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Close the health gap: improving patient access to psychiatric treatment through primary care and telepsychiatry integration
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Close the health gap: improving patient access to psychiatric treatment through primary care and telepsychiatry integration
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Content
Close the Health Gap: Improving Patient Access to Psychiatric Treatment Through
Primary Care and Telepsychiatry Integration
Grand Challenge Innovation Prototype
SOWK 722: Implementing Your Capstone and Re-Envisioning Your Career
The USC Suzanne Dworak-Peck School of Social Work
Professor Ronald Manderscheid, Ph.D.
by
Jennifer Blewett
Submitted in Partial Fulfillment of the Requirements for the Degree
Doctor of Social Work
Suzanne Dworak-Peck School of Social Work
University of Southern California
May 2020
2
Progress Note
Description of Innovation
The capstone project PsychPartner (psychiatric collaborative network and innovative
telepsychiatry software that provides access to real-time interactive, on-demand network of
psychiatric professionals) will address the problem of inadequate access to appropriate mental
health services for patients and their provider populations that have limited access to mental
health services (example: nonmetropolitan populations) which compromises healthy lives for
marginalized populations (Improving Patient Access to Psychiatric Treatment Through Primary
Care and Telepsychiatry Integration). This is important because unaddressed and untreated
psychiatric conditions must be treated, and individuals and their providers should be able to
access treatment. At this time, there is a significantly neglected population of individuals living
in rural settings within the United States of America that do not have access to specialized
psychiatric treatment. An additional problem is the lack of comprehensive psychiatric knowledge
by primary care providers. In addition to emergency room practitioners, primary care providers
in the United States of America are on the frontlines of healthcare diagnosis and assessment
today. With 1 in 4 adults in the United States experiencing a mental health symptom, primary
care providers more than ever are being asked to make the appropriate assessment, diagnosis and
treatment plan for patients struggling with mental health and substance disorders. There are
multiple barriers to accessing appropriate mental health treatment and disparities exist in
healthcare for those with psychiatric needs. There is a significant need to remove the healthcare
gap that exists for marginalized populations. Through an extensive review of the population and
demographics of the state of Massachusetts, Hampden County in the western part of the state
3
will serve as the PsychPartner program pilot location. The goal is to implement PsychPartner as a
six-month program piloted to serve at the mental health delivery system for systemic change
with the population of patients at Chicopee Health Center. Healthcare providers at this outpatient
healthcare clinic are having challenges accessing specialty mental health treatment due to the
rural setting in which the primary care providers are based. Chicopee Health Center in Hampden
County will serve as the community-based setting where primary care providers will be the first
to utilize the innovative PsychPartner software collaborative.
Development of a healthcare-based infrastructure for direct, on-demand access to
psychiatric providers within a hospital-based setting will be the beacon that will provide direct,
clinically effective specialized treatment for this underserved, rural patient population. Through
development of a telepsychiatry communication software (PsychPartner) primary care providers
will have real-time access to specialized psychiatric providers through virtual treatment
collaboration which will provide significantly improved, universal patient engagement and
psychiatric treatment. The capstone will be piloted over a six-month period and in one outpatient
community healthcare clinic (Chicopee Health Center) in collaboration with 25- psychiatric
specialty providers from Partners Health Inc, (25 Psychiatrists) and 12-Primary Care Providers.
The PsychPartner Pilot Program innovation application will aim to provide an
experimental trial and study of feasibility to examine on a small-scale the effectiveness of this
innovative telepsychiatry software. PsychPartner would ultimately be utilized within a large-
scale program over time to help organizations implement improved psychiatric and behavioral
health assessment, and treatment. The anticipated outcomes will deliver a universal
telepsychiatry software model for the county, state and potentially national level for psychiatric
collaborative treatment.
4
Purpose of Prototype
The overall purpose of this prototype is to provide a booklet of instructions known as a
Program Manual. This program manual, which will be available in both paper and digital (PDF)
formats, will provide instructions and training for the PsychPartner Telepsychiatry 2020 Pilot
Program. This manual is intended for use by the Primary Care Physician participants enrolled in
the inaugural PsychPartner Pilot Program who will be implementing their use of this program at
Chicopee Health Center in collaboration with Partners Healthcare Inc. (Massachusetts General
Hospital and Brigham and Women’s Hospital). The proof of concept of this program manual is
on implementing the PsychPartner collaborative software intervention for the patients of
Chicopee Health Center (community-based primary care clinic) in Hampden County,
Massachusetts. The goal of this prototype is to fully improve the quality of each preformed task
as a reference and training document.
Description of Prototype Methodology
The proof of concept of the PsychPartner program manual is to provide purpose,
objectives and goals for staff and provider participants to have succinct clarification of the
PsychPartner telepsychiatry software pilot program mission. This program manual will serve
staff and providers as a clear and concise procedural manual. It will also target a review of
program policies and procedures. These procedures will include PsychPartner standard operation
procedures (SOP) as well to guide staff and provider participants a review of main objectives and
vision of the PsychPartner telepsychiatry software pilot program initiative.
The methodology of the PsychPartner telepsychiatry software prototype is to be used as a
program manual for training purposes of PsychPartner program staff and pilot program medical
5
provider participants. The goal will be for all staff and provider participants to review and
understand the aims of this program manual. Various facilities, materials and equipment will be
explained in the program manual.
Results
This capstone prototype will be tested once during the six-month pilot program in which
PsychPartner will be utilized by primary care physicians at Chicopee Health Center in Chicopee,
Massachusetts in collaboration with psychiatry specialty providers (psychiatrists and
psychopharmacologists) employed by Partners Healthcare, Inc. beginning on May 1
st
, 2020. This
program manual prototype will be reviewed following the pilot program to test the
appropriateness of the material as well as the effectiveness of the program manual. The
PsychPartner Advisory Board will continuously be engaged with the primary care providers and
specialty psychiatric provider during this six-month pilot program to survey and evaluate the
effectiveness of the PsychPartner collaborative software. Participants (Chicopee Health Center
primary care providers) will be asked to complete a five-question satisfaction survey of the
program weekly. The survey will be sent electronically through an email to each provider.
Additionally, patients of Primary Care Providers at Chicopee Community Health will be asked at
random the satisfaction of their care and current health symptoms through electronic Patient
Reported Outcome Measures (PROMs) and all answers are anonymous.
How will your prototype impact implementation of the project?
The overall purpose of this prototype will be utilized primarily as a general procedural
manual and to provide specific training material to those engaged in both participation and
implementation of PsychPartner program. This prototype will also serve as a tool to provide
program implementation consistency, especially for the initial programs stages such as the six-
6
month pilot program phase. As a new program, it will be essential to ensure consistency to all
engaged in the different facets of the innovative PsychPartner telepsychiatry software, with the
goal to reduce variations within the program. The program manual guide will help to both clearly
state the purpose of the PsychPartner software as well as guide staff and provider participants on
the compliance necessary for this program to be successful. This manual is not a patient
instructional manual and should not be used as an orientation guide for patient populations.
PsychPartner telepsychiatry software will address the problem of inadequate access to
appropriate mental health services for patients and their provider populations that have limited
access to mental health services specifically in rural, medically underserved areas. Through
implementation of the PsychPartner pilot program and utilization of this program manual, the
main goal is to directly improve patient access to psychiatric treatment through primary care and
telepsychiatry integration. There are several significant barriers to accessing appropriate mental
health treatment in rural settings in the United States at this time and it would be in the best
interest for our communities to reduce the disparities that currently exist in healthcare for those
in need of psychiatric treatment. In conclusion, with the emergence and implementation of
PsychPartner telepsychiatry software collaboration, the goal is to be a positive result that will
show the significant need for mobile and telehealth forms of specialized psychiatric treatment for
those living in rural and nonmetropolitan communities. We believe that the PsychPartner pilot
program will be a reputable model that will not only be able to grow but be able to be replicated
as a form of mental health service delivery in multiple community-based healthcare settings.
