California Telepsychiatrists
American Telepsychiatrists
Telepsychiatry International
Telepsychiatry Internatioinal is a Linked-In group.
This is a group about and for professionals involved in the development and provision of Telepsychiatry and TeleMentalHealth services world wide. We want to promote a community forum to support individuals on the front line of this quickly growing method of improving access to mental health care.
The Triple Aim of Telepsychiatry is:
1. To Improve Mental Health Care Access
2. To Improve Mental Health
3. To Reduce Mental Health Care Costs
The Triple Aim of the Telepsychiatry International Group is:
1. Improve communication and camaraderie between practicing Telepsychiatrists
2. Bring practicing Telepsychiatrists into direct contact with Telemedicine researchers, designers, engineers, manufacturers, and distributors and thus foster improved development of products
that will greatly enhance and promote the provision of Telepsychiatry and TelementalHealth worldwide.
3. To connect Telepsychiatry providers with patients in need of access to mental health care while reducing the stigma of mental illness and bringing diverse cultures closer together.
Blogs Related to International Telepsychiatry and TeleMentalHealth
Providers of Telepsychiatry and TeleMentalHealth
Greg Smith, MD, Telepsychiatry in South Carolina, USA
Loyola University--Chicago, The Future of Mental Health Care
JSA Health, Houston, Texas
Peter Yellowlees, MD, University of Califronia at Davis
BBC newscast, Telemedicine
By Mary Sheppard, CBC News
Reposted from CBC.CA News.
Posted: May 27, 2011 2:13 PM ET
From the CBC CA article:
“It works. It’s the next best thing to being there.” Dr. Tony Pignatiello is talking about the telepsychiatry program at the Hospital for Sick Children (SickKids) in Toronto. The program has grown over the past 10 years, wants to grow some more, and may well be part of a renewed focus on children’s mental health acrossCanada. Dr. Antonio Pignatiello, medical director of Telepsychiatry, Hospital for Sick Hospital, Toronto, says next steps are to continue to train more people in northern and rural communities. The very first remote consultation in Ontario took place by teleconference in 1994 in Parry Sound. Jeffrey Hawkins, executive director of the Hands Children’s Mental Health Centres in North Bay and Parry Sound, was there for the first call. “We did it over a phone line and got the money through an innovation grant. But it was very exciting and was the beginning of keeping at-risk northern children in their communities. It grew from there.”
Telepsychiatry
Telepsychiatry is a consultation program done by hospitals, conducted through high quality video teleconferencing, where the doctor is in one location and the patient is in another.”The kids are comfortable with the technology, they rather like it,” says Dr. Clive Chamberlain, a child and youth consultant at SickKids and at the Centre for Addiction and Mental Health. “It feels like I’m there in the room. After about two minutes you lose the sense there’s any technology. The cameras are good enough to pick up a blush or a tear.”
You can read more of this article by clicking here.
Iowa, USA
DES MOINES – Both the Iowa House and Senate moved legislation last week that has the state taking a greater role in taking care of the mentally ill.
But whether it’s the House plan that offers property tax relief or the Senate plan that creates eight mental health regions in the state, or some sort of hybrid, there still will be the problem of getting mental health services to rural communities.
“The primary concern for rural Iowa is really related to recruiting psychiatrists to practice in rural parts of the state,” said Dr. Bhasker Dave, superintendent of the state-run Mental Health Institute of Independence. “It becomes an access issue for the people who live there.”
Iowa ranks 47th out of 50 states in the number of psychiatrists per capita and 46th per capita in the number of psychologists, according to the most recent figures available from the U.S. Department of Health and Human Services.
According to Roger Tracy, assistant dean at the University of Iowa’s Carver College of Medicine, as of December 2010 more than a quarter of the available psychiatrist jobs in the state – positions that are budgeted for – are unfilled, the lowest percentage since 2006.
Furthermore, of the 235 adult and child psychiatrists working in the state, 60 percent of them work in Polk, Linn or Johnson counties while the majority of the counties don’t have a practitioner within their borders.
There are a variety of potential answers to the problem, including the increased use of psychiatric physician assistants, nurses with specialty certifications in psychiatric health and telepsychiatry, which is treatment of patients from remote locations via computer link.
But none is a panacea.
