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The Hybrid Practitioner of the future. Peter Yellowlees MD Professor of Psychiatry, UCD. PY is funded by AHRQ and is a video editor for Medscape. Book “ Telepsychiatry and Health Technologies – a guide for mental health professionals” published Jan 2018. Objectives. Understand:
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The Hybrid Practitioner of the future. Peter Yellowlees MD Professor of Psychiatry, UCD
PY is funded by AHRQ and is a video editor for Medscape. • Book “Telepsychiatry and Health Technologies – a guide for mental health professionals” published Jan 2018
Objectives Understand: • Why psychiatrists/providers need to work differently • How technologies can improve efficiency and be more patient-centered • How we can move to a new standard of care in a hybrid clinical environment
Summary • What is telepsychiatry - Hybrid practitioner perspective • Synchronous v Asynchronous • Video is one of many data streams • Changes and Predictions – a new standard of care
Where are the patients? • Inpatient – corrections (CA reduced 30% of psych beds 1995 – 2012) • Outpatient – primary care, county services for SMI and ED’s • Numbers of insured and aging- 20% over 65 by 2030
Where are the psychiatrists? • 40k total – deficit 10k now • Mean age 56, 65% male, major retirements in next decade • Replacements – 55% female (work 20% less) – rate of training static, so deficit increasing with population and demand increases • Estimate 20% less clinical time available in 10 years
What is the solution? Psychiatrists have to work differently……… • less time for individual care • more integrated/primary care • more team based • more technology facilitated • more population focused
Current vs Future Telemental health care • Current – current methods primarily ensure good quality care, using similar methods of interaction as in-person, just removed at a distance • Future – future models will provide better care delivered in a way that is different from now – 24/7, mobile, asynchronous, monitoring of data, population based, including genetic profiles and decision support etc
Digital Natives VS. Digital Immigrants DIGITAL IMMIGRANTS DIGITAL NATIVES • Use Internet for information second rather than first • Print out email • Share computer content in-person • Learn slowly, step-by-step, one thing at a time • Parallel processing & multitasking • Prefer graphics & visuals • Instant gratification & rewards • Prefer to be networked • Learn with information fast, presented in a random fashion • Based on Mark Prensky’s “Digital Natives, Digital Immigrants.” http://www.marcprensky.com/writing/Prensky%20-%20Digital%20Natives,%20Digital%20Immigrants%20-%20Part1.pdf . Accessed 12/30/2016. • Icons are open-source under SIL OFL 1.1 license. Font Awesome by Dave Gandy,http://fontawesome.io
Psychiatric Practice web-based videoconferencing videoconferencing telephone email EHR mobile web 2000 2010 2020 1990 • In-person • Telephone • Videoconferencing • Email • Mobile (text and phone) • EHR (patient portals) • Web • Social Networking • AI • Robotic • Metrics/data mining • APPS • Virtual Reality Models attempt to replicate current in-person care at a distance Improved care through enhanced models across different modalities-24/7, mobile, asynchronous and coordinated.
Technologies in Psychiatric Practice BASE TECHNOLOGIES EMERGENT TECHNOLOGIES • Virtual reality treatments • Social networking • Artificial intelligence, machine learning, & cognitive computing • Avatars • Geospatial tracking • E-mail • Electronic medical record (EMR) • Videoconferencing • Web-based apps • Mobile phones, apps, & devices • Icons are open-source under SIL OFL 1.1 license. Font Awesome by Dave Gandy,http://fontawesome.io
Hybrid care VIRTUAL SPACE PHYSICAL SPACE • Advantage for those with avoidant behavior, PTSD, and anxiety • Convenient & immediate • Provider can observe patient in their environment • Indirect & off-hours care opportunities • Modalities include videoconferencing, e-mail, text messaging & telephony • Traditional in-person gold standard • Immediacy & trust in interpersonal interaction • Physical boundaries can be set for therapeutic frame • Ample research and practice guidelines available for healthcare in the physical space • Diagram and illustrations by @StevenChanMD. Content based on Peter Yellowlees & Jay Shore.
Advantages of Telepsychiatry FOR THE PSYCHIATRIST • Work from anywhere • Flexibility of time • Opportunities to work with different populations • New models and configurations for care • Diagram and illustrations adopted from @StevenChanMD. .
Advantages of virtual space FOR THE PATIENT FOR THE PROVIDER • Can see providers outside of the patient’s community • Can have highly intense, intimate and empathic relationships • Can discuss embarrassing, stigmatizing, or awkward topics • Can give more direct feedback to patients • Can safely patients who are placed in dangerous settings — e.g. correctional institutions • Can be an objective observer PHYSICAL DISTANCE • Diagram and illustrations by @StevenChanMD. Content based on Peter Yellowlees & Jay Shore.
Asynchronous Telepsychiatry • Generates subtitles for Telepsychiatry videos in real-time • Interfaces with existing online and offline transcription and translation services
ATP Summary of Findings • Diagnostically reliable across differing language groups with translation • Good for monitoring treatment progress • Easier management admin/scheduling • Improved communication between patient and reporting provider
The 2017 UCD psych referral choices: a “stepped care” integrated menu • PCP education – formal/informal/online/in-person • Routine screening in PCN – PHQ-9, GAD-7, Audit • Registry review – care coordination, panels, sentinel events, diagnostic groups, health coaching. • Curbside telephony advice/consult - indiv • Email/secure messaging/e-consult – indiv • ATP to PCN • STP to PCN • In person consults – Psych in PCN/Spec OPD • ED
Psychiatry in 2025? • Automated data capture – multiple data sources including video • Increasing mobile care and monitoring • Virtual Reality and Avatar driven therapists • Algorithmic screening and social network monitoring • Artificial intelligence and predictive assessments–big data analytics on the fly- genomics/phenomics - facial and voice recognition • Fully interoperable wireless patient owned health histories • And many more……..
Comparison Psychiatrist work practices • Traditional – 30 patient care hours, 10% no show – sees 40 pt’s per week (4 new, 10 one hour, 26 half hour) • Future – 30 patient care hours – no show time used for ATP. 15 hours spent traditional approach – 20 pts. 15 hours – team (4 new per hour – 5 hours) and ATP (2 new per hour – 10 hours) – 40 pts. Sees/consults 60 patients per week
Summary • Psychiatrists are starting to work differently • A range of technologies can provide more referral choices for PCP’s and patients • New models/technologies can transform the work of psychiatrists to increase their efficiency and reach, and to use continuously collected data on the fly.
Thankyou……………. pmyellowlees@ucdavis.edu @peteryellowlees