7
PsychPartner
PsychPartner Telepsychiatry Communication Software
and Real-Time Interactive Services Program Manual
Updated 2020
PsychPartner.com
8
PsychPartner Telepsychiatry 2020 Pilot Program Training Manual
This manual is intended for use by Primary Care Physician pilot program participants who will
be implementing the inaugural PsychPartner Telepsychiatry Software to their patients at
Chicopee Health Center in collaboration with Partners Healthcare Inc. (Massachusetts General
Hospital and Brigham and Women’s Hospital)
9
Table of Contents
I. Telehealth and Telepsychiatry Overview
a. Types of Telehealth
b. Telepsychiatry Introduction and Overview
i. Introduction of PsychPartner Telepsychiatry Software Innovation
ii. Key Program Phases
iii. PsychPartner Telepsychiatry Pilot Program
II. Key Partners
a. Chicopee Health Center, Chicopee, Massachusetts (Rural Healthcare Host Site)
b. Partners Healthcare Incorporated, Boston, Ma (Psychiatric Collaboration Site)
i. Brigham and Women’s Hospital, Boston, Massachusetts
ii. Massachusetts General Hospital, Boston, Massachusetts
c. About AthenaHealth (Software Developer)
d. About iClickCare (HIPAA Encryption Software Developer)
e. Partners Healthcare IT (Telehealth Technology Support Contractor)
f. Massachusetts Department of Public Health (State Organization, DPH)
g. PsychPartner Advisory Board
III. Definitions
a. Clinical Definitions
b. Technical Definitions
IV. Telepsychiatry Program Design (PsychPartner)
a. Introduction to PsychPartner Encrypted Telepsychiatry Communication Software
b. Positions and Roles Supporting PsychPartner Telepsychiatry Program
10
c. Current Telepsychiatry Programs, Initiatives and Software Applications
d. PsychPartner Telepsychiatry Sites
e. PsychPartner Telepsychiatry
f. Site Contacts
g. PsychPartner Billing and Health Insurance Coverage
V. PsychPartner Telepsychiatry Program Process and Phases
a. Selection Process for Programming (Site Locations)
b. Provider Approval Process
c. Psychiatric Specialty Provider Selection Process
d. PsychPartner Telepsychiatry Education and Training Process
e. PsychPartner Telepsychiatry Clinical Guidelines
f. Access to PsychPartner Telepsychiatry On-Demand Consultation Request
g. Connecting to Psychiatric Collaboration Host Site (Partners Healthcare Inc.)
h. Confidentiality and Privacy
i. Telehealth/Telepsychiatry Equipment, Software and Technology
i. Telepsychiatry Checklist
VI. PsychPartner Collaboration On-Demand Appointments
a. Roles of Primary Care Provider Initiating Collaboration
b. Roles of Psychiatric Treatment Provider Assisting with Treatment
c. Documentation
d. Follow Up Treatment and Requirements
e. Quality Assurance
f. Safety Reporting
11
g. Emergency Telepsychiatry Services
VII. PsychPartner Telepsychiatry Technical Support
a. Partners Healthcare IT (Telehealth Technology Support Contractor)
i. Technology System Requirements (Host Site)
ii. Technology System Requirements (Psychiatric Collaboration Site)
iii. PsychPartner Technical System Maintenance
1. Monthly Checklist
2. Equipment Maintenance
iv. On-Demand Help Desk Services
v. Basic Technology Troubleshooting
VIII. PsychPartner Data Collection and Monitoring
a. Data Collections
i. Daily, Weekly, Monthly Statistics
ii. Voluntary Patient Questionnaire
iii. Host Site Survey Tracking
IX. PsychPartner Telepsychiatry Present and Future Planning
a. Advisory Board
b. Working Groups
i. Monthly PsychPartner Coordinators Meeting
c. Promotion and Marketing
X. Additional Resources
XI. Appendix
12
Mission Statement
PsychPartner telepsychiatry communication software strives to connect, collaborate and
enable primary care providers in rural, need-based settings directly with specialized psychiatric
providers through real-time, virtual collaboration to deliver patients with greater access to
clinically effective specialized psychiatric treatment and higher quality care.
I. Telehealth and Telepsychiatry Overview
Telehealth is defined as the innovative, technological process of providing
healthcare from any distance through a technology-based platform. This may include
forms of videoconferencing, on-demand medical services or various forms of
communication technology. Telehealth, also known as Telemedicine, can be a very useful
resource as it can support and promote long-distance clinical health care, various forms of
patient and professional health-related education and even public health alerts.
Telepsychiatry is defined as a subset of telehealth or telemedicine that involves
providing a vast range of psychiatric services remotely over small or large distances,
including remote and rural areas. Psychiatric services may include, but are not limited to,
diagnostic psychiatric evaluations, therapy and counseling services (including individual
therapy, couples therapy, family therapy, group therapy), patient psychoeducation, case
management, and psychopharmacology and medication management. Psychiatric care
can be directly delivered in a real-time, interactive, live platform or through recoding of
past medical information for communication and review (videos, images, notes, etc.).
13
a. Types of Telehealth
There are various types of telehealth in today’s current technological landscape.
Current technologies include encrypted internet communication, videoconferencing,
store-and-forward imaging, direct-streaming media and wireless-terrestrial
communication. The different telehealth applications include Mobile Health
(mHealth), Remote Patient monitoring (RPM), Live Videoconferencing
(synchronous), and Store-and-Forward videoconferencing (asynchronous). Mobile
Health (mHealth) is the provision of health care and public health information
through a mobile device or smart phone application software. This health care
information can include patient appointments, prescription lists, general medical
education, patient-provider communication, or notification about certain illness or
disease outbreaks. Remote Patient monitoring (RPM) is the connected use of
electronic and technologically-based tools that record a patient’s personal medical
health data all in one location that can be used by various providers in various
locations. Many of today’s hospitals use this technologically for their patient medical
record systems. Live Videoconferencing (synchronous) is the use of a two-way
audiovisual technology link between patients and a provider or medical institution as
a form of communication. Store-and-Forward videoconferencing (asynchronous) is
one of the more widely used formats of telehealth and it involves the communication
and transmission of documentation and recording of medical health history to another
health provider or specialist.
b. Telepsychiatry Introduction and Overview
14
i. Introduction of PsychPartner Telepsychiatry Software Innovation
PsychPartner is a telepsychiatry communication software that connects
primary care providers in real-time access to specialized psychiatric providers
through a combination of virtual treatment collaboration and clinically
effective specialized psychiatric treatment (CESPT) with a goal to provide
engaged and improved patient care.
ii. Key Program Phases
The key program phases of PsychPartner telepsychiatry software initiative
and collaboration go far beyond the actual six-month pilot program. The
initial innovation and design of the PsychPartner initiative began with the
identification of the problem of patient access around the United States to
comprehensive mental health care treatment. Through a thorough examination
of rising rates of mental health and substance use disorders in adults in the
United States, there was a clear understanding that those living in rural or
nonmetropolitan areas were experiencing a gross inability to access
psychiatric treatment. Further research locally within the state of
Massachusetts showed that Hampden County, the states’ poorest county and
county with the most limited access to healthcare, also had limited resources
for psychiatric treatment and assessment. After two plus years of collaboration
with community healthcare clinics, mental health providers, methadone
clinics, non-profit programs, shelters, hospitals, insurance companies, local
politicians, there was the determination to partner to provide a more
innovative and creative approach to mental health delivery in western
15
Massachusetts. Our collaboration led to an advisory board of experts in. the
field of healthcare and mental health. Partners Healthcare Inc. had
psychiatrists that displayed an interest in participating in volunteer efforts to
help bridge this healthcare gap and after examination of community resources
in western Massachusetts, Chicopee Health Center soon was on board to be
the initial host site of PsychPartner. This concluded our outreach and planning
phase. Once the framework for PsychPartner was established, software
developer AthenaHealth assisted in the concrete development of the
PsychPartner telepsychiatry software. For HIPAA compliance, iClickCare
joined forces with PsychPartner as a consultant to provide the utmost security
and privacy for our providers and patient clientele. PsychPartner
telepsychiatry software is currently implementation ready for the May 1
st
,
2020 “go live” date when the six-month pilot program begins which will be
our implantation phase. There will be a four-hour training required by all
providers enrolled in the PsychPartner program and will take place at each
site. During the PsychPartner pilot program and immediately following the
pilot, the evaluation phase of data, effectiveness and patient engagement will
occur. This phase will help PsychPartner determine the effectiveness of the
program as an innovative mental health delivery platform and weigh future
program effectiveness versus a cost-benefit analysis. PsychPartner and its
pilot program aims to directly impact the treatment that primary care
providers give to patients with mental health substance use disorders by
improving diagnosis, assessment and treatment of this patient population.
16
iii. PsychPartner Telepsychiatry Pilot Program
1. Problem: Patient Access to Psychiatric Care in Hampden County
2. Collaboration: 25 Psychiatric Providers from Partners Healthcare
Inc., Massachusetts community members, healthcare providers,
politicians, social policy leaders, health insurance companies
3. Pilot: 12 Primary Care Physicians Chicopee Health Center will use
PsychPartner and be trained on how to use PsychPartner
4. Implementation: Providers use integrative telepsychiatry software to
enhance treatment
5. Patients: Receive improved, appropriate psychiatric care through
consultation
6. Outcomes: Impact on patient health, reduction of high-risk scenarios,
effectiveness as a mental health delivery intervention
II. Key Partners
a. Chicopee Health Center, Chicopee, Ma (Rural Healthcare Host Site)
Chicopee Health Center is a community-based, federally funded non-profit
community health center located in Chicopee, Massachusetts that will serve as the
primary care pilot program host site and 12 of their primary care providers will
participate in the pilot program. Chicopee Health Center is located in the southwestern
part of the state of Massachusetts and provides healthcare services to the communities
throughout Chicopee and the Pioneer Valley. The Pioneer Valley of Massachusetts has
the highest rate of poverty in the state as well as the least amount of healthcare providers
17
per capita. Chicopee Health Center serves more than 2,400 patients per year with a staff
of 200 which includes 30 full time medical and dental providers, 30 nurses, 50 bilingual
medical and dental assistants, case managers, outreach workers, administrators, and
financial counselors. Chicopee Health Center never refuses a patient seeking healthcare
due to inability to pay. They are a community healthcare program committed to the idea
that healthy families make healthy communities and there must be a commitment to both.