“I think it has to be parts of all of those,” said Chuck Palmer, director of the Iowa Department of Human Services, who has suggested offering scholarships and other incentives to bring psychiatrists to the state and keep them here. “There is no one thing, but there has to be a discussion about money.”
Telepsychiatry
Dr. Alan Whitters, a Cedar Rapids psychiatrist, has treated 100 patients from his home while they stay close to theirs. He was one of the state’s earliest adapters of telepsychiatry in which patient and doctor are connected by computer link.
“All of them were rural patients,” Whitters said. “They would be hooked up at their local hospital or their clinic for a visit, and they came from a lot of different areas.”
Whitters talks his patients in the past tense because he stopped using telepsychiatry when he left the country for work in New Zealand. He’s back now and plans to start up his telepsychiatry practice again with a partner.
He said telepsychiatry allows him to see more patients over greater distances than would otherwise be possible.
It also allows rural patients the chance to get emergency help that might otherwise not be available save for a long trip into an urban center.
“The disadvantage is to do really good care, we need to smell and see and observe the patient,” he said. “This observation gives us clues to what’s going on that we might not otherwise see over a monitor.”
Supply and demand
The University of Iowa operates the only psychiatry program in the state. It graduates 10 psychiatrists a year, four of which have certifications so they can go into internal medicine or family medicine if they choose.
Tracy said the expense of the program, which includes residency, is the main reason the U of I program is not larger.
So experts are looking at ways that mental health services could be provided to people in rural areas without using psychiatrists.
Dr. Michael Flaum, director of the Iowa Consortium for Mental Health, said the psychiatry shortage isn’t just an Iowa phenomena, it’s nationwide.
He suspects that the day-to-day mental health work in rural communities will be handled by physician assistants or nurses who have a special certification in psychiatric service.
These professionals could work in consultation with psychiatrists – perhaps through teleconferencing – to help treat patients. He said that a program along these lines is under development in Keokuk, where a physician assistant is the primary contact for the area’s mental health services.
Flaum said one of the issues that still needs work is how the consulting psychiatrists get paid. Right now, most doctors don’t get paid for consulting with their colleagues, but they do get paid for seeing patients. That makes spending time with patients, instead of talking with peers, much more valuable.
Another issue is training for people who work in the rural areas. Dave said there are no greater or lesser incidents of specific mental health problems in rural dwellers than their urban counterparts.
Still, as the 2010 census showed, Iowa’s rural residents are generally older than people in the rest of the state and at greater risk for mental disorders associated with old age, such as dementia. Therefore, professionals who practice in mental health would benefit from specializing in geriatric mental health.
“That’s almost a fine point,” Flaum said. “We’re not even there. A specialty would be nice but we need psychiatrists period.”
Reblogged from the Des Moines Globe Gazette.
South Carolina
By: M. ALEXANDER OTTO, Internal Medicine News Digital Network
FROM THE ANNUAL MEETING OF THE AMERICAN PSYCHIATRIC ASSOCIATION
Major Finding: Telepsychiatry consults reduced hospital admissions for mental health patients from about 12% to 8% at 25 hospitals in South Carolina, and shortened emergency department stays from an average of four to three days.
Data Source: Outcomes data for more than 6,000 telepsychiatry patients and matched controls.
Disclosures: Dr. Chapman and her colleagues said they have no disclosures. The study was funded by the National Institute of Mental Health and the Duke Endowment.
HONOLULU – A statewide telepsychiatry consulting service in South Carolina shortened emergency department stays and reduced hospital admissions for more than 6,000 mental health patients. Those patients also used outpatient psychiatric services more, and their care was less expensive, said Dr. Stephanie R. Chapman at the annual meeting of the American Psychiatric Association.
Under the program, psychiatrists assess emergency department patients remotely via live video link. So far, 25 hospitals – none of which have readily available onsite psychiatric consulting services – are participating; the South Carolina Department of Mental Health plans to enroll 15 more within a year, according to Dr. Chapman, a psychiatry resident at the University of South Carolina, Columbia.
“In our state, we have so many mental health patients who are not receiving the care they need in the emergency room. A lot of facilities have no psychiatrists working in them. Someone has to drive in days later to see these patients,” she said. “It’s a big problem. That is why this was initially implemented” in March 2009, she said.
