Telehealth is coming. It's an exciting new venture, but as with all new opportunities comes all new concerns. Telehealth is a mechanism by which a CMHC can use technology to be able to serve their clientele in a way that provides remote access to the population. This is good in a sense that clients who have certain phobias, health issues or transportation concerns can still see their preferred therapist without having to get there if it is too challenging.
However, telehealth has not been able to catch up with the rising issues that may be on the horizon. For example, issues with privacy and confidentiality. Issues surrounding face to face communication and being able to work with an individual, in person, rather than through a computer screen.
Legally, we have not been able to keep up with the changing tides of counseling as it relates to telehealth, either. Technology and society is changing faster than the legislator, so practicing effective telehealth may become more of a lawless field than a regulated one which could be bad for both client and professional alike.Although some states do have some regulation in place, while others have legislation pending.
However, there are some mechanisms in place and there are some ways to safeguard yourself when a client wants to pursue telehealth and you'd like to try it as a professional.
First, notice that AMHCA has updated their Code of Ethics and Standards to include telehealth in their parameters. This was done over a long period of time and the members of the Ethics Committee worked hard to try and encompass as much regarding telehealth as possible to give the clearest picture of what is expected of a provider offering this service.
Second, understand the HIPAA requirements and what that means for your practice. Emails and text messages are regulated in the same way under HIPAA. If you text with a client, it absolutely has to be encrypted texting, just like an email. You cannot use any unsecured technology at all for communication. Gmail or Yahoo accounts, even your private practice email that is provided when you sign up for a domain are not considered HIPAA compliant and will leave you liable for malpractice. The best practice for text messaging is to simply not do it. If you do text you must, under HIPAA keep the texts, you cannot erase them from your phone. You must also provide your clients access to that data and be able to allow that person to amend them. Just like a case file you have on that person. All texts must be placed, word for word, in your client file as well.
Emails are regulated the same way. However, having an encrypted email can be costly. There is a webservice called Hushmail (www.hushmail.com) that offers secure, encrypted email service to anyone....AND IT'S FREE! Make sure, however, that both you and your clients sign up for this to email.
All "Skype-like" technology must be HIPAA compliant as well. Skype is not HIPAA compliant. These services also must be secure and encrypted. There are free services out there for this as well. However, before using them, ensure, in writing, that they are HIPAA compliant. Simply thinking it was and using that as a defense is not enough. You must vette the services you use.
In MA, we are meeting telehealth with enthusiasm and excitement. We have been in talks with insurance companies (mainly Blue Cross and Blue Shield) and are excited to report that we will be receiving insurance reimbursement, from them in a 2 year pilot project, for telehealth services starting January 1st. We are also in a coalition that is backing broader telehealth legislation in MA This is exciting for all mental/behavioral health providers in MA. There are some stipulations as there are with all issues as involved in this, but we have been able to find ways to educate and inform our members and community. I'm interested in what others have to say about telehealth as it approaches. Please let me know what you think.
Also, please feel free to check MA regulations surrounding this issue provided at this link: http://www.mass.gov/ocabr/licensee/dpl-boards/mh/regulations/rules-and-regs/262-cmr-800.html looking primarily at the Board Advisory on Distance Counseling.
You can also look at the MaMHCA guidelines for LMHCs on Electronic Counseling and Social Media at www.mamhca.org