TAMPA – The growth of telepsychiatry has been driven largely by needs of access, particularly in rural areas without specialists. But telemedicine is convenient, and those growing up with computers, smartphones, and other technology are going to demand this type of access to their clinicians, according to a leader of a course on telepsychiatry at the annual meeting of the American College of Psychiatrists.

“Digital natives – the consumers – are going to drive the use of technology more and more. They are used to videoconferencing. They want to see their doctors over video. They want to communicate via text and email. They want that convenience, and they are much more comfortable with it,” said James (Jay) H. Shore, MD, director of telemedicine at the Johnson Depression Center at the University of Colorado Denver.

The term “digital natives” refers to individuals who have grown up and had access to technology from early childhood, Dr. Shore explained. “Digital immigrants” are those who have been exposed to technology after childhood/adolescence. The age of exposure appears to make a difference, said Dr. Shore, citing evidence that early access to technology might be analogous to learning languages at a young age, leading to faster processing and greater fluency.

Meanwhile, telepsychiatry is evolving, allowing for more sophisticated approaches and expanded applications.

“When we started doing video conferencing technologies, we basically were taking what we do in person and just doing that over video,” Dr. Shore said. “Where we are now, we are actually using the technologies to change how we interact with patients, deliver structured care, and get reimbursement.”

A prolific author on the topic of telepsychiatry and long involved in this practice, Dr. Shore has said that the widespread introduction of fiber optic networks and other technological advances over the last 15 years has advanced all forms of digital technology. These are enabling and will likely accelerate synergies possible with integration of different platforms, such as electronic health records, patient portals, videoconferencing, and various methods of communication.

In his own experience, which includes providing remote services from his office in Denver to native populations in Alaska, he has discovered some unexpected advantages to telepsychiatry. For example, some victims recounting histories of domestic abuse feel more secure during videoconferencing than during a face-to-face interview, facilitating capture of a complete history. In general, he now prefers telepsychiatry in those situations.

As telepsychiatry advances, it will be increasingly integrated into hybrid models of care that involve communicating with both the patient and other clinicians over multiple platforms (for example, in-person, video, patient portals). This is not just relevant to patients in a geographically distant facility. With greater acceptance and integration, videoconferencing will be part of this mix of communication tools that might also include in-person consultations. The goal will be to use the most convenient communication strategies to coordinate the diagnosis, a treatment plan, and follow-up.

“The neat thing about telepsychiatry is really the virtual teaming models that we can create,” Dr. Shore said. However, he acknowledged that this type of team participation requires an adjustment in reimbursement models for psychiatrists that traditionally have centered on psychopharmacology. The problem with the models limited to prescription writing is that they “do not tap into the psychiatrist’s leadership of the mental health team, knowledge of human behavior, and they are not, at least for me, as personally rewarding.”

He believes that the growing array of technologies contained in telepsychiatry will increase opportunities for psychiatrists in a host of such settings such as crisis management in emergency care settings or coordination of psychiatric care in residential treatment settings.

The expansion of telemedicine already is reflected in the growing number of companies marketing services directly to consumers. Dr. Shore listed several offering virtual health care that may contribute to both acceptance and demand for medical care delivered digitally. Although telepsychiatry already is associated with many effective applications, Dr. Shore reiterated that consumer demand will be a driver for further expansion of telemedicine in general.

He also emphasized that change involving digital advances in psychiatry is inevitable. According to Dr. Shore, artificial intelligence, virtual reality treatments, and social networking are among potential tools for altering care. Inside and outside of medicine, the pace of change driven by advances in digital exchange of information has been and is expected to continue to be brisk.

“Then there is the technology that is going to disrupt us all that we can’t see coming,” Dr. Shore said. “It is being invented right now in somebody’s garage in Palo Alto.”

Dr. Shore reported that he is chief medical officer of AccessCare Services, which provides telehealth services and technologies.

Demand, not need, may drive further expansion of telepsychiatry