The digital shift

Two major changes — electronic record-keeping and telehealth — are poised to dramatically change the health-care landscape, and psychology practitioners need to pay close attention to them, said speakers at a State Leadership Conference workshop.

In the realm of electronic record-keeping, the federal government will be spending close to $50 billion to build an infrastructure by 2015 for all health professionals to use.

Health-care experts and policymakers have only recently included behavioral health in such federal discussions of electronic record-keeping, which means it’s important for psychologists to make their voices heard now on such key issues as privacy protections for mental health and substance abuse information, said David Wanser, PhD, a psychologist at the LBJ School of Public Affairs at the University of Texas at Austin. He is also a member of federal Health Information Technology Policy Committee’s Privacy and Security Workgroup, which is advising the U.S. Department of Health and Human Services on health information technology.

“There are significant policy decisions being made every single day, and it’s all moving extremely rapidly,” he said. “We are significantly behind the curve.”

To join the dialogue on digital record-keeping at the state level, psychologists should engage with their state mental health and Medicaid agencies or the state legislature, he added. “Virtually every governor in this country has some kind of work group on health technologies,” he said.

To ensure the next generation of health professionals understands the implications of electronic health records, psychology and other health-related programs should consider expanding training in such areas as privacy and confidentiality, clinical data collection and the ethical use of technology, Wanser said. The University of Texas at Austin, for example, is developing a summer certificate program on health information technology, including how electronic health records affect business and the ways e-records will change workflow in health-care settings, Wanser said. The university is also building a mock clinical setting where it will teach students to use electronic records.

Psychology also has to more closely monitor technology-enhanced practice, the speakers said. “Telepsychology” practice includes video counseling, using e-mail and smart phones to communicate with clients, and using technologies such as Skype and voice recognition and language translation software. As yet, there are no federal laws or regulations on telepsychology, but states and state psychology licensing boards are beginning to regulate it.

Psychologists should know what their state regulates before providing such services, especially across state lines, said Deborah Baker, JD, director for prescriptive authority and regulatory affairs in APA’s Practice Directorate. In a 50-state review of laws and regulations on telehealth, she found that 22 states have enacted telehealth laws. Of those states, only three specifically include psychologists: California, Kentucky and Vermont. California, for example, requires written and verbal consent from a patient to provide services “using interactive video, audio or data communications” but does not yet regulate phone conversations or e-mail between patients and providers.

Eight state psychology licensing boards have also issued rules or policies on telehealth practice: Colorado, Florida, Georgia, Massachusetts, North Carolina, Texas, Virginia and Wisconsin. If you don’t see your state on this list, you may soon, she said. Many other states have indicated they are developing policies.

“Because things are constantly changing, you want to check with your board to see what its policies or stance on the issue is,” said Baker.

It’s also a good idea to check with your malpractice carrier to see if those types of services are covered under your policy, she said.

Psychologists who plan to provide telehealth services out of state should also learn the laws of that state and check with its licensing board about whether licensure is required before offering services.

The Ohio Psychological Association became the first state to issue telepsychology guidelines for its members last year. Among other strategies, the guidelines suggest practitioners get written consent from clients before providing telepsychology services, said Kenneth P. Drude, PhD, who led the guideline-drafting process. Practitioners should also develop policies about e-mail response times and use encrypted text messages and secure Web sites (Telepsychology Guidelines).

Consumer demand for telepsychology services will only increase as technology expands, said speakers. Even psychologists who don’t consider themselves tech-savvy should join efforts to ensure a smooth transition for psychology, said Wanser.

“It’s not about technology,” he said. “It’s about policy, clinical practice and improving clinical outcomes. If you know anything about any of those things, this is your area.”

Results from the survey of psychology licensing boards and telehealth laws are available at the APA Practice Organization Web site.