When telepsychiatry is called for, a video cart is rolled into the patient’s room. At the other end of the feed is a psychiatrist in Charleston, Columbia, Aiken, or Greenville, S.C.
The patient and psychiatrist are able to see one another and talk over the link. The psychiatrist does the assessment over about 30 minutes, prepped beforehand with the patient’s history, lab results, and other findings.
Afterward, the psychiatrist might recommend hospitalization or set up an outpatient appointment through the local mental health department, Dr. Chapman said.
At present, the service is available 16 hours a day. Psychiatrists take turns manning the feed at offices in the four towns, usually in 8-hour shifts. When a shift ends in Aiken, for example, a psychiatrist in the Greenville office might pick up the feed.
To see how the program is doing, Dr. Chapman and her colleagues compared the 6,000-plus telepsychiatry patients’ outcomes with those for matched controls at hospitals not yet participating in the program.
About 8% of telepsychiatry patients were admitted, vs. 12% of control patients. With telepsychiatry, “we now have a more specialized person performing the consult” and perhaps making better calls on who needs to be hospitalized, Dr. Chapman said.
Emergency department stays averaged three days for telepsychiatry patients, but four days for controls. About 85% with severe mental illnesses in the telepsychiatry group had outpatient follow-up within 30 days, compared to 22% in the control group.
The program saves money, too. Medicaid telepsychiatry patients had median charges of $2,000; median charges were $2,800 among Medicaid patients in the control group. With other payer mixes, median charges for telepsychiatry patients were $6,800, vs. $11,000 for those in the control group.
Overall, about 80% of patients said they were satisfied with the service. About 90% of physicians said they were satisfied, too, and about three-quarters said telepsychiatry increased productivity.
In short, “the patient receives a higher quality of care, and the hospitals have reduced costs,” Dr. Chapman and her colleagues concluded in their summary of the findings.
Dr. Chapman said she has no disclosures. The study was funded by the National Institute of Mental Health and the Duke Endowment.
The plan “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014” reports that by 2020 behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide.
The plan stresses the need for the mental health field to use information technology to share information. By using technology, information can be obtained from national surveys, surveillance activities, and on evidence-based practices. Also, the web, print, social media, and public appearances should be used to reach the general public, providers, and other stakeholders involved in the mental health field.
The plan points out that in the past, the specialty behavioral health system has often operated independently from the broader health system and this has resulted in differences in the type and scope of information technology used.
The goal for SAMHSA is to work collaboratively with the Office of the National Coordinator for HIT, to drive the adoption of HIT and EHRs, and to enable specialty behavioral health to be easily exchanged with primary care by 2014.
On the state level, Nebraska has faced slow growth in their technical infrastructure because of limited investment capital. According to Nebraska’s Operational eHealth Plan, the state’s behavioral healthcare services are operated on a shoestring, and many of the providers rely on fundraising efforts to be able to continue to deliver services.
In general, consumers in the state are actively participating in Nebraska’s largest active health information exchange the Nebraska Health Information Initiative (NeHII). Consumers are also extremely satisfied with the telehealth services provided through the Nebraska Statewide Telehealth Network.
The state is continuing to improve behavioral health resources, and as a result, the new state Health Information Exchange “Behavioral Health Information Network” (eBHIN) will be activated in Region V in the southeast part of the state. According to Wende Baker, the Network Director for eBHIN, the system will go live in June 2011
eBHIN will include software with enterprise architecture a software solution that operates on a single database supporting the requirements of multiple organizations, multiple practices, and multiple locations.
Federal funds made available through the State HIE Cooperative Agreement program will help fund eBHIN’s Central Data Repository (CDR) as proposed for the HIE system. The CDR with a centralized database will maintain wait lists, referrals, and provide easy access to centralized consumer data, and lab results.
The system will reduce redundant data entries, improve consumer safety through clinical data sharing, have capabilities to report data at any level, decrease the cost of deploying and maintaining software across regions, and accomplish all of the goals while complying with HIPAA. The CDR will operate in a web-enabled environment located at an existing state-of-the-art data center with the capability to assure system security 24/7.
Very importantly, CDR will provide the Virtual Behavioral Healthcare records that can be uploaded to NeHII and be available to medical providers across the state. This will be the vehicle by which medical records available from NeHII will be available to behavioral healthcare clinicians.
