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The Hybrid Practitioner of the future.

Explore the evolving landscape of telepsychiatry and health technologies in mental healthcare. Learn why providers need to adapt, how technology enhances patient care, and what the new standard of care entails in a hybrid clinical environment.

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The Hybrid Practitioner of the future.

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  1. The Hybrid Practitioner of the future. Peter Yellowlees MD Professor of Psychiatry, UCD

  2. PY is funded by AHRQ and is a video editor for Medscape. • Book “Telepsychiatry and Health Technologies – a guide for mental health professionals” published Jan 2018

  3. Objectives Understand: • Why psychiatrists/providers need to work differently • How technologies can improve efficiency and be more patient-centered • How we can move to a new standard of care in a hybrid clinical environment

  4. Summary • What is telepsychiatry - Hybrid practitioner perspective • Synchronous v Asynchronous • Video is one of many data streams • Changes and Predictions – a new standard of care

  5. Where are the patients? • Inpatient – corrections (CA reduced 30% of psych beds 1995 – 2012) • Outpatient – primary care, county services for SMI and ED’s • Numbers of insured and aging- 20% over 65 by 2030

  6. Where are the psychiatrists? • 40k total – deficit 10k now • Mean age 56, 65% male, major retirements in next decade • Replacements – 55% female (work 20% less) – rate of training static, so deficit increasing with population and demand increases • Estimate 20% less clinical time available in 10 years

  7. What is the solution? Psychiatrists have to work differently……… • less time for individual care • more integrated/primary care • more team based • more technology facilitated • more population focused

  8. Current vs Future Telemental health care • Current – current methods primarily ensure good quality care, using similar methods of interaction as in-person, just removed at a distance • Future – future models will provide better care delivered in a way that is different from now – 24/7, mobile, asynchronous, monitoring of data, population based, including genetic profiles and decision support etc

  9. Digital Natives VS. Digital Immigrants DIGITAL IMMIGRANTS DIGITAL NATIVES • Use Internet for information second rather than first • Print out email • Share computer content in-person • Learn slowly, step-by-step, one thing at a time • Parallel processing & multitasking • Prefer graphics & visuals • Instant gratification & rewards • Prefer to be networked • Learn with information fast, presented in a random fashion • Based on Mark Prensky’s “Digital Natives, Digital Immigrants.” http://www.marcprensky.com/writing/Prensky%20-%20Digital%20Natives,%20Digital%20Immigrants%20-%20Part1.pdf . Accessed 12/30/2016. • Icons are open-source under SIL OFL 1.1 license. Font Awesome by Dave Gandy,http://fontawesome.io

  10. Psychiatric Practice web-based videoconferencing videoconferencing telephone email EHR mobile web 2000 2010 2020 1990 • In-person • Telephone • Videoconferencing • Email • Mobile (text and phone) • EHR (patient portals) • Web • Social Networking • AI • Robotic • Metrics/data mining • APPS • Virtual Reality Models attempt to replicate current in-person care at a distance Improved care through enhanced models across different modalities-24/7, mobile, asynchronous and coordinated.

  11. Technologies in Psychiatric Practice BASE TECHNOLOGIES EMERGENT TECHNOLOGIES • Virtual reality treatments • Social networking • Artificial intelligence, machine learning, & cognitive computing • Avatars • Geospatial tracking • E-mail • Electronic medical record (EMR) • Videoconferencing • Web-based apps • Mobile phones, apps, & devices • Icons are open-source under SIL OFL 1.1 license. Font Awesome by Dave Gandy,http://fontawesome.io

  12. Hybrid care VIRTUAL SPACE PHYSICAL SPACE • Advantage for those with avoidant behavior, PTSD, and anxiety • Convenient & immediate • Provider can observe patient in their environment • Indirect & off-hours care opportunities • Modalities include videoconferencing, e-mail, text messaging & telephony • Traditional in-person gold standard • Immediacy & trust in interpersonal interaction • Physical boundaries can be set for therapeutic frame • Ample research and practice guidelines available for healthcare in the physical space • Diagram and illustrations by @StevenChanMD. Content based on Peter Yellowlees & Jay Shore.

  13. Advantages of Telepsychiatry FOR THE PSYCHIATRIST • Work from anywhere • Flexibility of time • Opportunities to work with different populations • New models and configurations for care • Diagram and illustrations adopted from @StevenChanMD. .

  14. Advantages of virtual space FOR THE PATIENT FOR THE PROVIDER • Can see providers outside of the patient’s community • Can have highly intense, intimate and empathic relationships • Can discuss embarrassing, stigmatizing, or awkward topics • Can give more direct feedback to patients • Can safely patients who are placed in dangerous settings — e.g. correctional institutions • Can be an objective observer PHYSICAL DISTANCE • Diagram and illustrations by @StevenChanMD. Content based on Peter Yellowlees & Jay Shore.

  15. Asynchronous Telepsychiatry • Generates subtitles for Telepsychiatry videos in real-time • Interfaces with existing online and offline transcription and translation services

  16. ATP Summary of Findings • Diagnostically reliable across differing language groups with translation • Good for monitoring treatment progress • Easier management admin/scheduling • Improved communication between patient and reporting provider

  17. The 2017 UCD psych referral choices: a “stepped care” integrated menu • PCP education – formal/informal/online/in-person • Routine screening in PCN – PHQ-9, GAD-7, Audit • Registry review – care coordination, panels, sentinel events, diagnostic groups, health coaching. • Curbside telephony advice/consult - indiv • Email/secure messaging/e-consult – indiv • ATP to PCN • STP to PCN • In person consults – Psych in PCN/Spec OPD • ED

  18. Psychiatry in 2025? • Automated data capture – multiple data sources including video • Increasing mobile care and monitoring • Virtual Reality and Avatar driven therapists • Algorithmic screening and social network monitoring • Artificial intelligence and predictive assessments–big data analytics on the fly- genomics/phenomics - facial and voice recognition • Fully interoperable wireless patient owned health histories • And many more……..

  19. Comparison Psychiatrist work practices • Traditional – 30 patient care hours, 10% no show – sees 40 pt’s per week (4 new, 10 one hour, 26 half hour) • Future – 30 patient care hours – no show time used for ATP. 15 hours spent traditional approach – 20 pts. 15 hours – team (4 new per hour – 5 hours) and ATP (2 new per hour – 10 hours) – 40 pts. Sees/consults 60 patients per week

  20. Summary • Psychiatrists are starting to work differently • A range of technologies can provide more referral choices for PCP’s and patients • New models/technologies can transform the work of psychiatrists to increase their efficiency and reach, and to use continuously collected data on the fly.

  21. Thankyou……………. pmyellowlees@ucdavis.edu @peteryellowlees

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