b. Partners Healthcare Incorporated, Boston, Ma (Psychiatric Collaboration Site)
Partners Healthcare, Inc. is a large, not-for-profit healthcare system based in
Boston, Massachusetts and will provide the 25 specialty psychiatrists for the
PsychPartner pilot program. Qualifications for PsychPartner Psychiatric Providers (25
Specialty Psychiatric Providers from Brigham and Women’s Hospital and Massachusetts
General Hospital were chosen) PsychPartner Board of Advisors conducted interviews
with each provider based on their qualifications. Partners Healthcare, Inc. was founded in
1994 by Brigham and Women's Hospital and Massachusetts General Hospital, Partners
Healthcare, Inc. includes community and specialty hospitals, a health insurance plan, a
physician network, community health centers, home care and long-term care services,
and other health care entities. Collaboration among their institutions and health care
professionals is central to their efforts to advance the field of healthcare.
i. Brigham and Women’s Hospital, Boston, Massachusetts
Brigham and Women’s Hospital (BWH) is a world-renowned hospital
serving virtually every area of adult medicine and healthcare. It is a teaching
hospital of Harvard Medical School. Brigham and Women’s Hospital’s
mission is based in state-of-the-art treatments and technologies, patient- and
18
family-focused care, patient quality and safety, and biomedical breakthroughs
to improve the health of people around the world.
ii. Massachusetts General Hospital, Boston, Massachusetts
Massachusetts General Hospital is the original and largest teaching
hospital of Harvard Medical School and a biomedical research facility located
in Boston, Massachusetts. It is the third oldest general hospital in the United
States and is one of the two founding members of Partners HealthCare, the
largest healthcare provider in Massachusetts. Massachusetts General Hospital
conducts the largest hospital-based research program in the world and is
currently ranked as the #2 best hospital in the United States by U.S. News &
World Report.
c. About AthenaHealth (Software Developer)
AthenaHealth, Inc. is a private American company based in Watertown,
Massachusetts that provides network-enabled services for healthcare and
point-of-care mobile apps in the United States. AthenaHealth has a network of
more than 160,000 providers and 110 million patients and offers a suite of
services to manage medical records, revenue cycle, patient engagement, care
coordination, and population health. AthenaHealth is the software developer
that has provided both guidance and basic framework that has functionally
created the software for PsychPartner. During the pilot program, software
technicians from AthenaHealth will provide daily IT support and
troubleshooting for pilot program participants.
d. About iClickCare (HIPAA Encryption Software Developer)
19
iClickCare is a telemedicine application software developer that
specializes in the creation of and building the structure for HIPAA-
compliancy in telemedicine apps. iClickCare will be providing the software
and IT engineering to enable PsychPartner software to be a HIPAA compliant
application with secure medical messaging, virtual video sessions and protect
patient's demographics. iClickCare has also assisted with the coordination of
the patient distribution of the Patient Reported Outcome Measures (PROMs)
electronic questionnaires.
e. Partners Healthcare IT (Telehealth Technology Support Contractor)
Partners Healthcare, Inc. will be providing the information technology,
enterprise research infrastructure and support services for those providers
using the PsychPartner telepsychiatry software during the pilot program.
Partners Healthcare IT is available 24 hours a day at (857)282-7001.
f. Massachusetts Department of Public Health (State Organization, DPH)
The Massachusetts Department of Public Health regulates, licenses and
provides oversight of a wide range of healthcare-related professions and
services. Additionally, the Department focuses on preventing disease and
promoting wellness and health equity for all people. Information is available
for residents, providers, researchers, and stakeholders. The Massachusetts
Department of Public Health will be providing regulation and structure
guidelines for the PsychPartner pilot program.
g. PsychPartner Advisory Board
20
• Jennifer Blewett, MSW, LICSW Clinical Social Worker, Clinical Care
Coordinator at Massachusetts General Hospital
• Marc Bolduc, MSW, LICSW, CADC-II, CGP Clinical Social Worker, Group
Psychotherapy Program at Massachusetts General Hospital
• Marlene Freeman, MD Associate Medical Director, Clinical Trials Network &
Institute; Director of Clinical Services, Perinatal and Reproductive Psychiatry
Program at Massachusetts General Hospital; Associate Professor of Psychiatry,
Harvard Medical School
• Emily Greising, MSW, LICSW Program Manager at Wide Horizons For
Children
• John Kelly, PhD Staff Psychologist and the of the Director Recovery Research
Institute at Massachusetts General Hospital; Professor of Psychiatry in Addiction
Medicine at Harvard Medical School
• Laura Kehoe, MD Assistant Director, Primary Care Medicine at Massachusetts
General Hospital
• Roy Schoenberg, MD President and CEO, American Well (AmWell) Telehealth
and consultant to Blue Cross Blue Shield (Massachusetts)
• Elizabeth Wharff, PhD, MSW, LICSW Psychiatry Social Work Supervisor;
Director, Boston Children’s Hospital; Assistant Professor of Psychiatry, Harvard
Medical School
III. Definitions
a. Clinical Definitions
21
Client/Patient: This term refers to the patient or client that is receiving the treatment
from the primary care provider during the PsychPartner pilot program at Chicopee
Health Center.
Clinical Services: This term includes the virtual consultations that are recommended
by the specialty psychiatric providers that are employed by the Partners Healthcare
Inc. sites that will provide the specialty psychiatric consultation, assessment,
evaluation and clinical recommendations to support patient care at Chicopee Health
Center.
Clinical Support: These are the services that will be provided by the specialty
psychiatric providers at the psychiatry host site.
Educational Services: This refers to the educational services and training that will be
provided by the specialty psychiatric providers at the two host sites at Partners
Healthcare Inc. (Brigham and Women’s Hospital).
Endpoint: Is the actual videoconferencing telepsychiatry physical equipment at each
site (primary care host site and specialty psychiatric provider host site) which will be
using either a laptop or a desktop unit in the providers office in a healthcare facility.
Healthcare Provider: This is the healthcare provider (in this case primary care
provider) that is a medical professional that will be evaluating the patient in real-time
and is requesting psychiatric consultation via PsychPartner telepsychiatry. During the
6-month pilot program, this will be a primary care provider at Chicopee Health
Center.
22
Host or Healthcare Provider Site: This is the site at Chicopee Health Center where
primary care providers will initiate the PsychPartner telepsychiatry virtual
collaboration regarding a patient request or consultation.
Referral or Partners Healthcare Inc. Site: This is the telehealth/telepsychiatry site
where the specialized psychiatric provider connects with PsychPartner to collaborate
virtually with the primary care provider. This site is the receiver of the PsychPartner
request.
Site Contact: The site contact is the direct contact person at each site to provide
guidance, instruction and troubleshooting during the PsychPartner program.
Telehealth/Telemedicine: Telemedicine or also commonly referred to as Telehealth
is an innovative practice that allows healthcare professionals to evaluate, diagnose
and effectively treat patients while using telecommunications technology.
Telemedicine is becoming an increasingly important part of the healthcare
infrastructure in the United States.
Telepsychiatry: Telepsychiatry is an innovative practice in virtual healthcare that
employs telemedicine directly to the field of psychiatry. It is the delivery of
psychiatric evaluation, assessment and care via a specific telecommunications
technology, commonly videoconferencing.
Virtual Room: Is the virtual meeting space for videoconferencing used to connect
multiple sites (two or more) using a specific designated site or call-in number with
PsychPartner. Each participant will with join the same room or dial-in site that has
been assigned the PsychPartner software.
b. Technical Definitions
23
Bandwidth: This is the amount of information that can be transferred during one
period of time over a specific internet network.
Codec: This is the specific hardware responsible for the input and output of the
PsychPartner virtual telepsychiatry video and audio during the telepsychiatry virtual
session. It allows both endpoints of the PsychPartner telepsychiatry software to
communicate with each other.
Drops: This is the network cabling that is run through the data closet site at Chicopee
Health Center that connects a secure internet network connection to a port.
Firewall: This is a network security system that monitors and controls information in
and out of the network firewall into a security platform.
Health Information Network (HIN): This term refers to a set of standards, policies,
and procedural measures that permits the secure exchange of private and secure
patient health insurance information over the internet during the PsychPartner
program.
Integrated Services for Digital Network (ISDN): This is the act of transmission of
either audio or virtual videoconferencing over a network.
IP Address (Internet Protocol Address): This is the address label for each device
that will be utilizing PsychPartner at the Chicopee Health Center site that identifies
each device on the network. This provides each device address with a specific
location.
Point-to-Point: This is the direct connection between two PsychPartner virtual video
conferencing endpoints (primary care site) where one endpoint is calling/connecting
24
to the other endpoint’s IP address at the specialty psychiatric sites (Brigham and
Women’s Hospital, Massachusetts General Hospital).