The initial pilot includes Blue Valley Behavioral Health, Community Mental Health Center of Lancaster County, and ByanLGH Medical Center Behavioral Health Services. The pilot will be based on the current Community Health Solutions database purchased from Nextgen.
It will be eBHIN’s responsibility to collaborate with stakeholders, the NITC eHealth Council, the State Health Information Technology Coordinator, NeHII, and the Office of the National Coordinator to comply with reporting requirements. For more information, email Wende Baker atwbaker@region5systems.net.
Reblogged from Federal Telemedicine News.
Texas, USA
Texas A&M Team Providing Mental Health Services By Videoconference
A Texas A&M University-led team is providing mental health services to rural residents who might not otherwise have such vital assistance because of their remote locations.
Capitalizing on videoconferencing and internet opportunities, a Texas A&M University-led team is providing mental health services to rural residents who might not otherwise have such vital assistance because of their remote locations.
The program, called Telehealth, is operated by the Department of Educational Psychology in Texas A&M’s
College of Education and Human Development in cooperation with other Texas A&M and local government
health entities. It is the first program of its kind to be supported by a community group.
Telehealth uses videoconferencing equipment and a secure internet connection with a television-speed refresh rate.
The Telehealth program is the culmination of efforts by the Brazos Valley Health Partnership—a nonprofit entity comprised of seven Brazos Valley counties, two advisory groups and the Center for
Community Health Development—to better meet the mental health needs of rural residents. It got its start in part as the result of a survey conducted by the Center for
Community Health Development (CCHD) in the School for Rural Public Health, which is part of the Texas A&M Health Science Center.
The Telehealth team is planning to expand into Madisonville and possibly build a partnership with Prairie View A&M to offer mental health services programs in those areas, notes Timothy Elliott, Texas A&M professor of counseling psychology.
The service operates out of the Leon County Health Resource Center in Centerville and the Counseling and Assessment Clinic (CAC), which is located in Bryan and run by the Department of Educational Psychology at Texas A&M.
“Basically what we’re doing is trying to take the CAC and all its services that are available to people in Bryan/College Station and use long-distance technology to provide these same services throughout the Brazos Valley,” Elliott says.
“Telehealth is consistent with the mission of Texas A&M University and certainly with our college, and it reflects what we can be doing with applied science and community outreach,” Elliott emphasizes. “It’s certainly being responsive to a group of people who encounter disparities in services simply by the virtue of where they live.”
Rural residents, he observes, experience significant disparities in their ability to access mental health services due to factors such as travel time, expenditures, lack of health insurance and a shortage of eligible providers.
An individual with mental health problems living in Leon County, for example, would have to drive approximately 60 miles to Bryan to see a therapist for a 45-minute session. Then that individual would have to trek another 60 miles back home.
Telehealth, however, brings that mental health provider as close as the local public health center.
“By using Telehealth to provide mental health services at the local health resource center free of charge, we increase residents’ abilities to access much-needed mental health services,” Elliott notes.
Three counseling psychology doctoral students, including Kirsten Salerno, Gerardo Gonzalez and Meredith Williamson, provide Telehealth assessment and counseling services at least twice a week. Some sessions are available in Spanish.
The doctoral students gain valuable experience and are supervised by counseling psychology faculty, who are accredited by the American Psychological Association.
Other participants in the project include Monica Wendel, director of the Center for Community Health Development at the Texas A&M Health Science Center; Linda Castillo and Daniel Brossart, both Texas A&M associate professors of counseling psychology; and community leaders in Centerville and Leon County.
From KBTX.com in Bryan / College Station.
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Information Technology
Healthcare Information Technology consultant who specializes in Public Behavioral Health. "Things have been at the status quo for a while, and I believe its time to change the conversation."
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Infrastructure
This is one of those stunning uses of tele-conferencing and robotics that stops you dead in your tracks…stunned that nobody had thought of this sooner. What a wonderful story.
Reblogged from texomashomepage.com:
“All of last year, I was either in the hospital or at home doing all my work. I had no social interaction whatsoever.”
Lyndon Baty has been fighting all his life. He suffers from Polycystic Kidney Disease and has virtually no immune system. So doing normal things, like going to school, used to be impossible.
