November 1st, 2013

Electronic treatment raises complicated issues

Technology has invaded many aspects of daily life and some psychologists may be ready to make the leap into digital therapy. But before engaging in tele-treatment, psychologists should consider a number of factors, including patient privacy and jurisdictional regulations.

Nancy T. Silberg, Ph.D., who works in the Bariatric Program in the Department of General Surgery at the Health Centre at Williston, Vermont and also has a private practice, Associates in Psychology, in Burlington, says that medical disciplines have been using technology, particularly teleconferencing, for some time. But psychologists who want to offer therapy electronically face some challenges.

Privacy ranks as one of the biggest concerns with electronic therapy. “In some ways it’s the same as for face-to-face treatment. You have to protect the confidentiality and shared information. That gets complicated when using technology,” says Silberg. “It’s critical to be in compliance with HIPAA.”

Moreover, since the Final Rule related to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was recently implemented, psychologists also have to be in compliance with the business associate providing the technology they are using. “Any vendor that provides software that holds protected health information data on a server, even if it’s encrypted or not viewed for any period of time, is considered a business associate. This applies to Skype and videoconferencing companies.”

While tele-psychology might be convenient, providers should consider other patient-related factors. “It’s important that psychologists do a lot of homework up front and have informed consents in  place. They also need to think about plans for dealing with an emergency plan for each patient. Given the unique circumstances of each client, you should have a good idea of what approach to take,” Silberg says. “It’s also good to check in face-to-face periodically. There could be a unique liability issue here.”

But one of the greatest concerns with telepsychology relates to inter-jurisdictional issues. To date, Vermont is the only state to issue a Psychology Telehealth Provision, according to the American Psychological Association Practice Directorate, Legal & Regulatory Affairs. “If you are a psychologist in Vermont providing services to a person in another state, the Vermont licensing board sees you as a practitioner in Vermont. The other state’s regulations may dictate that you need to be licensed in that state,” says Silberg. Violation of the provision could result in a $5,000 fine and/or one year in prison.

As an example, Silberg cited a college student she treated in person while the student was at school in Vermont. “The student wanted to continue treatment over the summer by phone or video. In order to treat this person, I would have to be licensed in New York and I’m not,” she says.

In Massachusetts, the licensing board in the Office of Consumer Affairs and Business Regulation (OCABR) has not issued a position on the provision of services via electronic means. As of March 2006, the agency had not “…come to any conclusions about the appropriateness of providing psychological services electronically because this is an emerging area of practice on which APA is presently working.” The statement cautions psychologists to consider several factors before providing electronic services. Some issues of concern include how to sustain relationships; verifying client identity; emergency contingency plans; informed consent; confidentiality; computer security; and fees and financial arrangements.

Although Massachusetts has not issued a formal telehealth provision, the Board of Registration of Psychologists states that, like Vermont, the psychologist must be licensed in the state in which he or she is practicing, i.e., if a Massachusetts licensed psychologist renders electronic services to an out-of-state client that provider should contact the licensing board in the other state to determine whether such practice is permitted in that jurisdiction.

Karen Schwartz, Ph.D., program coordinator, Board of Registration of Psychologists, Division of Professional Licensure, says, “The Board has not developed any newer position on this.”

By Phyllis Hanlon

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