Port/Jack: Is the term used to describe where the telehealth unit is connected to the
telehealth/telepsychiatry network for usage. The port/jack on the wall will be labeled
at the primary care site at Chicopee Health Center with “telehealth” or
“PsychPartner” label reference name.
Router: Is a network device that directs internet network traffic.
IV. Telepsychiatry Program Design (PsychPartner)
a. Introduction to PsychPartner Encrypted Telepsychiatry Communication Software
Welcome to PsychPartner, an innovative telepsychiatry software and
collaborative program designed to improve direct mental health assessment,
evaluation and treatment provided by primary care providers through direct, real-time
consultation with specialty psychiatric providers. PsychPartner will embark on its
inaugural pilot program that will take place over a 6-month period of time at
Chicopee Health Center in Chicopee, Massachusetts located in Hampden County.
Partners Healthcare Inc. based in Boston, Massachusetts has partnered with
PsychPartner to provide the 25-speciality psychiatric providers (board certified
psychiatrists). During the 6-month PsychPartner telepsychiatry pilot program began
with identification of the major systemic problem, which is patient access to
psychiatric care and treatment in Hampden County in Massachusetts. From there a
collaborative was built between the PsychPartner advisory board, community-based
providers in Hamden County, psychiatric specialists in Boston, Massachusetts, and
25
clinicians from the mental health field in Massachusetts. The pilot program for
PsychPartner was devised to not only implement the PsychPartner software on a
preliminary basis but also to see over a short period of time the effectiveness of the
innovative telepsychiatry software. The implementation phase of the PsychPartner
pilot program will involve providers use the integrative telepsychiatry software to
enhance direct patient treatment by primary care physicians. Patients will receive not
only improved, direct mental health delivery services but also services that are
appropriate through psychiatric consultation. The outcome goals will be an positive
and direct impact on patient health, mental health, mortality and reduction of high-
risk scenarios.
b. Positions and Roles Supporting PsychPartner Telepsychiatry Program
During the PsychPartner six-month telepsychiatry program included several
position and roles supporting the PsychPartner initiative. The program’s staffing
model will include program leadership this is compromised of the PsychPartner
advisory board, a program director, PsychPartner pilot program coordinator, two
training and new user facilitators and a program assistant. The staffing model for
PsychPartner patient focused care includes the 25 specialty psychiatric providers from
Partners Healthcare Inc (from either Brigham and Women’s Hospital and
Massachusetts General Hospital), 12 primary care providers from Chicopee Health
Center in Chicopee, Massachusetts. PsychPartner is a telepsychiatry software that
included software and technology staffers (most volunteering their time and
expertise) which include a PsychPartner telehealth technical lead, 3 software
installation associates from AthenaHealth, and 5 software engineers from iClickCare
26
HIPAA compliant encryption services. PsychPartner also has one volunteer research
assistance that is responsible for pilot program data collection and analysis.
c. Current Telepsychiatry Programs, Initiatives and Software Applications
There are several forms of telehealth and telemedicine on the market at this time
as this form of patient care is the largest form of direct-care healthcare within the
United States. PsychPartner telepsychiatry is unique in that is provides primary care
providers direct access to specialty psychiatric care in real-time live video
telepsychiatry services. The modality is provider-to-provider with on-demand
consultation and support through specialty real-time, on-demand provider
consultation services. The technology platform is direct videoconferencing and also
secure phone consultation as additional support to providers. Technology
requirements include utilization of encrypted broadband internet access through a
laptop or desktop computer. Through a comparative analysis of other telepsychiatry
programs include a review of Telemynd, SOC Telemed and Insight telehealth. These
programs also bring some similar components to PsychPartner, but none offer the
same innovative components that the PsychPartner modality has.
d. PsychPartner Telepsychiatry Sites
There are three sites with medical, healthcare providers that will be the foundation
of the PsychPartner pilot program. Chicopee Health Center in Chicopee,
Massachusetts in Hampden County which will provide the location site for the 12
primary care providers that will be participating in the PsychPartner pilot program.
The additional two sites that will provide the receiving end of the PsychPartner pilot
program and will be providing the 25 specialty psychiatric providers to provide
27
clinical consultation, assessment, evaluation and recommendations will be held at
Partners Healthcare Inc large hospital institutions located in Boston, Massachusetts at
Brigham and Women’s Hospital and Massachusetts General Hospital.
e. PsychPartner Telepsychiatry
PsychPartner (psychiatric collaborative network and innovative telepsychiatry
software that provides access to real-time interactive, on-demand network of
psychiatric professionals) will address the problem of inadequate access to
appropriate mental health services for patients and their provider populations that
have limited access to mental health services (example: nonmetropolitan populations)
which compromises healthy lives for marginalized populations (Improving Patient
Access to Psychiatric Treatment Through Primary Care and Telepsychiatry
Integration). This is important because unaddressed and untreated psychiatric
conditions must be treated and individuals and their providers should be able to
access treatment because all deserve access to mental health treatment no matter your
location, demographic or economic status.
f. Site Contacts
At each pilot program site there will be a designated PsychPartner program
assistant to aid in the coordination of the PsychPartner “go live” rollout, ongoing
communication, troubleshooting, consultation questions and emergency preparedness.
There will be a PsychPartner representative designated to each site: Chicopee Health
Center and Partners Healthcare Inc (Brigham and Women’s Hospital and
Massachusetts General Hospital).
g. PsychPartner Billing and Health Insurance Coverage
28
All patients are welcome, regardless of a patient’s ability to pay or what their
healthcare insurance may be, or if they do or do not have health insurance for care at
the Chicopee Health Center. During the 6-month PsychPartner telepsychiatry pilot
program, PsychPartner will not be charging any costs of program site (Chicopee
Health Center). Additionally, all patients seen by their primary care providers with a
provider participating in the PsychPartner telepsychiatry pilot program will not be
charged or billed for any services. PsychPartner will not be billing or in contact with
any patient healthcare coverage insurance companies during this pilot program. Any
services that they receive will be billed as part of their normative primary care or
urgent care appointment. All patients at Chicopee Health Center are welcome no
matter what health insurance they have or their ability to pay. The majority of their
patients have MassHealth healthcare insurance under the Affordable Care Act (ACA).
Chicopee Health Center does operate under a sliding scale model, which means that
not all pay may be free, depending on a patient’s income. Patients are required to
provide documentation for financial need in order to receive free services or services
at a reduced cost.
V. PsychPartner Telepsychiatry Program Process and Phases
a. Selection Process for Programming (Site Locations)
Three community-based healthcare sites were considered during the collaborative
process of working with a site interested in a telepsychiatry pilot program. Due to the
economic struggles and lack of access to psychiatric and. Specialized psychiatric
care, it was determined that Hampden County in Massachusetts was the county that
29
should host the pilot program as they would potentially see the largest benefit from
the services. Hampden County is also a two-hour drive from Boston and its major
medical hospitals and so Hampden County would benefit greatly from using a
virtual/telehealth software due to distance. Chicopee Health Center was chosen as the.
Primary Care Provider host site due to its location in Hampden County, the average
number of patients seen in the outpatient setting for primary care and because of the
high number of patients who have MassHealth for health insurance. MassHealth is a
state un health insurance that is available to all in Massachusetts under the Affordable
Care Act (ACA). After several meetings, Chicopee Health Center welcomed the
PsychPartner telepsychiatry software pilot program initiative with open arms.
b. Primary Care Provider Approval Process
Due to the size of the Chicopee Health Center, the number of medical doctors
providing primary care at the size, it was determined that 12 primary care doctors
would take place in the PsychPartner pilot program. All 12 primary care doctors that
volunteered to take part in PsychPartner were admitted to partake in the pilot
program. All 12 doctors are medical doctors and hold a license to practice in the state
of Massachusetts. The doctors all have worked at the Chicopee Health center for at
least two years and have an interest in learning more about the best delivery of mental
health and substance use treatment in a community-based community healthcare
setting with their patients. All providers have at least an intermediate understanding
of video conferencing and technology skills.
c. Psychiatric Specialty Provider Selection Process
30
Qualifications for PsychPartner Psychiatric Providers (25 Specialty Psychiatric
Providers from Brigham and Women’s Hospital and Massachusetts General Hospital
were chosen) PsychPartner Board of Advisors conducted interviews with each
provider based on their qualifications. Providers were asked in September 2018 to
volunteer for the program if interested in participating in this innovative,
collaborative mental health delivery software. After a careful selection process by the
PsychPartner Advisory Board, 25 specialty psychiatric providers. The following
qualifications were required to apply to partake in the program:
• Current and valid board certification in psychiatry
• Medical degree from an accredited medical school and completion of an
approved psychiatric residency
• Licensed to practice medicine in state of Massachusetts
• Current DEA registration
• Excellent knowledge and familiarity with current DSM criteria
• Familiar with crisis assessment tools and techniques
• Strong working knowledge of general psychiatric principles and practices
• Must possess excellent interpersonal and communication skills, perceptive
skills, strong listening skills, and be excellent critical thinkers
d. PsychPartner Telepsychiatry Education and Training Process
Prior to the start of the 6-month PsychPartner pilot program, there will be a
mandatory training for both the 12-primary care providers from Chicopee Health
Center as well as a training for the 25-psychiatrists from Partners Healthcare Inc.