But now, new robotic technology is making it possible for Lyndon to do what he’s always wanted to do-be in class, with his friends.
“It’s absolutely amazing,” said Lyndon.”I would have never thought when I was sick that I would ever have any interaction, much less this kind. It is just like I am there in the classroom.”
It was by a chance phone call Administrators at Knox City ISD came across the technology known as VGO (vee-go).
“We had a salesmen call on us, and said ‘we have this product, we’re not exactly how it would work in the school, but we want you to see it’,” said Mike Campbell, the Education Specialist for Technology with Region 9.
Now that they have the VGO for Lyndon, school officials say it reminds them why they started teaching in the first place.
“This is one of those occasions where we see a dramatic improvement of a student who wasn’t able to go to school,” explained Campbell,”but now as a result of the technology, [Lyndon] has been able to attend class. That’s something that most of us take for granted.”
“When he’s able to be in there, and hear what everyone’s opinion is, plus the teachers, and hear all the classroom discussion, he gets that,” said Sheri Baty, Lyndon’s mother.
“That’s incredible to see and see in his eyes.That’s invaluable as a parent to see he’s getting that.”
While learning directly from his teachers is great, Lyndon says what he loves most is just being able to interact with kids his age.
“My best friends were my parents. No offense against them, but I want other friends,” said Lyndon.
“I feel like I’m right there,” continued Lyndon,”like I’m right at the school.”
“He has a reason to get up,” said Sheri,”he gets up, takes his medicine, eats. He’s sitting and waiting for that [school] bell to ring.”
The VGO unit Lyndon uses has a price tag of just over $5,000 and a battery life of 8 hours.
According to the company that makes it, VGO Communications, it’s the only unit currently in use at a Texas school.
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Research
Researchers in the field of Telepsychiatry and TeleMentalHealth (and Related Article)
Interesting article from Medscape about what may be a valuable tool in cognitive assessment….Goodbye MMSE?
Reprinted from Medscape News.
Megan Brooks
November 10, 2010 — Researchers from Boston, Massachusetts, have developed and validated a 16-item cognitive assessment tool known as the “Sweet 16″ that can identify problems in thinking, learning, and memory among older adults.
The Sweet 16 tool grew out of a need to have an instrument that would be quick to administer and free to use, Tamara G. Fong, MD, PhD, assistant professor of neurology at Harvard Medical School and staff neurologist at Beth Israel Deaconess Medical Center, Boston, explained in an email to Medscape Medical News.
“There are a lot of other brief cognitive tests available,” she noted, “but these often required pen and paper or other props such as special forms to administer, or the instruments weren’t well validated, or they took too long,” she noted. “The copyright on the Mini-Mental State Examination [MMSE], with its fee per usage, was another challenge. Thus, we decided to develop a new test that would improve on what was currently available.”
Their report was published online November 8 in the Archives of Internal Medicine.
To develop the Sweet 16, Dr. Fong and colleagues used information from 774 patients aged 65 years and older who completed the MMSE before being admitted to a skilled nursing facility directly from an acute medical or surgical hospitalization. The Sweet 16 performance characteristics were then independently validated in 709 participants in the Aging, Demographics, and Memory Study using clinical consensus diagnosis and 2 different dementia and cognitive decline rating scales.
Table 1. Description of Sweet 16 Items
| Item No. | Item Description | Cognitive Domain | Points |
| 1 – 8 | Orientation to time and place | Temporal/spatial orientation | 8 |
| 9 – 11 | Immediate repetition (3 items) | Registration | 3 |
| 12 – 13 | Digit spans backward | Sustained attention | 2 |
| 14 – 16 | Recall (3 items) | Short-term memory | 3 |
In the development cohort, the Sweet 16 correlated highly with the MMSE (P < .001). There was significant (P < .001) overall agreement between the 2 instruments at “clinically relevant thresholds (< 14 for Sweet 16 and < 24 for MMSE),” the investigators report.
Validated against the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P = .06), they further report.
The results, Dr. Fong told Medscape Medical News, “actually exceeded our expectations for how well the Sweet 16 instrument performed in comparison to the MMSE. As a screening instrument, it had better sensitivity and was much quicker to administer (2 minutes compared to a minimum of 10 minutes for the MMSE).”
