people involved in the consultation. It can be between a patient/Family member and a clinician or between two health professionals.
It can be initiated by any of the stakeholders mentioned.
VC consultation in future: SNC has started offering VC consultation in the light of favorable guidelines by the Indian government. The team is aware that at this stage this has been introduced in the light of the current pandemic. SNC hopes to continue offering VC in future as well. However, this may not be possible if the Indian government revises its current Telemedicine guidelines unfavorably.
Video Consultation as part of Tele-Psychiatry means the consultation is done using tele-communication technologies. Samvith Neuropsychiatric Center (SNC) is using exclusively Google Hangout and Skype based video technologies. This means the patient and the psychiatrist/psychologist will be at their own environment and meet through these video communication technologies.
The consultations are done by appointments only. Patients agreeing has to give an informed consent before starting the VC. Our Practice Managers at SNC will contact you 1-2 days before the scheduled appointment to discuss about the procedures involved and for a quick trail run of the technologies mentioned above.
You will be provided with a document explaining all the details related to VC. Please go through it and sign it if you agree. Informed consent means granting permission to a procedure after having full knowledge of the procedure and possible consequences including risks and benefits.
Yes. As per the guidelines of SNC you need to give us the details of nominated person (s) before starting the VC. The informed consent does ask for details and signature of nominated person (s). This is mainly to support you in the event of untoward emergencies emerging during the consultation.
The VC is strictly confidential and will be conducted using secure line in a relatively quiet/private space. The VC are not recorded by either the Psychiatrist/Psychologist or the patient. However, the Psychiatrist/Psychologist will make brief notes of the consultation which will go to patient’s clinical file maintained at SNC.
No. At the moment SNC is offering VC only to previously registered patients.
No. SNC doesn’t offer emergency VC. You need to visit the nearby Hospital/Emergency department for face to face evaluation. Emergencies across Medical field including Psychiatry needs face to face evaluation by a Medical Professional.
This has been explained in detail in the informed consent. Please go through it fully. your nominated person has to arrange for taking you to the nearest hospital/Emergency department for further evaluation in case your mental state deteriorates during the VC. Your psychiatrist/psychologist and SNC will assist over the phone during these scenarios.
Your Psychiatrist will scan the original prescription to you via your given email address.
The payments have to be made before the start of the consultation. Our Practice Managers at SNC will explain to you regarding the various payment options. They will also explain to you regarding options available in an unlikely scenario of interrupted VC due to unforeseen reasons.