These orientations will be split by provider discipline (primary care providers from
31
Chicopee Health Center Orientations and psychiatrists from Partners Healthcare Inc).
Orientations will last 4- hours in length and will be led by PsychPartner staff with
representatives from AthenaHealth and Partners Healthcare Inc. Information
Technology (IT) Department. These orientations will take place virtually through a
virtual Zoom meeting on Monday, April 20
th
, 2020 and Tuesday, April 21
st
, 2020.
There will be additional 1-hour sessions provided throughout the last two weeks of
April for any providers that would like to meet directly with PsychPartner staff or
have additional questions. Orientations for providers will include an introduction to
the PsychPartner telepsychiatry software, introduction to PsychPartner staff, mission
of PsychPartner, review of software and technology requirements, and the below
curriculum:
Core Competencies of PsychPartner Telepsychiatry Software
1. Definition of Telehealth, Telemedicine, Telepsychiatry
2. Demonstrate an understand of the role of Primary Care Provider versus Psychiatrist
implementing telepsychiatry within the outpatient community-based healthcare clinic
3. Demonstrate competency to support the patient and their needs throughout
telepsychiatry consultation while utilizing PsychPartner software
4. Demonstrate an understanding of the importance of PsychPartner consult requests,
treatment preparation, quality and safety, patient support, and follow-up care.
e. PsychPartner Telepsychiatry Clinical Guidelines
PsychPartner follows the clinical guidelines as recommended by the American
Telemedicine Association. These guidelines include 1. Gather professional and
patient identity and location. 2. Determine whether your patient can handle and
32
benefit from telemedicine appointments. 3. Get informed consent. 4. Create an
acceptable physical environment for the appointment. 5. Have an emergency
management plan in place. 6. Use quality videoconferencing equipment and
applications. 7. Have a backup plan for technology glitches. 8. Take all precautions to
ensure privacy of the appointment. PsychPartner believe that all patient care and
transmission of healthcare information as a critical and secure component of the
telepsychiatry program.
f. Access to PsychPartner Telepsychiatry On-Demand Consultation Request
Connecting and “logging on” to PsychPartner is simple. A provider would click
on the PsychPartner icon on their desktop (this icon and feature will already be
downloaded, and software will be pre-loaded by PsychPartner technology staff prior
to the start of the pilot program), they then would be. Prompted to login and sign into
their username and enter their secure password. PsychPartner participant usernames
will be assigned during provider orientations in April 2020 and providers will have
the opportunity to pick their password at that time as well. Primary care provides
would then click on the button that says, “connect to a psychiatrist” and would be
connected through the PsychPartner telepsychiatry software application directly to a
specialty psychiatrist from a Partners Healthcare Inc. hospital (Brigham and
Women’s Hospital or Massachusetts General Hospital). Provider requesting to
connect with a psychiatrist can either chose to have a videoconference call or a voice-
line only call with the provider. Within a few moments, a videoconferencing image
would appear.
g. Connecting to Psychiatric Collaboration Host Site (Partners Healthcare Inc.)
33
At the time that a primary care provider from Chicopee Health Center initiates a
consultation request (psychiatric consultation, assessment, evaluation or treatment
planning for their patients) through the PsychPartner software platform, PsychPartner
will electronically connect the primary care provider to a psychiatrist at Partners
Healthcare Inc. The alert is received two ways: there is a direct “page” sent to the
psychiatric providers’ beeper/pager denoting that there is a PsychPartner consult
request and there is also a message sent to the psychiatrist through their login within
the PsychPartner telepsychiatry software (a message alert appears on the screen and
also makes an “alert sound”).
h. Confidentiality and Privacy
PsychPartner telepsychiatry software application is dedicated to protecting
patients’ private health information and safeguarding the highest level of
confidentiality of medical and healthcare records. The PsychPartner privacy policy
defines the medical information gathered, how any sensitive patient healthcare
information is used, and the standards and procedures designated to protect at the
highest level any personal, sensitive, nonpublic medical information. All
PsychPartner staff, its advisory board and providers strictly adhere to this privacy
policy and the security practices and procedures described herein to ensure the
confidentiality of all patient private health information (PHI).
i. Telehealth/Telepsychiatry Equipment, Software and Technology
i. Telepsychiatry Checklist
34
Please see Telehealth/Telepsychiatry Equipment below section for more
information on specific technology hardware, connectivity and bandwidth
required for the pilot program.
VI. PsychPartner Collaboration On-Demand Appointments
a. Roles of Primary Care Provider Initiating Collaboration
PsychPartner telepsychiatry software allows a primary care provider direct access
to both a virtual, on-demand consultation with a specialty psychiatrist as well as the
ability to review a patient current symptoms, disposition and possible treatment
planning. During the 6-month PsychPartner pilot program, primary care providers at
Chicopee Health Center using the PsychPartner telepsychiatry software will be able
to use PsychPartner to impact their direct patient care in two ways. One primary care
providers can sign-in to the PsychPartner software, which will have been downloaded
on to the hard drive of their office desktop at the Chicopee Health Center, and be able
to request a real-time, on-demand, virtual consultation with a psychiatrist with
specialized psychiatric training) to provide consultation to the primary care provider
and the patient. The other option is for the primary care provider to use PsychPartner
prior to or following the patient appointment. Primary care providers that would like
to receive psychiatric and psychopharmacologic consultation can use PsychPartner to
connect with a psychiatric provider (psychiatrist) from Partners Healthcare Inc.
b. Roles of Psychiatric Treatment Provider Assisting with Treatment
PsychPartner affords primary care providers to directly connect with board
certified, specialty trained psychiatrists at Partners Healthcare Inc. Psychiatrists will
35
be available “on call” through the PsychPartner telepsychiatry software 12- hours per
day, with a further goal to be able to offer the service 24-hours per day. Any primary
care provider that needs psychiatric consultation, assessment, evaluation or treatment
planning for their patients can request assistance with a psychiatrist through the
PsychPartner software. PsychPartner will electronically connect the primary care
provider to a psychiatrist at Partners Healthcare Inc. The alert is received two ways:
there is a direct “page” sent to the psychiatric providers’ beeper/pager denoting that
there is a PsychPartner consult request and there is also a message sent to the
psychiatrist through their login within the PsychPartner telepsychiatry software (a
message alert appears on the screen and also makes an “alert sound”). Psychiatrist
will be scheduled for specific 2-hour slots during the week as to when they. Are “on
call” with their availability. During their allotted shift for PsychPartner, psychiatrists
should be logged-in to PsychPartner and should be monitoring the PsychPartner
referral system in the event a primary care provider requests a psychiatric
consultation. During the 6-month pilot program, psychiatrists will be directly
connected to the primary care provider at Chicopee Health Center through the
PsychPartner software.
c. Documentation
All service providers (primary care providers and psychiatrist) enrolled in the
PsychPartner telepsychiatry software pilot program must follow the clinical record
documentation policies and standards as followed by all medical providers within the
Commonwealth of Massachusetts and under the Massachusetts Department of Public
Health. Similar to psychiatrists, the primary care providers at Chicopee Health Center
36
must make sure to fully document each patient visit and document that if a
PsychPartner consultation occurred during the live patient appointment. If
PsychPartner telepsychiatry was used before or after the patient appointment, then
documentation is not required. Psychiatric documentation should include but is not
limited to documentation on all mental health services provided, including
assessment, evaluation, plan development, psychotherapy, case management or
referral recommendations, medication management and support and any collateral.
d. Follow Up Treatment and Requirements
Any primary care provider that meets with a patient in a primary care setting does
not require follow-up treatment with the primary care provider, however it is highly
recommended that all individuals meet with their primary care provider annually.