Table 2. Performance of the Sweet 16 and MMSE Compared With IQCODE and Clinical Diagnosis
| Measure | Sweet 16 Score <14, % (95% CI) | MMSE Score <24, % (95% CI) |
| IQCODE | ||
| Sensitivity | 80 (67 – 91) | 64 (51 – 77) |
| Specificity | 70 (65 – 91) | 86 (83 – 89) |
| Clinical diagnosis | ||
| Sensitivity | 99 (97 – 100) | 87 (78 – 95) |
| Specificity | 72 (68 – 77) | 89 (86 – 92) |
CI = confidence interval; IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly; MMSE = Mini-Mental State Examination
An IQCODE score higher than 3.5 and a clinical diagnosis were used as reference standards to compare with both the MMSE score lower than 24 and the Sweet 16 score lower than 14.
“This instrument could be used in the research setting for study eligibility screening, to measure risk, and as an outcome measure,” Dr. Fong said. “For the clinician, the Sweet 16 could be used to screen patients in a primary care setting who complain about memory problems, or in the hospital to determine if someone might have some cognitive impairment that puts them at a higher risk for complications such as delirium.”
Dr. Fong emphasized that the Sweet 16 is only a screening test for cognitive impairment and is not intended to replace more sensitive and comprehensive tests of cognitive function.
“The Sweet 16 on its own is not intended to be a definitive test to diagnose dementia but, rather, to identify patients who might need further evaluation by a neurologist or other specialist,” she said.
The Sweet 16 instrument, training materials, and equivalency scores are available online.
Clear Need for Better Assessment Tools
Reached for comment on the Sweet 16, James Galvin, MD, MPH, clinical professor of neurology and psychiatry at NYU Langone Medical Center and clinical director of the Pearl Barlow Center for Memory Evaluation and Treatment in New York City, said, “There is a clear need and a push by many investigators, including myself, to develop tools to assist primary care providers in detecting cognitive impairment in older adults.” Dr. Galvin is the developer of the AD8 dementia screening test.
“This attempt at developing a very, very brief performance measure is admirable,” Dr. Galvin added. However, he said, “it’s unclear from the study whether the Sweet 16 would assist doctors in defining the very earliest signs of dementia, which are diagnostically the most challenging.
“There are people in the validation sample that have severe dementia, which is not a diagnostic dilemma,” he points out. “I think it would have been more useful to only do the study comparing healthy older adults vs people with the very mildest signs of dementia because that is the challenge — including mild cognitive impairment, which is even more of a diagnostic challenge.”
Development of simple and effective cognitive assessment tools for primary care is “timely,” Dr. Galvin noted, given the requirement in the health reform bill that primary care physicians assess for cognitive impairment as part of the annual wellness visit for Medicare beneficiaries.
Dr. Fong and colleagues have disclosed no relevant financial relationships. Dr. Galvin is developer of the AD8 dementia screening test but has disclosed no other relevant financial relationships.
Arch Intern Med. Published online November 8, 2010.
Medscape Medical News © 2010 WebMD, LLC
Send press releases and comments to news@medscape.net.
What you’re looking at are neurons grown from a schizophrenic person. An incredible study, published today in Nature, reveals how scientists grew schizophrenic brain cells to understand the inner
workings of this still-mysterious neurological disorder.
A team of scientists from research institutes across the US collaborated to conduct this first-of-a-kind experiment. Schizophrenia is known to be an inherited, genetic disease in the majority of
cases, and the researchers drew their samples from the skin of four people with clearly inherited schizophrenia. Three were from families where one parent and all their siblings were also
schizophrenic, and one had been diagnosed with schizophrenia at the age of 6. The scientists “reprogrammed” these cells to become stem cells, then neurons, creating small colonies of cells whose
genetic profile exactly matches schizophrenic neurons.
Over a period of weeks, they watched the cells develop, testing them to see how they differed from a control group of cells. They already knew from previous studies that schizophrenic neurons don’t form many connections with other neurons, and indeed this was exactly what they found. Neural connections, which are electrical and chemical links between cells called synapses, allow your brain to form new memories, learn, and come up with new ideas. (You can see them in the fine threads between neurons in the pictures that illustrate this story.) But schizophrenic neurons don’t reach out to each other.