During the PsychPartner telepsychiatry pilot program, providers will be asked to
complete follow-up appointments with patients engaged in treatment with their
primary care providers and who are in treatment for mental health and substance use
disorders. If a patient has been recently presented to the emergency room or been
admitted to the hospital for inpatient treatment, it is a requirement that the primary
care provider follow-up with the patient regarding their disposition within one week.
e. Quality Assurance
During the 6-month PsychPartner pilot program, quality assurance and patient
care will be the priority during this time period. As telehealth and telemedicine have
become more widely used and expected in healthcare as a communication treatment
tool it is important to ensure that the quality of effectiveness of this form of
psychiatric treatment be maintained. Recent research studies have questioned the
37
ability to maintain quality assurance while utilizing a telehealth or telemedicine
module of treatment. The goal of the PsychPartner program is to improve the mental
health assessment, evaluation and treatment of patients by having their primary care
providers be better equipped with the increased knowledge and ability to consult
specialty psychiatrists. Patient adherence and engagement in treatment with their
primary care providers remains the same as if the patient were being seen by the
psychiatrist directly within the office setting. Throughout the 6-month pilot program,
there will be monitoring and evaluation of quality of care in collaboration with
Partners Healthcare Inc providers.
f. Safety Reporting
In the case of a perceived or an acute psychiatric emergency where a patient is
reporting that they are feeling unsafe (either toward themselves or toward others) it is
mandatory by law that notification of others is required. In the state of Massachusetts,
a Section 12 order can be filed by a medical doctor when the admission of an
individual to a general or psychiatric hospital for psychiatric evaluation or treatment
is deemed necessary due to risk of harm to themselves or others. This is an
involuntary section and patient must go to the hospital for evaluation for a minimum
of 72 hours. If patient is experiencing a psychiatric crisis and is willing to go to the
nearest emergency room or call 911, then there may be no need to file a section 12 as
the patient is voluntarily seeking treatment. PsychPartner psychiatric providers can
always be asked to consult when there may be question of safety reporting or a need
to seek a higher level of care for the patient.
g. Emergency Telepsychiatry Services
38
In the case of a perceived or an acute psychiatric emergency where a patient is
reporting that they are feeling unsafe (either toward themselves or toward others),
notification of others is required. If the primary care provider at Chicopee Health
Center determines and observes that a patient is in need of emergency services for a
psychiatric emergency a PsychPartner psychiatrist can be contacted (during the 6-
month pilot program, a designated Partners Healthcare Inc. provider will be on call 24
hours for any psychiatric emergency to provide assessment and evaluation) but in the
context of safety to both the patient and others, it is recommended that the patient
present to the nearest emergency room or that 911 services be called. The BEST team
(Boston Emergency Services Team) out of Massachusetts General Hospital and North
Suffolk Mental Health can be a secondary option when there is a psychiatric crisis.
The BEST team is a mobile unit that presents directly to a patient’s home in the case
of a psychiatric emergency. A clinician observes the patient and makes a clinical
determination for hospitalization or a filing of section 12. In the state of
Massachusetts, a Section 12 order can be filed by a medical doctor when the
admission of an individual to a general or psychiatric hospital for psychiatric
evaluation or treatment is deemed necessary due to risk of harm to themselves or
others.
VII. PsychPartner Telepsychiatry Technical Support
a. Partners Healthcare IT (Telehealth Technology Support Contractor)
Partners Healthcare Inc. will be the technical lead who will be responsible for all
technical support during the PsychPartner pilot program. Support will include
39
providing the information technology, enterprise research infrastructure and support
services for those providers using the PsychPartner telepsychiatry software during the
pilot program. Partners Healthcare IT is available 24 hours a day at (857)282-7001.
i. Technology System Requirements (Host Site)
Technology requirements for the 12-primary care providers at the
Chicopee Health Center host site are access to a computer, with camera for
teleconferencing, mouse and keyboard (laptop or desktop unit). Internet
access is required, and an appropriate bandwidth will need to be in place.
Also, a secure internet firewall is required for the network security system.
Prior to the rollout of the PsychPartner telepsychiatry software pilot program,
two PsychPartner staff members and a representative from AthenaHealth will
lead a test “go live” software run to confirm there are no
technology/connectivity problems at the Chicopee Health Center. Providers
can contact the PsychPartner Telehealth Technical Lead for IT support during
the pilot program. All providers will be taught during the one-day, four-hour
PsychPartner orientation on videoconferencing etiquette and have a. review of
the basic. Process and policies of PsychPartner.
ii. Technology System Requirements (Psychiatric Collaboration Site)
Technology requirements for the 25-primary care providers at both of the
Partners Healthcare Inc. locations (Brigham and Women’s Hospital,
Massachusetts General Hospital) sites are psychiatrists must have access to a
computer, with camera for virtual visits and teleconferencing, mouse and
keyboard (laptop or desktop unit). Broadband bandwidth for internet access is
40
required and should be broadband, highspeed internet. A secure internet
firewall is required for the network security system. Prior to the initial rollout
of the PsychPartner telepsychiatry software pilot program, two PsychPartner
staff members and a representative from AthenaHealth will lead a test “go
live” along with IT from Partners Healthcare Inc. All providers will be taught
during the one-day, four-hour PsychPartner orientation on videoconferencing
etiquette and have a. review of the basic. Process and policies of
PsychPartner.
iii. PsychPartner Technical System Maintenance
1. Monthly Checklist
On a monthly basis the PsychPartner Technical Lead staff member
along with Partners Healthcare Inc. IT staff and two developers from
AthenaHealth will conduct a monthly review of the. PsychPartner
telehealth software system and review any troubleshooting issues,
challenges and review that all videoconferencing equipment is
working properly. These monthly system checks will take place in the
overnight hours as to not disrupt direct patient care.
2. Equipment Maintenance
No equipment maintenance is required for any of the technology or
PsychPartner software. Any unplanned equipment maintenance will be
conducted at Partners Healthcare facilities through Partners Healthcare
IT support. Any equipment or. Technology maintenance required at
the Chicopee. Health Center should be coordinated by The
41
PsychPartner Telehealth Technical Lead for IT during the 6-month
pilot program.
iv. On-Demand Help Desk Services
The PsychPartner Telehealth Technical Lead for IT support during the
pilot program will be available 24 hours a day for both sites, Chicopee Health
Center and Partner Healthcare Inc hospitals. Additionally, Partners
Healthcare, Inc. IT is available 24 hours a day at (857)282-7001.
v. Basic Technology Troubleshooting
If a provider at any of the sites determines there is a problem with either
telehealth equipment or the PsychPartner software, there are some basic
troubleshooting tips that the healthcare provider can attempt prior to contact
IT support, such as checking internet connection, power connection (wall
outlet, screen cord, mouse, keyboard) or if there are any wireless components
(batteries or are they charged. Providers can contact the PsychPartner
Telehealth Technical Lead for IT support during the pilot program and has the
ability to gain remote access for troubleshooting and testing purposes.
Partners Healthcare IT support should be contacted immediately once a
problem is determined with PsychPartner as to not delay or negatively impact
any treatment support for patient care. Support will include providing the
information technology, enterprise research infrastructure and support services
for those providers using the PsychPartner telepsychiatry software during the
pilot program. Partners Healthcare IT is available 24 hours a day at (857)282-
7001.
42
VIII. PsychPartner Data Collection and Monitoring
a. Data Collections
i. Daily, Weekly, Monthly Statistics
PsychPartner advisory board will work with program participants (Primary
Care Providers) to gather feedback to evaluate and further improve
implementation of the PsychPartner software program. Participants will be
asked to complete a five-question satisfaction survey of the program weekly.
The survey will be sent electronically through an email to each provider.
Providers are also encouraged to contact PsychPartner administration with any
urgent complaints or problems. Additionally, patients of Primary Care
Providers at Chicopee Community Health will be asked at random the
satisfaction of their care and current health symptoms through electronic
Patient Reported Outcome Measures (PROMs) and all answers are
anonymous.
ii. Voluntary Patient Questionnaire
During the 6-month PsychPartner pilot program, patients seen by the 12-
primary care providers that will be implementing PsychPartner at Chicopee
Health Center will be provided an iPad to participate in an anonymous,
survey. The survey used will be the Patient Reported Outcome Measures
(PROMs) survey and all results will be electronically submitted to the
PsychPartner research assistant. Following the completion of the PsychPartner
pilot program, a qualitative analysis of the patient data will be reviewed and
43
effectiveness vs future cost-benefit analysis of the program will be
determined.
iii. Host Site Survey Tracking
During the 6-month pilot program, both the 12-primary care providers at
Chicopee Health Center as well as the 25 psychiatric providers from Partners
Healthcare Inc. will be surveyed on their review of the PsychPartner program.
The primary care providers will take part in a weekly, 5-question email survey
that will be directly submitted to the PsychPartner advisory board. The
psychiatric providers will take place in a twice-a-month virtual survey with
the PsychPartner board that will conducted by the virtual Zoom
teleconferencing system.
IX. PsychPartner Telepsychiatry Present and Future Planning
a. Advisory Board: PsychPartner Advisory Board meets on a weekly basis on
Thursdays. Advisory Board members are part of a triangulation of communication
and information that is continuously received from program leadership, program
participants and Patient Reported Outcome Measures (PROMs). The goal of the
advisory board is to use qualitative analysis and innovation. Concept reflexivity will
be utilized to further evaluate the PsychPartner pilot program and to improve the
program for future use as a mental health delivery service. Meeting is held virtually
with a call-in option at (605)313-4118 using access code 690451.
List of Board Members:
• Jennifer Blewett, MSW, LICSW
44
• Marc Bolduc, MSW, LICSW, CADC-II, CGP
• Marlene Freeman, MD
• Emily Greising, MSW, LICSW
• John Kelly, PhD
• Laura Kehoe, MD
• Roy Schoenberg, MD
• Elizabeth Wharff, PhD, MSW, LICSW
b. Working Groups
There will be two forms of formal and organized committees that will be working
to evaluate and support participants and staff during the PsychPartner pilot program.
Such topics will be to evaluate the initial stages of the pilot program and its
effectiveness, technology troubleshooting, implementation strategies and provider
feedback.
i. Monthly PsychPartner Coordinators Meeting
For coordinators of the PsychPartner pilot program, monthly coordinator
meetings will be held virtually over Zoom videoconferencing calls. The goal
of these meetings is to provide an opportunity to receive ongoing feedback
regarding program implementation, updates, site visits, and ongoing strategic
planning.
ii. Advisory Board
PsychPartner Advisory Board meets on a weekly basis and members are
part of a triangulation of communication and information that is continuously
received from program leadership, program participants and Patient Reported
45
Outcome Measures (PROMs). The goal of the advisory board is to use
qualitative analysis and innovation. Concept reflexivity will be used to further
evaluate the PsychPartner pilot program and to improve the program for
future use.
c. Promotion and Marketing
Currently PsychPartner is developing numerous forms of marketing and
informational materials for further promotion of the PsychPartner software
collaborative. Forms of promotion materials that have been developed are brochures,
business cards, and posters for regional promotion. Future plans for promotion and
growth of the PsychPartner program are in preliminary stages.
X. Additional Resources
Levels of Psychiatric Health Care (Highest to Lowest)
I. Inpatient care
a. Inpatient Psychiatric Hospitalization (Acute Care): Is intended to stabilize a
mental health crisis. Takes place in an inpatient hospital setting and is intended
for people who need 24-hour care. Is often recommended for people who aren’t
able to care for themselves. Inpatient care is also needed for people who may
harm themselves or others. Includes group therapy. Also includes meetings with a
team of professionals, including a psychiatrist.
b. Inpatient Residential Treatment: Lower acuity of care than an inpatient
hospitalization facility and can be tried when additional available outpatient
approaches have failed. Is meant to be a short-term placement to stabilize the
46
person. Should take place as close to the person’s home as possible. May offer
group, individual, and family therapy.
II. Outpatient care
a. Partial Hospitalization Program (PHP): Is an intense, structured program and
involves treatment five to seven days per week for six hours each day. Can
include group, individual, and family therapy. Often includes an evaluation by a
psychiatrist. Is helpful for patients who are at risk of hospitalization or can be
utilized as a step-down for patients who have been hospitalized.
b. Intensive Outpatient Program (IOP): Is a structured treatment that teaches how to
manage stress and cope with emotional and behavioral issues. Involves frequent
visits (usually three to five days per week). Takes about three to four hours of
treatment per day. Often lasts four to six weeks. Is structured so patients can
continue with their normal daily routines.
c. Comprehensive Outpatient Treatment: There are various types of routine
outpatient care which include outpatient diagnostic psychiatric evaluations,
therapy and counseling services (including individual therapy, couples therapy,
family therapy, group therapy), patient psychoeducation, case management, and
psychopharmacology and medication management. Individual counseling and
psychotherapy include one-on-one sessions with a licensed therapist.
Psychopharmacological evaluation and medication management includes visits
with a psychiatrist or nurse practitioner. They can help decide whether medication
would be helpful. Group therapy includes weekly group sessions with other
47
people with mental health issues. Group therapy allows people to learn from one
another’s experiences.
d. 12-Step Programs (Please see below reference list): Are usually community-based
and free. Include programs such as Depressed Anonymous, Emotions
Anonymous, and the National Alliance on Mental Illness (NAMI). Allow you to
connect with other people in recovery and offer support and strategies for a
successful recovery.
Self-Help Groups and 12-Step Programs
Self-help groups, also known as mutual help, mutual aid, or support groups, are
groups of people who provide mutual support for each other. In a self-help group, the
members share a common problem, often a common disease or addiction.
AA - Alcoholics Anonymous http://www.aa.org/
Alcoholics Anonymous is an international fellowship of men and women who have had a
drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and
available almost everywhere.
Al-Anon/Alateen, for friends and families of alcoholics http://www.al-anon.org/
Al-Anon defines itself as an independent fellowship with the stated purpose of helping
relatives and friends of individuals with a history of alcohol or substance use.
Al-Anon
holds the view that alcohol use disorder is a family illness.
CA - Cocaine Anonymous http://www.ca.org/
Cocaine Anonymous is a fellowship of men and women who share their experience,
strength and hope with each other that they may solve their common problem and help
others to recover from their addiction. The only requirement for membership is a desire
to stop using cocaine and all other mind-altering substances.
CMA - Crystal Meth Anonymous http://www.crystalmeth.org/
Crystal Meth Anonymous is a fellowship of men and women who share their experience,
strength and hope with each other, so they may solve their common problem and help
others to recover from addiction to crystal meth.
48
GA - Gamblers Anonymous (Compulsive Gambling)
http://www.gamblersanonymous.org/ga/
Gamblers Anonymous is a fellowship of men and women who meet on a regular basis to
share their experience, strength, and hope in order to arrest their gambling and cope with
other gambling-related problems.
Gam-Anon/Gam-A-Teen http://www.gam-anon.org/
For friends and family members of problem gamblers- Gam-Anon groups are composed
of men and women who are husbands, wives, relatives or close friends of compulsive
gambler.
HA - Heroin Anonymous (Opioid Use) http://www.heroinanonymous.org/
Heroin Anonymous is a non-profit fellowship of men and women who have found a
solution to heroin addiction. HA is a fellowship of complete abstinence from all drugs
and alcohol.
MA - Marijuana Anonymous https://www.marijuana-anonymous.org/
Marijuana Anonymous is a fellowship of men and women who share our experience,
strength, and hope with each other that we may solve our common problem and help
others to recover from marijuana addiction.
NA - Narcotics Anonymous https://www.na.org/
Narcotics Anonymous (NA) describes itself as a "nonprofit fellowship or society of men
and women for whom drugs had become a major problem". Narcotics Anonymous uses a
traditional 12-step model that has been expanded and developed for people with various
substance use issues and it is the second-largest 12-step organization.
NicA - Nicotine Anonymous https://nicotine-anonymous.org/
Nicotine Anonymous is a non-profit 12-step fellowship of men and women helping each
other live nicotine-free lives.
OA - Overeaters Anonymous http://www.oa.org/
Overeaters Anonymous (OA) offers a program of recovery from compulsive overeating,
binge eating and other eating disorders using the Twelve Steps and Twelve Traditions of
OA. OA is not just about weight loss, weight gain, maintenance, obesity or diets.
OLGA - Online Gamers Anonymous http://www.olganon.org
Online Gamers Anonymous has created a 12- step recovery program designed
specifically for gaming addicts. In addition to this program, they also provide support
through their online community, which includes a gaming addiction forum, 24/7 chat
rooms, and scheduled weekly chats. http://www.olganon.org
SMART Recovery https://www.smartrecovery.org
SMART Recovery is an abstinence-oriented, not-for-profit organization for individuals
with addictive problems.
49
XI. Appendix
I. PsychPartner Telepsychiatry Software Program Initiative
II. PsychPartner Telepsychiatry Software Program Phases
III. PsychPartner Telepsychiatry Software Specifications
IV. PsychPartner Telepsychiatry Pilot Program
V. Functional Staffing Model
VI. Line Item Budget
VII. Professional References
VIII. PsychPartner Program Flowcharts
IX. Theory of Change Model
50
PsychPartner Telepsychiatry Software Program Initiative
Challenges
Patient Access to Psychiatric Care in Rural
Community Settings
Strategies
Building of Collaborative Community
Network
Telepsychiatry Communication Software
Connects Primary Care Providers
Real-time Access to Specialized Psychiatric
Providers
Virtual Treatment Collaboration
Benchmarks for Success
Clinically Effective Specialized Psychiatric
Treatment (CESPT)
Sustainability
Engaged and Improved Patient Care
51
PsychPartner Telepsychiatry Software Program Phases
Phase 1: Research and Building Partnerships and
Collaborations
Phase 2: Outreach and Planning
Phase 3: Implementation
Phase 4: Evaluation
Phase 5: Prospective Future
52
PsychPartner Telepsychiatry Software Specifications
Custom Application
PsychPartner is an innovative telepsychiatry software application that can be utilized by primary
care physicians (PCP’s) within a medical and clinical setting to connect in real-time directly
with specialty psychiatry providers (psychiatrists, psychopharmacologists) to help aid primary
care physicians with the direct treatment of their patients (diagnostic clarification, assessments,
medication management, referral recommendations). PsychPartner is a direct doctor-to-doctor
software application. This specification applies to the application software that would be shown
in 3-4 wireframe images.
Contents
1. Summary
2. User Personas
3. Permissions and Restrictions
4. Specifications
a. Login and Access
i. User Login Flow
ii. User Password Management Flow
b. User Sign Up
c. User Web Access
i. Module
ii. Module Media- PDF
iii. Module Media- Video
iv. File Upload
v. Add/Remove Media
d. Administrator User
i. User Object:
1. Administrator Site Wide Actions
2. Metrics Dashboard
3. View Module
4. Edit Module
5. Edit Categories
e. User Profile
i. Edit User Profile
ii. View User Profiles
f. Additional Technical Specifications
5. Marketing Microsite www.PsychPartner.com (Wordpress or Squarespace)
53
PsychPartner Telepsychiatry Pilot Program
Pilot Project Innovation: Proposal, Disrupt, Eliminate
Outcomes: Impact on patient health, reduction of high-risk scenarios
Patients: Receive improved, appropriate psychiatric care through
consultation
Implementation: Providers use integrative telepsychiatry software to
enhance treatment
Pilot: 12 Primary Care Physicians Chicopee Health Center will use
PsychPartner
Collaboration: 25 Psychiatric Providers from Partners Healthcare Inc.