And the research team now has a much better picture of why this is. Partly it’s because schizophrenic neurons are low on proteins that help build those connections. But the researchers also found unusual behavior in genes needed to regulate two cell processes (called “signalling pathways”) that help neurons communicate with each other. What it all boils down to is that schizophrenic neurons suffer from a number of problems, all of which make it harder for them to create the kind of dense neural network your brain needs.
At left, you can see two neural cultures – on the left is the control group and on the right are the schizophrenic cells. Note that the schizophrenic cells have formed far fewer connections than the control group has.
The researchers also tested 5 antipsychotic drugs on the neurons, and found that only loxapine helped the cells form more connections with each other.
In a technical summary, the authors write:
Schizophrenic human-induced pluripotent stem cell neurons showed diminished neuronal connectivity in conjunction with decreased neurite number, PSD95-protein levels and glutamate receptor expression. Gene expression profiles of SCZD hiPSC neurons identified altered expression of many components of the cyclic AMP and WNT signalling pathways. Key cellular and molecular elements of the SCZD phenotype were ameliorated following treatment of SCZD hiPSC neurons with the antipsychotic loxapine.
So what’s the upshot? We know that most of the problems in schizophrenic neurons come from an inability to form neural connections, and now we know that these problems are caused by a very complicated set of factors. There is no “schizophrenia gene.” And there is no one type of neurological damage that leads to schizophrenia. The good news is that we have a detailed cellular model of one form of schizophrenia now, and what these researchers have found will help others in the field get closer and closer to a therapy that might one day reprogram schizophrenic neurons to be more like typical neurons, forming a web of connections with their fellow cells in the brain.
Read the full scientific paper via Nature
Reblogged from iO9.com.
Laws and Rules
CMS finalized a new rule for telemedicine services to ensure that patients in rural or remote areas continue to receive cutting edge medical care from local hospitals. The final rule changes the process that hospitals and CAHs use to credential and grant privileges to physicians and practitioners delivering care via telemedicine services.The rule simplifies how hospitals and CAHs can partner with hospitals and non-hospital telemedicine entities such as teleradiology facilities to deliver care to their patients. The streamlined process will be particularly beneficial to patients of small hospitals and CAHs in rural or remote areas that may lack staff or resources to deliver specialized clinical expertise to their patient populations.Before this rule, CMS practitioners could not provide care via telemedicine unless they were granted practice privileges both by their home hospital as well as by the remote hospital or CAH to which the telemedicine services were being delivered. The final rule aims to reduce the burden of the traditional credentialing and privileging process for Medicare-participating hospitals and CAHs.
A hospital or CAH furnishing telemedicine services to patients via an agreement with a distant hospital or telemedicine entity may now rely upon information furnished by the distant hospital when making credentialing and privileging decisions for the physicians and practitioners at the distant site that will furnish the services.
via Federal Telemedicine News: CMS Finalizes New Rule.
Reblogged from Hospital and Health Networks
By Mary Jo Gorman, M.D.
Bureaucratic obstacles for physicians and nurses are hindering telemedicine’s potential.
It is estimated that by 2025, the United States will face a shortage of as many as 159,000 physicians and 260,000 registered nurses. Health care reform, particularly universal health care, as well as the aging of America, will add to the demand for doctors and nurses. Already, access problems to both primary care and specialty care exist in many parts of the country.
Telemedicine has become a viable option to address shortages as well as improve quality of care and health care efficiencies, and the industry continues to grow. The U.S. telemedicine device and service market is projected to reach $3.6 billion per year by 2014. Technology is becoming more commonplace in delivering medical care—as evidenced by the use of smart phones, Skype, electronic health records and more. Technology that brings caregivers to patients continues to grow, and the Federal Communications Commission’s recent proposal to boost broadband investment in rural areas will further expand technology’s reach.
Now that caregivers are becoming comfortable with the technology, telemedicine’s biggest obstacles are regulatory. Before we can fully realize telemedicine’s benefits, we need to develop a federal medical license. Such a license would reduce bureaucratic burdens faced by physicians and medical centers, ensure better outcomes for patients, and provide better access to health care specialists and technologies.