Problem: Patient Access to Psychiatric Care in Hampden County
54
Functional Staffing Model
PsychPartner Staffing Model Allocation (Standard
Formula)
Subject to budget
availability
Program Leadership
Advisory Board
PsychPartner Director (1) Full time
Pilot Program Coordinator (2), 2 Part time
Training Facilitator (Pilot,
New User Utilization
Training)
(2), 1 Full time, 1 Part time
Program Assistant (1) Full time
Patient Focused Care
25 Psychiatric specialty
providers from Partners Health
Inc
15 Psychiatrists (15) Specialty Psychiatrists
10 Clinicians (5) Social workers, (5)
Psychologists
12 Primary Care Providers
(Chicopee Health Center)
(12) Providers
Software and Technology
Telehealth Technical Lead (1) Full time
Software Installation
(AthenaHealth)
(3) Full time from
AthenaHealth
HIPAA Encryption Software
Installation (iClickCare
HIPAA complaint encryption)
(5) Full time from iClickCare
Data Collection/Analysis
Research Assistant (1) Part time
55
PsychPartner Pilot Program Line Item Budget
56
Professional References
January 15
th
, 2020
To whom this may concern,
This letter is in admiration for the PsychPartner telehealth program. We are thrilled at
Massachusetts General Hospital in Boston, Massachusetts to be embarking on this new pilot
program that will begin this May. We are always looking for ways way to engage our patients in
new and innovative ways of treatment and we are excited to begin as a host for the PsychPartner
pilot program. Integration of both outpatient primary care and specialty psychiatric treatment is a
needed entity at this time as we receive the majority of our referrals from outpatient primary care
providers eager to seek help for their patients.
Through the pilot program of PsychPartner we hope to discover new ways to help care
for those individuals in our country who are in need of and deserving of the excellent and
comprehensive psychiatric treatment that Massachusetts General Hospital provides. We as a
department are looking forward to the PsychPartner pilot program in collaboration with Partners
Health Inc and the Chicopee Health Center located in Chicopee, Massachusetts. We are
enthusiastic that this pilot program provide a groundbreaking platform for future growth within
the field of primary care, psychiatry and virtual telehealth.
Please don’t hesitate to contact my office directly with any questions you may have
regarding this correspondence at (617)643-6919.
Sincerely,
___________________________________
Estee Sharon, PsyD
Clinical Psychologist
Department of Psychiatry
Massachusetts General Hospital
42 CFR part 2 prohibits unauthorized disclosure of these records.
WARNING! This patient information has extra protections and re-disclosure is generally prohibited.
• Do not copy and paste this information into other notes or documents.
• Do not further release, use, or share this information.
Questions? Contact MGH Privacy Office at 617-726-1098.
57
PsychPartner Program Flowcharts
Telepsychiatry
Communication
Software
Development
Real-time Access to
Specialized
Psychiatric Providers
Clinically Effective
Specialized
Psychiatric
Treatment (CESPT)
Connects Primary
Care Providers
Virtual Treatment
Collaboration
Engaged and
Improved
Patient Care
PsychPartner-T elepsychiatry Software
Building of
Collaborative
Network
Problem
Identification
and Need for
Change
Problem:
Patient Access to
Psychiatric Care in
Hampden County
Pilot: 12 Primary Care
Physicians Chicopee
Health Center will
use PsychPartner
Patients: Receive
improved, appropriate
psychiatric care
through consultation
Collaboration:
25 Psychiatric Providers
from Partners
Healthcare Inc.
Implementation:
Providers use integrative
telepsychiatry software
to enhance treatment
Outcomes:
Impact on patient
health, reduction
of high-risk
scenarios
PsychPartner-Telepsychiatry Pilot Program
Capstone Project Innovation: Proposal, Disrupt, Eliminate
58
Theory of Change Model
Patients in Need of
Specialized
Psychiatric
Evaluation and
Treatment
Rural Community-
Based Healthcare
(Primary Care
Providers)
Close the Health Gap:
Improving Patient Access to Psychiatric Treatment Through Primary Care and
Telepsychiatry Integration Primary Care Clinics PsychPartner Telepsychiatry Communication
Software and Real-Time Interactive Services
q Chicopee Health Center: Primary Care Providers
have direct access to specialty psychiatry care
providers
q PCP’s gain real-time access to psychiatrist for
consultation, assessment, and treatment
recommendations
q Providers use integrative telepsychiatry software to
enhance treatment, virtual collaboration
q Patients: Receive improved, appropriate
psychiatric care, reduced stigma
q Engaged and Improved Patient Care
q Less patient ED visits, inpatient admissions,
accidental death/overdoses
Benefits
q Increase specialty psychiatric treatment access to patients in rural communities
q Provide Primary Care Providers a comprehensive, real-time software system to
consultant and access high risk patients
q Decrease healthcare costs to patients
q 1 in 4 adults in the US experiences a mental illness in a given year
q Among those adults, roughly half also experience a co-occurring substance use
problem
q Youth mental health is worsening in the US
q People wait an average of 10 years before seeking treatment
q Suicide is the 10
th
leading cause of death in the U.S.
q Mental health costs America over $200 billion in lost earnings per year
q Significant need for mental health services in rural America: 2017 survey stated
about 19% of adults in nonmetropolitan counties had a severe mental illness,
over 7 million people
Methodolog
y
Patients (in need of Clinically Effective
Specialized Psychiatric Treatment CESPT)
q Significant need for comprehensive
psychiatric treatment at Chicopee
Health Center in Hampden County
q Hampden County is the poorest
county in Massachusetts with the
least access to psychiatrists/psych
treatment
q Problem: Patient Access to
Psychiatric Care in Hampden
County
q Through PsychPartner
Telepsychiatry Communication
Software connect Primary Care
Providers at Chicopee Health
Center through virtual treatment
collaboration in real-time to
specialized psychiatric treatment
providers at Partners Healthcare
Inc.
q Underserved, rural population
receives Clinically Effective
Specialized Psychiatric Treatment
(CESPT)
q PCP’s provide better treatment
through collaboration
q Patients are engaged and receive
improved patient care
q Affordability vs accessibility of
treatment services
q Decrease the number of patients
presenting to ER’s for urgent care,
inpatient treatment, mortality rate
PsychPartner Software and Collaborative
Network: Comprehensive service system to
connect rural Primary Care Providers with real-
time access to Specialized Psychiatric Providers
Advisory
Board
(Stakeholders)
q Chicopee Health Center and their
Primary Care Providers (Community-
based healthcare practice)
q Patients (Providing PROMs feedback)
q Partners Healthcare Inc. (Collaborating
Hospital Organization)
Massachusetts General Hospital,
Brigham and Women’s Hospital
(Providing Specialty Psychiatric
Consultation)
q PsychPartner Advisory Board
(Psychiatrists, Nurses, Social Workers,
Psychologists, Case Managers)
q Identify Problem: Access to specialty psychiatric care in
rural communities
q Build collaboration of expertise: psychiatrists, clinicians,
Partners Healthcare, Insurance Companies, Chicopee
Health Center PCP’s, trainers, advisory board
q Software development: Collaboration with AthenaHealth
and iClickCare HIPAA compliance
q Prototype development: PsychPartner Program
Training Manual
q Development of PsychPartner Telepsychiatry
Communication Software
q PsychPartner software is implementation ready
q PsychPartner Telepsychiatry Pilot Program, 6 month
program to begin on 5/1/20 at Chicopee Health Center,
Chicopee, Ma
q Following pilot program, review data, is program
effective, what is the cost-benefit analysis
PsychPartner Software/Training Pilot Program
Development
Impact and Evaluation Component
q Chicopee Health Center Primary Care Providers
have weekly 5-question electronic surveys
q Continuous feedback loop with PsychPartner
Advisory Board
q Collect data, track patient engagement, patient
emergency room visits, feedback and program
adjustments
q Patient satisfaction and wellness will be tracked
by electronic Patient Reported Outcome
Measures (PROMs)
q Collaborative network of medical and psychiatric
providers
q PsychPartner allows virtual collaboration
q Patients receive Clinically Effective Specialized
Psychiatric Treatment (CESPT)
q Patients increased engagement with primary
care providers, receive improved patient care
Abstract (if available)
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Asset Metadata
Creator
Blewett, Jennifer Grace
(author)
Core Title
Close the health gap: improving patient access to psychiatric treatment through primary care and telepsychiatry integration
School
Suzanne Dworak-Peck School of Social Work
Degree
Doctor of Social Work
Degree Program
Social Work
Degree Conferral Date
2020-05
Publication Date
10/19/2021
Defense Date
04/17/2020
Publisher
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Tag
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