Regulatory Obstacles
Obtaining a state license for physicians is different in every one of the 50 states. While the requirements are generally the same, the applications, document requirements and accepted sources can vary. Even worse are the affiliation and employment verifications, which often can be time-consuming and difficult. The Federation Credentials Verification Service overcomes some of this by housing and validating some of the primary source documents, such as education and training. Accepted in many states, the FCVS is an improvement; however, the variation in required continuing medical education, personal visits and jurisprudence exams creates an obstacle for physicians to serve a geographically dispersed population.
For medical activities that require hospital privileging and credentialing, the problems are greater. Every hospital requires its own application and specific forms, most of which are not standardized. Currently, the Centers for Medicare & Medicaid Services precludes hospitals from relying on information affecting credentialing and privileging decisions of telemedicine physicians from another accredited hospital (a process developed nearly 10 years ago by the Joint Commission). This severely adds to the administrative burden of credentialing, especially for small and rural hospitals.
The American Telemedicine Association and other organizations have been involved actively in clarifying and resolving this issue, and CMS is reviewing regulations that would allow Medicare-participating hospitals to credential and grant privileges to telemedicine physicians in a manner similar to the Joint Commission’s process. Further clarification is expected this month.
Extending Current Systems
Using tools already in place, such as the Uniform Application for Physician State Licensure and the National Practitioner Data Bank, a methodology can be designed at the national level to develop a federal medical license. The uniform application was designed to simplify the physician licensing application. However, there is limited acceptance of the application, and it has little impact on such state-specific requirements for verifications or special requests as an in-person interview or special tests.
The National Practitioner Data Bank, a centralized, electronic database for any adverse licensure, clinical privileging or other negative findings against incompetent physicians and other health care practitioners, was created by Congress to improve quality of care and address the increase in medical malpractice litigation—”nationwide problems that warrant greater efforts than those that can be undertaken by any individual state,” according to the congressional findings. However, the data bank has not been used to reduce the redundancies of the state processes.
Using tools and databases already in place to create a federal license is possible. The license must cover diagnosing as well as prescribing and treating, and a state license in good standing should be sufficient to qualify an individual for a federal license. The states’ medical board financial interests can be supported with an individual state activation fee paid by the federal license holder who desires to practice in the state.
Joining Forces to Break Down Barriers
For telemedicine to reach its full potential, industry and government leaders at both state and federal levels need to work together to reduce regulatory barriers. We know telemedicine leads to improved patient access to specialists, better patient outcomes and more efficient health care.
Hospitals and health systems that are considering telemedicine programs should start early to identify issues and solutions. If the telemedicine provider is Joint Commission-certified, hospitals can and should accept the provider’s credentialing of physicians.
Hospital leaders also should work within their own states to enact legislation that allows them full use of telemedicine’s capabilities. For instance, hospitals and health systems can support legislation for state medical boards not only to accept FCVS source documents, but also to eliminate physician interviews or conduct them by phone or videoconference.
Nursing care across state lines via telemedicine holds similar challenges. To help, hospital leaders can support state legislation for a nursing compact if their state does not belong to the Nurse Licensure Compact, a mutual recognition model of nurse licensure among states.
Supporting legislative efforts like these will help the industry move toward creating a federal medical license, reduce burdens faced by hospitals and clinicians, and provide greater access to care as well as better outcomes. Without a federal medical license, the promise of telemedicine will be limited, and the urgency is great.
Mary Jo Gorman, M.D., M.B.A., is the CEO of Advanced ICU Care in St. Louis.
Tech Talk
Tech Talk Podcast on Telepsychiatry from the New York Times March 16, 2011
Telemedicine Resource Centers
Center for Telehealth and E-health Law (CTEL)
www.telehealthlawcenter.org
- Physician Licensure State by State:
www.ctel.org/expertise/physican-licensure
Telehealth Resource Centers
www.telehealthresourcecenter.org
Southwest Telehealth Resource
Center (SWTRC)
"The SWTRC assists start-up telehealth programs in their development and serves as a resource for existing programs regarding changes in technology and other issues affecting telehealth in the
Southwest region."
www.southwesttrc.org
California Telemedicine & eHealth Center
(CTEC)
www.cteconline.org
Northwest Regional Telehealth Resource
Center
www.nrtc.org
Great Plains Telehealth Resource & Assistance
Center
www.gptrac.org
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